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Business Insurance Group Health Benefits

Middlesea Primary
Health Scheme

 Middlesea Enhanced
Health Scheme
 Middlesea
Elite
Health Scheme 
In-Patient
Treatment		 The benefits must be reasonable and customary

Accomodation, nursing care, ward prescribed drugs 

Maximum 5 nights at €174.40  (Lm75) per night €116.47 (Lm50)per episode for Day Surgery)
 Full Refund Full Refund
Use of operating theatre, surgical drugs and dressings, intensive care, diagnostic procedures, including Pathology and Radiology Major Operation:
€349.41 (Lm150)
Intermediate Operation:€698.81 (Lm300) Minor Operation:
€116.47 (Lm50) 		Full Refund Full Refund
Professional fees for Surgeons, Anaesthetists and Physicians and medical consultants Major Operation:
€931.75 (Lm400)
Intermediate Operation:€698.81 (Lm300) Minor Operation:
€349.41 (Lm150) 		Full Refund Full Refund
Psychiatric, Nervous
And Mental conditions
 None Full Refund Full Refund
Charges made to you as a parent staying overnight in hospital with a child of under 14 years of age €23.29 (Lm10) per night (maximum 5 nights) Full Refund Full Refund
       
Out-Patient Treatment
Professional fees for specialist consulations , Diagnostic procedures including pathology and Radiology computerised Tomograohy, second surgical opinion Maximum of €232.94 (Lm100) (30 days prior and 30 days after hospital stay) Maximum of €465.87 (Lm200) (30 days prior and 30 days after hospital stay) Full Refund
Professional fees for specialist consulations , Physiotherapy, Pathology, Radiology, ECG Maximum of €232.94 (Lm100) Maximum of €465.87 (Lm200) Full Refund
professional fees for Oncology, Chemotherapy And radiotherapy Maximum 2 courses per year, up to €349.41 (Lm150) for each complete course Maximum of 2 courses per year, up to (€349.41) Lm150 for each complete course Full Refund
       
Alternative Therapy
Osteopathy,
Homeothapy,
Acupuncture,
Chiropractic
Treatment
And the like
 None
 Maximum of €465.87 (Lm200) per year Full Refund
 
Emergency Dental Treatment
Emergency dental treatment necessary to 
restore or replace sound
Natural teethlost or damaged following an accidental injury
 None Maximum of €465.87 (Lm200) per year Maximum of €698.81 (Lm300) per year
Nursing Care      
Home nursing by a professional nurse Following a surgerical intervention and if prescribed by a specialist €186.35 (Lm80) per week up to 15 weeks €186.35 (Lm80) per week up to 15 weeks €186.35 (Lm80) per week up to 15 weeks
MMDNA As Required As Required As Required
       
Private Ambulance      
Private ambulance ( proivided by the medical profession on medical grounds) Maximum of  €582.34 (Lm250) per year Maximum of €582.34 (Lm250) per year Full Refund
       
General Practitioner Charges
General Practitioner Charges Maximum of €58.23 (Lm25) per year Maximum of €58.23 (Lm25) per year Maximum of €58.23 (Lm25) per year
       

Cash Benefits-

 
 

First 30 nights
 €34.94 (Lm15) p/night €34.94 (Lm15) p/night €46.59 (Lm20) p/night
Next 30 nights €23.29 (Lm10) p/night €23.29 (Lm10) p/night €23.29 (Lm10) p/night
Day care (following surgery) €23.29 (Lm10) per day/episode €23.29 (Lm10) per day/episode €23.29 (Lm10) per day/episode
Maternity cash benefit
 none
 none
 €465.87 (Lm200) per child
       
Overall Maximum
Payable
 €116,468.67            Lm50,000   €116,468.67          Lm50,000                                   

 €174,703 Lm75,000

       
Optional Benefits      
Funeral expenses
 €1,164.69 (Lm500)
per event
 €1,164.69 (Lm500
per event
 €1,164.69 (Lm500
per event
(Additional premium of €5.24 Lm2.25 per person) up to a maximum of €3,494.06 (Lm1,500
per policy		 up to a maximum of €3,494.06 (Lm1,500)
per policy		 up to a maximum of €3,494.06 (Lm1,500)
per policy
Cover for Medicines (Additional premium of €4.66 Lm2.00 per person) None Maximum of €104.82 (Lm45) per person per year, following a major operation Maximum of €104.82 (Lm45) per person per year, following a major operation

Territorial Scope
The Primary Health Scheme and the Enhanced Health Scheme cover treamtment received in Malta only, whilst the Elite Health Scheme proivdes cover for treatment received anywhere in the wold excluding USA and Canada.

Purpose of policy
The purpose of the policy is to provide cover for the Customary and Reasonable fees of recognised treatment, which is medically necessary for acute medical conditions. This policy is not intended to cover experimental or unproven treatment but should such situations arise we will discuss these with the beneficiary's specialist and decide whether the cost of the proposed treatment is covered. Claims will be paid for those items specified in the policy benefits (up to the amounts stated, if applicable).

If the policy benefit does not cover the full cost of treatment, the beneficiary will be liable for paying the balance.

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Middlesea Insurance p.l.c.
Middle Sea House
Floriana, FRN1442
Malta
Tel: (+356) 21246262
Fax: (+356) 21248195
  
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Middlesea Insurance p.l.c. is a company authorised under the Insurance Business Act, 1998 to carry on both Long Term and General Business and is regulated by the Malta Financial Services Authority.Registration Number: C5553. 

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