MAPFRE Health Insurance Claim Form Logo
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  • Health Insurance Claim Form

  • Important Notes

    All Treatment must be undertaken and given by and under the control of a Specialist or your General Practitioner. A referral by a Specialist is required for CT/MRI Scans, Hospital Admissions, Alternative and Psychiatric Treatment.

    For approval of cover for planned In-patient/ Day Case Treatment you must always contact MAPFRE Middlesea at healthclaims@middlesea.com  to confirm eligibility and extent of cover.

    All Claims documentation must be submitted within 3 months of initial date of treatment.

  • 1. Policy Holder/Patient Details

  • Invalid Policy number - Your Policy number should be 13 digits long and starts with 151,152,153 or 281

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  • 2. Reason for Seeking Medical Advice

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  •  Date of first consultation must be before date of last consultation 

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  • 3. Documentation Upload

  • Browse Files
    Drag and drop files here
    Choose a file
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  • * Invoices that are not supported by receipts will not be eligible for reinbursement 

  • You may utilise the existing paper based claim form to obtain details of your medical condition and the signature/stamp of your medical practitioner. Alternatively please ask for your medical practitioner to sign and stamp a detailed medical report and subsequently taking a picture and uploading.

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  • 4. Bank account details

    to facilitate any claim payments
  • We cannot process claims without this information. Please complete all fields and provide correct details.

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  • Declaration

  • I understand that in the event of an incomplete and/or non-disclosure of material information, MAPFRE Middlesea p.l.c reserves the right to repudiate the claim. I authorise MAPFRE Middlesea p.l.c. to share information with others (including insurers and Insurance Associations) in order to prevent fraudulent claims. I declare that all the answers given and the statements made are true and correct. Furthermore I declare that I have not withheld any information relevant to the claim. I give explicit and unequivocal consent to MAPFRE Middlesea p.l.c. to seek any information from any doctor, surgeon, hospital, clinic, laboratory or persons that have records or knowledge of my health in order for the validity of the claims to be established.

    I hereby authorise any doctor, surgeon, hospital, clinic, laboratory or persons that have records to provide full medical information concerning myself and my dependants.

    I give consent to MAPFRE Middlesea p.l.c. to process my personal data supplied by myself or any person, body or entity in order to process, handle and settle the claim.

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  • DATA PROTECTION 

    MAPFRE Middlesea p.l.c. is legally bound to follow the provisions of the Data Protection Act, 2018. If you require any further information about how MAPFRE Middlesea Plc processes your personal data, please follow this link https://www.mapfre.com.mt/privacy-policy .

  • MAPFRE Middlesea p.l.c. (C-5553) is authorised by the Malta Financial Services Authority (MFSA) to carry on both Long Term and General Business under the Insurance Business Act. MAPFRE Middlesea p.l.c. is regulated by the MFSA.

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