Why buy Private Health insurance?
State-funded medical services strive to make quality healthcare available to all. However, various elements are creating high demands on this service, and you may find that you have to wait longer than you are comfortable with to receive medical treatment.
Having private medical insurance cover is a way of making sure you receive prompt access to private medical treatment, giving you one less thing to worry about when you’re ill. In most cases, having private health insurance means you will receive treatment in top-of-the-line, comfortable facilities, which will be music to the ears of anyone who has spent time trying to rest and recover on a busy public hospital ward. Private health insurance is intended to complement the services provided by the national health service.
What is covered?
Private health insurance provides cover for short term medical care given by authorised medical practitioners, which is provided with a reasonable expectation to restore you to the same or possibly even better health than you enjoyed before having the medical treatment.
What is not covered?
- Cosmetic treatment
- Experimental, unproven or unregistered treatment or practices
- Treatment related to developmental problems, learning difficulties
- Pre-existing medical conditions
- Routine pregnancy checks and normal childbirth
- Treatment of chronic medical conditions
Full details are available in the General Exclusions section of the Policy.
What is a pre-existing condition?
Any disease, illness or injury for which you have already received medication, advice or medical treatment; or which you have experienced symptoms of before the start of your cover (whether the condition has been diagnosed or not).
We will usually not cover treatment for pre-existing conditions and conditions associated with them. Excluded conditions will be identified on your member certificate.
Don’t forget though, even if you do have a pre-existing condition it could still be worthwhile buying private health insurance as you will have cover for treatment of other unrelated conditions.
What is a chronic condition?
A Chronic condition is defined as a medical condition that keeps coming back or is likely to continue, and/or need regular or periodic monitoring, treatment, medication or medical advice.
Since private health insurance is designed to cover acute (short-term) medical episodes, and treatment for a chronic medical condition is likely to be a series of predictable, rather than unexpected, events, we will not pay for the ongoing management/treatment of such conditions. We will however pay for treatment required for the diagnosis and stabilisation of a new chronic condition; and for acute episodes of the condition which may occur in the future.
Examples of chronic conditions include diabetes, hypertension (high blood pressure), hyperlipidaemia (high cholesterol), psychiatric problems, allergies and certain skin disorders.
How do I apply?
Download a Proposal Form, and mail to us:
Citadel Insurance plc, Casa Borgo, 26, Market Street, Floriana FRN 1082, Malta
Please attach copies of medical reports and evidence of previous insurance cover where applicable. It will also help if you can provide us with your claims experience from your previous insurers if you have been recently insured elsewhere.
The proposal form contains questions relating to your medical history. If in doubt, please contact us so we can answer any queries or concerns you may have.
I am already insured – can I switch to CitadelHealth?
Yes, you may choose to transfer your cover from your existing health insurer to CitadelHealth – we will consider issuing your policy on no worse terms if you provide us with an up-to-date detailed claims experience from your current insurer. If we are satisfied that any medical conditions you may have will not pose a high risk, we will not impose new medical underwriting terms for your conditions. We will need a copy of your most recent insurance certificate, detailing any applicable personal executions. These will be carried to over your Citadel Health Policy.
How can I pay my premium?
Premium is payable annually in advance. Payment can be made by cash, card, cheque adressed to Citadel Insurance p.l.c. or by bank transfer (please select Citadel Insurance p.l.c. Non-Life from the payee list).
Will my premium keep going up?
Prices may go up, but we will try our best to keep these increases to a minimum. However, the fact remains that in order to stay in business, we have to make sure we have enough funds to cover the cost of our clients’ claims. Your age at renewal affects the price of your healthcare policy, simply because it’s a fact that as we get older we tend to require more medical treatment, and therefore make more claims.
What’s more, advances in medical treatment technology are made all the time, and more and more people are reaping the benefits of such treatment, which can save or transform lives. This all comes at a price – and the more customers use their health insurance to claim for them, the bigger the fund we would need to pay health care bills. To fund the uptake of these treatments, we share the cost among clients as a premium increase – after all, it could well be you or your family that needs them in the future.
In order to keep premium increases as low as possible we negotiate with hospitals locally and overseas to make sure their charges are fully justified. We’re proud to say that we’ve worked hard to ensure that our private health insurance policies offer good value for money.
How do I claim?
- Visit your GP for each new medical condition
- Your GP may then refer you for further treatment by a specialist
- Contact us on firstname.lastname@example.org before your treatment if you are having any of the following: in-patient or day-patient treatment; CT, MRI or PET scans; psychiatric treatment; home nursing.
We will confirm your cover in writing through our Payment Guarantee service, and where applicable, we will also liaise with the service provider to settle your bill directly, allowing you to concentrate on your treatment and recovery.
What do I do in an emergency?
In case of an emergency always seek medical care immediately. It is important that we are informed as soon as possible of your treatment so that we can confirm your cover and where applicable settle your bills directly with your service provider.
What are fair and reasonable costs?
We will reimburse charges that are considered to be fair and reasonable, subject to the specific terms of your policy and the policy being in force. The maximum benefits payable towards the fees charged are determined by us based on what the majority of medical service providers charge, after consulting widely with all branches of the medical profession.
In the event that you are charged in excess of these guidelines, then in all likelihood you will be personally responsible for the difference, known as a “shortfall”.
If your treatment proves to be more complicated than the procedure described, then we will be happy to consider paying further benefit provided that your specialist writes to us and explains the circumstances.
How often am I allowed to claim?
You may claim as often as you need, and we will continue to pay claims as long as your benefit is not exhausted and your cover is still in force.
How soon after joining can I claim?
You are covered when we have processed your proposal form, received payment of your premium and issued your member certificate which shows the cover start date. You can claim immediately for any new eligible medical conditions that arise after the cover start date. Certain treatment, such as psychiatric treatment and complications of pregnancy, may only be claimed when you have been insured for a specific period of time, more details are available in the Policy.
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