When looking at cover, it is useful to know that treatment is often categorised in the following way:
1. In-patient Treatment. This consists of treatment you receive when you are hospitalised and have to stay for one or more nights.
2. Day-patient Treatment. This is sometimes referred to as day-care, or day-case. You may need to go to hospital for treatment or investigations without the need to stay in hospital overnight.
3. Out-patient Treatment. This consists of treatment you receive from your doctor or consultant which does not require you to stay in hospital either as an in-patient or day-patient.
There are various policies with varying levels of benefits – starting from low-cost schemes, offering limited cover, to those which offer wide-ranging cover and benefits. Most schemes offer cover for both in-patient and day-patient care, but do not always offer a full refund. Some are limited to cover treatment in the Maltese Islands whilst others are extended to cover treatment overseas as well.
It is important to note that benefits described as ‘full refund’ will be limited to what the insurer considers as “customary and reasonable” charges. When an insurer determines the amount that is "customary and reasonable" for a claim, it examines the amounts it had already paid in claims for those services as well as the "reasonable cost of service" for your particular medical condition. Unfortunately, getting access to that information may be difficult for patients. Some insurers publish these rates on their website. However, medical practitioners are not bound by these rates.
It is best if you ask the doctor's office how much the medical intervention is going to cost. Once you have that amount, call your insurer, explain that you have an appointment for a particular service, and you need to know the customary and reasonable rates for that service.
Insurers usually have agreements with private hospitals to enable direct settlement with the hospital provider concerned. This depends on the level of cover you have chosen. Direct settlement may not be possible with some medical practitioners. You should therefore check with your insurer before undergoing treatment. This can be done either by calling them or by referring to their website.
Choose the scheme or plan that suits your requirements and budget.