THE LAFERLA INTERNATIONAL MEDICAL COVER
Covers You for worldwide treatment excluding USA and Canada

 
The following is a summary of the Benefits payable under your Private Medical Insurance Policy. For a full description of the Benefits and Policy conditions, please refer to the accompanying Policy wording.
This scheme gives the Beneficiary or Member as the case may be or their dependents the option to select COMPREHENSIVE COVER (benefits 1 to 19) or IN-PATIENT & DAYCASE COVER ONLY (Benefits 1 to 13).
The charges for any such treatment received must be reasonable and customary.
BENEFITS  COMPREHENSIVE   NOTES
Yearly maximum benefit: We will pay  up to the maximum shown each Year for each Beneficiary € 582,343.35 (Lm 250,000) This limit does not apply to Benefit 12.
If you have an excess it applies to each Beneficiary every year.
We will not pay Benefit until the Beneficiary:
    1. has had Treatment during the Year which qualifies for Benefits, and 

    2. has spent more on that Treatment than the excess amount
In-patient and Daycare
1.  Accommodation charges and ancillary charges . Full Refund Accommodation Charges are charges made by a hospital for In-patient or Daycare Treatment which includes the cost of the bed, meals, routine nursing and care services, and housekeeping.
Ancillary charges are fees for particular services provided by a hospital. Examples of such services are:
  • operating theatre charges:
  • special nursing;
  • drugs and dressings:
  • surgical appliances used by the Medical Practitioner during surgery.
2.  Surgeons' and Anaesthetists' Charges For In-patient and Daycare Treatment. This includes pre- and post-operative consultations whilst an In-patient or Daycare patient Full refund Related Out-patients consultations are payable under Benefit 14
3.  Physicians' charges For In-patient and Daycare Treatment. This includes intensive care Full refund .
4. Consultations, diagnostic Procedure & Physiotherapy Received as In-patient or Daycare patient Full refund Consultation means a consultation with another Medical Practitioner which is arranged by the Medical Practitioner treating You. Out-patient Diagnostic Procedures and Physiotherapy are payable under Benefit 18 even if they are related to In-patient or Daycare Treatment
5. Parent Accommodation Charges for one parent staying with a Child Beneficiary. Full refund when child Beneficiary is under 15 years, provided Treatment is in your country of residence or within your Area. .
6. Cash Benefit. For Treatment and Accommodation received free of charge € 34.94 (Lm 15) per night This Benefit counts towards the overall maximum of 180 days in any Year
  Other
7. Out-patient Surgical Procedure . Full Refund We will pay the Surgeons' and Anaesthetists' Charges and relevant Ancillary Charges for the procedure. Pre-or Post-operative consultations are payable under Benefit 14
8. Radiotherapy, Chemotherapy & Computerised Tomography (including Magnetic Resonance Imaging). Received as an In-Patient, Daycare patient or Out-patient. Full Refund Computerised Tomography and  Magnetic Resonance Imaging are medical techniques for brain and body scanning
9. Ambulance Cover . € 465.87 (Lm 200) for each Beneficiary. We will pay up to this amount in any Year towards a road ambulance for emergency transport to or between hospitals, or where the Medical Practitioner says it is medically essential.
10. Home nursing (MMDNA) 
i. Visits by a qualified nurse for the treatment of a Medical Condition immediately following In-patient or Day-case Treatment as recommended by the Specialist in attendance.
ii. Nursing Treatment, by day or by night, on the recommendation of the Medical Practitioner including blanket baths, prevention and treatment of bedsores, toenail cutting, injections, enemas and washouts, dressing of wounds, catheterisation, care and treatment of diabetics.
iii. Midwifery service by a state-certified midwife for ante-natal and post-natal visits.
. Services as required and given by the Malta Memorial District Nursing Association at no cost to Insured.
11. Outside Area of Residence.  When Beneficiaries travel on business or pleasure. This is to cover emergency Treatment or Treatment of a Medical Condition which arises suddenly whilst outside the Beneficiary's Area of Residence.  Benefits for the USA and Canada are limited to 6 weeks in any Year and cannot  exceed € 17,470.30 (Lm 7,500)  We will not pay Benefit if the Beneficiary  travelled to obtain Treatment whether that was the only reason or not, or travelled against medical advice.
 Repatriation Evacuation, Mortal remains, Funeral Expenses
12. International Emergency Medical Assistance  i. Repatriation. 
ii. Evacuation.
iii. Mortal Remains. 		 Full Refund.
Full Refund.
Full Refund.		 This Benefit is in addition to all other Benefits.
13. Funeral Expenses. . € 931.75 (Lm 400) for each Beneficiary
up to a maximum of € 1,863.50 (Lm 800)
Out-patient (optional): Benefits 14 to 19 inclusive are optional. They can be deleted from cover and the subscription reduced accordingly but they cannot be  bought alone. We will not pay for out-patient drugs, medicines, dressings, surgical/dental appliances, contact lenses or hearing aids.
14. Medical Practitioner Charges. Consultation charges
Overall limit for Benefits 14-18 each Year is € 3,494.06 (Lm 1,500).
 

 
There is a € 34.94 (Lm 15) excess for each visit for Benefits under 14, 15, 16 and 17. This excess is not enforced for visits to the Medical Practitioner in Malta (item 14). Additional Benefit for item 17 is limited to € 349.41 (Lm 150) each Year.
This includes Out-patient consultations even if related to In-patient or Day-care treatment
15.  Psychiatric Illness.  Consultations and Treatment received as an Out-patient. .
16. Accidental Damage to Teeth.  Treatment received as an Out-patient or in an emergency room in a hospital. For Treatment required immediately following accidental damage to natural teeth when given by a Medical Practitioner We will also consider paying Benefit, at our discretion, if such Treatment is given by a dentist. This is for the initial Treatment  only. It does not include any follow-up  Treatment.
17. Chiropractic Treatment & Osteopathy. For Out-patient Treatment given by a qualified Practitioner who is registered to practice as an Osteopath or Chiropractor where the Treatment is given. .
18.  Diagnostic Procedure & Physiotherapy Received as an Out-patient even if they are related to In-patient or Daycare Treatment We will not apply the excess to this benefit. We will not pay for consultations under this Benefit as they are payable under Benefit 14.
19.  Nursing at home. 

 

 When arranged by a Medical Practitioner out of medical necessity for a Beneficiary who needs a registered nurse immediately following In-patient or Daycare Treatment. Full Refund. We will pay up to 14 days a Year. .

 
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