Making a claim

6.03 Other claim information

Discretionary payments

We may, in certain situations, make discretionary or “ex gratia” payments towards your treatment. If we make any payment on this basis, this will still count towards the overall maximum amount we will pay under your membership. Making these payments does not oblige us to pay them in the future.

We do not have to pay for treatment that is not covered by your plan, even if we have paid an earlier claim for a similar or identical treatment.


Overpayment of claims

If we overpay you for your claim, we reserve the right to deduct the overpaid amount from future claims or seek repayment from you.


Claiming for treatment when others are responsible

You must complete the appropriate section of the claim form if you are claiming for treatment that is needed when someone else is at fault.

Examples: In a road accident in which you are a victim. If so, you will need to take any reasonable steps we ask of you to:

  • recover from the person at fault (such as through their insurance company) the cost of the treatment paid for by Bupa Malta, and
  • claim interest if you are entitled to do so.


Note: Subrogation

In the event of any payment of any claim under your membership, Bupa Malta or any person or company that it nominates may be subrogated to all rights of recovery of the member and any person entitled to the benefits of this coverage. The member shall sign and deliver all documents and papers and do whatever else is necessary to secure such subrogated rights to Bupa Malta or its nominated party. The member shall do nothing after the claim to prejudice such rights.


Claiming with joint or double insurance

You must complete the appropriate section on the claim form, if you have any other insurance cover for the cost of the treatment or benefits you have claimed from us. If you do have other insurance cover, we will only pay our share of the cost of the treatment.

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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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© 2014 Bupa Malta / GlobalCapital Health Insurance Agency Ltd