Making a claim

6.01 How to make a claim

Your claim form is important as it gives us the information that we need to process your claim. If it is not fully completed we may have to ask for more information. This can delay payment of your claim.

You must complete a new claim form:

  • for each member
  • for each condition
  • for each in-patient or day-case stay, and
  • if a condition continues over three months, we will ask for a further claim form to be completed.


What to send us

You need to return the completed form to us by post, with the original invoices, as soon as possible. This must be within three months of receiving the treatment for which you are claiming. Invoices sent to us after three months will not normally be paid.


Requests for further information

We may need to ask you for further information to support your claim. If we do, you must provide this.

Examples of things we might ask for include:

  • medical reports and other information about the treatment for which you are claiming
  • the results of any medical examination performed at our expense by an independent medical practitioner appointed by us
  • written confirmation from you as to whether you think you can recover the costs you are claiming from another person or insurance company.


If you do not provide the information that we ask for, we may not pay your claim in full.


Important

When making a claim please note:

  • you must have received the treatment while covered under your membership
  • payment of your claim will be under the terms of your membership and up to the benefit levels shown, that apply to you at the time you receive the treatment
  • we will only pay for treatment costs actually incurred by you, not deposits or advance invoices
  • we will only pay for treatment costs that are reasonable and customary
  • we do not return original documents such as invoices or letters. However, we will be pleased to return certified copies if you ask us when you submit your claim.


Confirmation of your claim

We will always send confirmation of how we have dealt with a claim to the principal member.

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GLOBALCAPITAL HEALTH INSURANCE AGENCY

GlobalCapital Health Insurance Agency Limited acts as an insurance agent and is regulated by the Malta Financial Services Authority (MFSA). Registered address: GlobalCapital Health Insurance Agency Limited, Testaferrata Street, Ta’ Xbiex XBX 1403, Malta.

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