Claiming

It’s only natural to feel anxious when you are ill. We will do everything we can to help make claiming for your treatment as simple and straightforward as possible. If you have a Bupa Malta plan, you should always call Bupa Malta on 21 342 342 before you see your specialist so we can help arrange and pay for your treatment.

We will, for example:

  • confirm whether or not your proposed treatment is covered under your membership
  • tell you whether your chosen specialist or therapist is recognised by Bupa Malta
  • send you a claim form

 

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How to make a claim

If you do not have a claim form you can either download it or call us on 21 342 342 and we will send you one. You will need to complete the claim form in full and return it to us by post, with the original invoices and receipts, immediately following your treatment. We need to have the completed form within three months of you receiving the treatment for which you are claiming against your Bupa Malta policy unless this is not reasonably possible.

Upon receipt of all the necessary documentation, your claim will be dealt with as quickly as we can.

You must provide any information or proof to support your claim if we make a reasonable request for you to do so. For example, we may ask for:

  • medical reports and other information about the treatment for which you are claiming
  • the results of any independent medical examination which we may ask you to undergo at our expense
  • written confirmation of whether you think you can recover the costs you are claiming from another person or insurance company
  • original accounts and invoices in relation to your claim

Please note we cannot accept photocopies of accounts, invoices or receipts.

We will pay for treatment under the terms and conditions of the plan that applies to you on the date you receive the treatment.

We will only pay for treatment costs and expenses actually incurred by you.

We will only pay eligible claims if:

  • you have prior approval for your treatment
  • all payments due to us in respect of your membership have been paid
  • you and your additional persons are not in breach of any terms and conditions of your membership

We reserve the right to change the procedure for making a claim. If we make a change we will notify you or your sponsor, if you are covered under group membership or bulk group membership.

How your claim will be paid

We appreciate that once you have treatment, you may not want to worry about arranging payment. We will try to pay eligible claims direct to the provider of your treatment, such as your hospital or specialist.

We reserve the right to send any benefit due to an appropriate person – for example, the executors of the will of someone who has died, or to an additional person on your membership who has settled a bill.

We will, of course, write to the main member to confirm how we have dealt with your claim.

Benefits shall be payable in Euros or, if requested by you when making a claim, in the currency of the treatment bill. If we have to make a conversion from one currency to another we will use the exchange rate that applies on either the date on which the invoices were issued or the last date of the treatment, whichever is the later. The exchange rate will be the official rate of exchange in Malta on each working day. If the date on which the invoices were issued or the last date of the treatment, whichever is the later date, is not a working day we will use the exchange rate that applies on the last working day before that date. Payment of benefits shall be subject to the provisions of any exchange control regulations in force at the time.

Please remember it is your responsibility to pay any charges that are not covered for payment under your cover.

Paying invoices yourself

If you pay any invoices yourself, please complete the appropriate section on your claim form, showing that you want us to send any covered payments to you. Please enclose the original invoices.