FAQs
When can members upgrade or downgrade?
Upgrading or downgrading your Bupa Malta policy is only possible at annual renewal. However, you can add USA cover on your Worldwide Health Options plan from Bupa International at any time.
How are discounts applied?
Any premium discounts applied are entirely at the discretion of Bupa Malta and may be reviewed or removed at renewal.
Why do premiums increase?
Bupa Malta does try to limit any increases in premiums however, this occurs as a result of the following two main reasons:
Cost increases linked to advances in medical technology including general increases in the costs of hospital/clinic equipment and room and board, specialists' fees, the price of medicines.
Over the years we have found that the increase in private medical services, have brought with them an ever-increasing number of claims.
How would I know if my planned surgery is covered by my membership?
Planned surgery, which is medically necessary, will be covered by your plan if the underlying condition is itself covered. Certain membership limits may apply with some plans.
In order to clarify precisely the extent of cover and confirm eligibility of the condition, all treatment must be referred to us beforehand by calling Bupa Malta first on: 21 342 342.
Bupa Malta firmly commits itself to pay those covered claims that are customary and reasonable. This means that the costs charged by your treatment provider should not be more than they would normally charge and be representative of charges by other treatment providers in the same area.
Guidelines for fees and medical practice (including established treatment plans, which outline the most appropriate course of care for a specific condition, operation or procedure) may be published by a government or official medical body. In such cases, or where published insurance industry standards exist, Bupa International may refer to these when assessing and paying claims. Charges in excess of published guidelines or reasonable and customary costs may not be paid.
What should I do if I am going to be admitted for in-patient treatment in hospital?
Bupa Malta has a hospital provider network, whereby a direct settlement facility is being provided to its clients. This means that any expenses incurred by the member will be paid out by Bupa Malta directly to the participating hospital. This is possible as Bupa Malta will confirm, with the hospital, that it can settle the bill directly. Therefore, if hospitalisation is pre-planned it is important that you advise Bupa Malta immediately by calling Bupa Malta first on 21 342 342. Once this has been done and cover approved we will settle your bill directly with the hospital concerned.
In the case of an emergency, you (or your relatives) will need to call Bupa Malta on 21 342 342 or our 24 hour emergency number 79 342 342. It is important that this line is not used for routine enquiries, as it could result in the line being engaged and unavailable for an urgent emergency call.
What do we mean by a Non-Participating Hospital?
A hospital with which Bupa Malta does not have a direct settlement facility. Meaning that Bupa Malta members would need to settle bills themselves for subsequent reimbursement by Bupa Malta.
What do we mean by 'Full Refund'?
We reimburse those fees and charges that are customary and reasonable for the procedure concerned. This means that the costs charged by your treatment provider should not be more than they would normally charge and be representative of charges by other treatment providers in the same area.
Guidelines for fees and medical practice (including established treatment plans, which outline the most appropriate course of care for a specific condition, operation or procedure) may be published by a government or official medical body. In such cases, or where published insurance industry standards exist, Bupa International may refer to these when assessing and paying claims. Charges in excess of published guidelines or reasonable and customary costs may not be paid.
What is the procedure to submit a claim?
Step 1: Your Family Doctor / Specialist must enter details of your medical condition, together with details of treatment on a Bupa Malta Claim Form
Step 2: Complete remaining sections of Bupa Malta Claim Form
Step3: Attach original invoices and receipts to the Bupa Malta Claim Form. Photocopies and credit card vouchers are not acceptable.
Step 4: Please address and post claim form to: Bupa Malta, The Claims Department, Testaferrata Street, Ta' Xbiex XBX1403, Malta.
Please note that the Bupa Malta Claim Form must be submitted immediately following or within three months of initial treatment for all Bupa Malta policies.
What documentation is required when making a claim?
A fully completed, signed and dated Bupa Malta Claim Form.
Original receipts / invoices. Please note that photocopies and credit card vouchers are not acceptable.
Any other documentation that Bupa Malta may request (such as medical reports from attending physicians, private Family Doctor, case summaries etc.) to confirm the eligibility of a claim.
What is the maximum acceptable time for a claim to be considered?
All claims must be forwarded to GlobalCapital Health Insurance Agency Ltd who are Bupa's representatives in Malta immediately or within three months of the initial date of treatment.
