Health Insurance

More information about our Health Insurance can be found here.

Options available are “Inpatient Only” Cover or “Inpatient and Outpatient” Cover. The Inpatient Only Cover is a cost reducing option providing insurance protection for hospitalisation. Cover is Worldwide for the Basic and Hospital Schemes subject to the limits contained in the respective Tables of Benefits. Under the International Scheme cover is Worldwide excluding USA and Canada although there is a limit for cover in this territory for emergency treatment only.

Basic Scheme covers essential health services, and refunds prearranged amounts for treatments. It includes in-patient services such as specialist consultations, pathology, radiology, diagnostic tests and physiotherapy; Reasonable Fees up to €325 per policy year

Hospital Scheme covers full refund of hospital accommodation, including intensive care and nursing care. It also comprises operating theatre charges, surgeons’ and anaesthetists’ fees for surgical operations, Computerised Tomography Scan (CT Scan), Magnetic Resonance Imaging (MRI) and PET Scans.

International Scheme provides in-patient and out-patient cover on a worldwide basis except USA and Canada. It offers full refund of osteopathy, homeopathy, acupuncture, and chiropractic treatments provided by qualified practitioners.

The Family Health Insurance Scheme covers all the health insurance needs of all family members, upon payment of a single premium only. This scheme protects family members in case of any injury or other medical contingencies such as hospitalisation, and medical and surgical expenses. This scheme offers out-patient benefits including refund for general practitioners’ fees, consultations with specialists, a dental benefit and a maternity cash benefit (€300 per pregnancy). If you become unemployed as a result of redundancy, and consequently not being able to pay for the Family Health insurance premium, MAPFRE Middlesea will cover the annual renewal premium for you.

The Hospital and International Schemes offer you the Second Medial Opinion Service if any member of your family is diagnosed with a severe illness and would like to get further confirmation, this service gives you access to a network of recognised international medical experts at no extra cost.

Under our policies a number of Extensions are available as shown below:

The aim of this policy is to provide cover for the reasonable fees of accredited treatments. This insurance is not planned to cover experimental or unproven treatments, but if such possibility occurs, we will discuss it with the policyholder specialist and decide if the cost of the suggested treatment will be covered.

For the full Policy exclusions please refer to your policy document. The following are some of the restrictions that apply to the policy, unless otherwise specified in Your Policy Schedule or Table of Benefits:

• We will not pay for pre-existing medical conditions that, however, will be covered after five years of continuous insurance with us, provided that during that period policyholder has not consulted any doctor for treatment or advice, or taken any medication (including drugs, medicines, special diets and injections) for that condition.
• We will only cover pre-existing cardiac or cancer conditions provided at the time when the condition reappears the beneficiary has been free from treatment, advice or medication for that condition during the previous ten years.
• We will not pay for fees charged for providing medical reports and prescriptions.
• We will not cover pregnancy or childbirth, other than for related complications arising at least ten months after the expectant mother contracted the policy. In the case of a caesarean section we will only pay the difference between the reasonable fee for the intervention, and the fee which would have been charged for a normal delivery.
• We do not cover contraception, sterilisation, termination of pregnancy, infertility and/or any form of assisted reproduction, and treatment of sexual problems. Treatments arising from or related to a sex change are excluded.
• The cost of vaccinations, routine or preventive medical examinations, medical screening including health check-ups, sight and hearing tests are excluded.
• Treatments received in health hydros, spas, nature cure clinics or in any similar establishments, even if they are registered as a hospital, are not included.
• We do not cover regular or long-term kidney dialysis or end stage renal failure.
• We do not pay for treatments caused by a deliberate self-inflicted injury or attempted suicide.
• Treatments given to relieve any allergic condition or disorder are excluded.
• We do not pay for treatments arising in any way from alcohol, drug or substance abuse.

We recommend to the policyholder, in order to receive benefits of all the guarantees of the policy, to consider some relevant aspects before and after contracting the policy:

• Premiums are payable to us in euros and must be paid on the date when they become due. If they are not paid by such date, we will have the right to cancel the policy with effect from the day when the premium or any instalment became due.
• If we accept new members under your policy, you will pay an additional premium. This additional premium will be a pro-rata premium based on the number of days remaining between the date of the acceptance and the renewal date following the said date.
• If you wish to pay your premium in instalments you may choose from Monthly, Quarterly or Half-yearly. A direct Debit mandate has to be completed for this to be set up with your bank. Frequency charges will apply.
• If you wish to pay your premium in instalments you may choose from Monthly, Quarterly or Half-yearly. A direct Debit mandate has to be completed for this to be set up with your bank. Frequency charges will apply
• If not in any member or his/her dependant wish to cancel the cover during the policy year, a pro-rata refund of premium will be made by us, provided that no claims, whether paid or not, shall have been made in connection with this policy during the period in which this cover is to be cancelled. The refund of the premium will be based on the number of days remaining between the cancellation date and the expiry date of the policy.
• The policyholder must give us notice of any planned In-patient treatment. This will give us the opportunity to confirm whether or not your proposed treatment is covered under your policy and the level of cover you have. An infringement of this condition will prejudice the payment of the claim.
• If you pay for appropriate overseas treatment in currency other than in euro, we will cover the equivalent in euro at the rate of exchange prevalent at the time of settlement of the claim.
• To qualify for the nursing at home benefit, all home nursing must immediately follow a period of in-patient or day-case hospital treatment covered by the policy, and be approved by a specialist.
• If you wish to pay your premium in instalments you may choose from Monthly, Quarterly or Half-yearly. A direct Debit mandate has to be completed for this to be set up with your bank. Frequency charges will apply.