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  • Health Insurance Claim Form

  • 1. Patient Details

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

  • ID Type*
  • Date of birth*
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  • Current Date
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  • ID Type*
  • Date of birth*
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  • 2. Reason for Seeking Medical Advice

  • Consultations*
  • Date of First Consultation*
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  • Date of Last Consultation*
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  •  Date of first consultation must be before date of last consultation 

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  • 3. Documentation Upload

  • Upload file checklist*
  • Browse Files
    Drag and drop files here
    Choose a file
    Cancelof

  • * 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

  • We will pay the claimant if they are 18 or over; otherwise, payment will be made to the policyholder.
    The eligible payee must be the bank account holder.

  • Payment Instructions
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  • Declaration

  • I declare that the information provided in this form is true, complete, and correct to the best of my knowledge and belief and I accept full responsibility for the statements made. I understand that if any material information is withheld or incomplete, Mapfre Malta p.l.c. may reject the claim.

    If this form has been completed by someone else on my behalf, I confirm that the information reflects my statements and that the contents have been fully explained to me.

    I understand that, for the purpose of assessing, validating and managing this claim, Mapfre Malta p.l.c. may request and receive medical information from any doctor, hospital, clinic, laboratory, insurance company or other professional who holds records about me or my dependants. I authorise these individuals or entities to disclose and release such information to Mapfre Malta p.l.c. where necessary for these purposes.

  • DATA PROTECTION 

    Mapfre Malta 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, Cap. 403 of the Laws of Malta. Mapfre Malta p.l.c. is regulated by the MFSA.

    If you would like to know more about how Mapfre Malta p.l.c. processes your personal data please refer to the following link: www.mapfre.com.mt/privacy-policy/.

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  • 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, Cap. 403 of the Laws of Malta. Mapfre Middlesea p.l.c. is regulated by the MFSA.

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