After submitting a claim why are further reports sometimes requested?
All claims require adequate documentary proof that they fall within the scope of our cover, and we do try to keep these requests for further reports to a reasonable minimum.
There is no set documentation for any claim. When conditions appear to us to be vague or unexplained, or perhaps related to a restriction or exclusion, we are bound to request further details in order to fairly assess a claim.
As a minimum, reports should always:
- specify the dates of first symptoms of a condition
- the diagnosis and treatment recommended
Why is it that sometimes a claim is not paid in full or in part?
Claims which do not fall under membership cover cannot be met, either partially or fully, as this is, in fact, the arrangement which has been agreed upon at inception of the insurance, through normal membership terms and conditions.
The most common reasons include:
- expiry of the three month limit for receipt of the Claim
- lack of Family Doctor referral for specialist treatment
- no actual medical condition
- routine screening or testing
- condition is non-acute or chronic
- membership limits have been exceeded
- pre-existing condition
- condition personally restricted or excluded
- premium unpaid
- no such benefit with that membership cover
- no referral to Bupa Malta of Hospital treatment from beforehand
- insufficient information to allow assessment of claim
For full details of what is and what is not covered on your plan, please refer to your membership guide and membership certificate.
Can I refer directly to a specialist without going to my doctor first?
Yes, in cases where a paediatrician, gynaecologist and eye specialist concerned. However, in all other cases, before treatment or advice is sought from a specialist you must first visit your doctor who will, in turn, refer you to a specialist if further treatment is required for that condition. Your doctor can treat many medical conditions without incurring the added expense of consulting a specialist for treatment.
Are routine preventative health check-ups covered?
Routine health check-ups / screenings although thoroughly recommendable, do not fall within the scope of membership cover.
For your guidance, any investigative treatment done on a routine basis, for example mammograms, pap smears and prostrate screening will not be covered. Nonetheless, we will cover treatment of acute conditions discovered in the course of a routine test. On the other hand, necessary investigative treatment based on a suspected condition is normally covered.
Certain purely routine screenings are available to Bupa Malta members that choose the Optional Extra Benefits.
What is the difference between acute and chronic conditions?
Your Bupa Malta membership covers you for an acute medical illness or injury. This refers to those conditions that:
- arise suddenly and unexpectedly
- require immediate medical treatment
- restore you to your previous state of health
Your Bupa Malta membership does not cover you either for a chronic or a non-acute condition. This refers to those conditions that:
- require extended treatment
- do not respond immediately to treatment
- are not curable
- did not require immediate medical attention following diagnosis
However, Bupa Malta does cover specific acute phases of a chronic condition. For instance, when a chronic condition becomes suddenly uncontrollable and it is medically necessary to undergo treatment to get the condition stabilised again.
What is a pre-existing condition and am I covered for it?
Medical conditions that are diagnosed before the start of cover are excluded from that particular cover, and you are therefore specifically not covered for such a condition.
Are clinic/waiting fees covered by my membership?
Bupa Malta reimburses all covered charges that arise directly from actual medical treatment. Indirect charges, such as clinic waiting fees, which are imposed upon the public by third parties, do not fall within the scope of cover and are therefore not covered.
How would you determine whether or not a test was routine?
Such cases are normally considered on a case-by-case basis. As a general rule, if an acute condition is not heavily suspected either from the particular test results or from the individual circumstances of the case, Bupa Malta would consider a test to be a routine one.
Where there has been such a condition we would normally allow a follow up test particular to that condition, though this should be confirmed by us beforehand.
To what extent am I covered for pregnancy and childbirth?
We only cover complications arising during pregnancy or childbirth.
Therefore this does not include normal childbirth. However, routine maternity cover may be purchased as an extra benefit subject to a number of criteria being met at application stage.
Are dentistry costs covered by my membership?
Some plans do contain limited cover for certain specific and emergency dental procedures. In these cases it is of the utmost importance to call Bupa Malta first on: 21 342 342 to confirm the eligibility of the procedure in question.
Ordinary dental care, such as cleaning, filling and most extractions, which inevitably arise periodically, are not covered.
These are the answers to some of the most frequently asked questions relating to Bupa Malta. All members are strongly advised to refer to the Membership guides of their particular plan should they have any further queries or call Bupa Malta first on: 21 342 342.