Laferla Health Insurance Claim Procedures

Overview

Maximizing your health benefits starts with a clear understanding of how to file a claim. The following procedures are designed to provide transparency and ease of use, guiding you through the documentation required and the timelines for settlement. Whether you are using the Laferla App or traditional methods, this overview will empower you to manage your health policy effectively and ensure you receive the support you need when it matters most.

In case of In–Patient & Day–Case Treatment (Hospitalisation)
 

1. For Treatment in Malta:

   Laferla has a Direct Settlement agreement with all private hospitals and clinics in Malta, meaning that we can pay the hospital or clinic directly if your health insurance plan offers a 'Full Refund of Reasonable Fees' for In-Patient and Day-Case treatment.
   
   We wish to help you by making your booking process as smooth as possible, so you may simply advise the hospital or clinic about your Laferla health insurance policy, providing your policy number and personal details, and they will get in touch with us in order for us to facilitate this process completely on your behalf.

   If your plan offers a 'Full Refund of Reasonable Fees', we will most likely cover the hospital / clinic fees including accommodation, nursing, in-patient medicine and operating theatre fees in full. 

   The professional fees for your Surgeon, Anaesthetist and/or Consulting Physician whilst you are admitted in hospital will be paid in line with our Schedule of Reasonable Fees. If your medical service providers' fees are higher than these, then you may be asked to pay the difference directly.
    

2. For Treatment outside of Malta:

   Unlike other insurers, Laferla does not have a limited/definitive list of hospitals, as we are able to cover treatment at any hospital within your area of cover, up to the Reasonable Fees in that territory.

   If you hold an 'International' health insurance plan, your plan will offer a 'Full Refund of Reasonable Fees' worldwide excluding the USA & Canada. Other health insurance plans may offer a limited benefit for treatment received outside of Malta. Please check your Table of Benefits or ask us if you have any doubts.

   Prior to admission to the hospital, please provide Laferla's contact details to the hospital. The hospital should contact us directly in order for Laferla to confirm cover for the treatment required, according to the extent of benefits offered to your under your health insurance plan, and the general terms of the Policy.

   
   Contact details:

   E-Mail: [e-mail]

   Phone (during office hours): [phone]

   Phone (24/7 for emergency cases): [phone]

   Laferla can always organise a direct settlement to pay all covered expenses directly to the hospital, subject to the hospital's acceptance. Sometimes, hospitals outside of Malta may not accept a direct settlement from us since we do not have a pre-signed agreement. In this case the issue may be outside of our control, and the hospital may ask you to pay the fees yourself and recover them under a claim with us.

Important - Reasonable Fees

Please refer to our website at https://www.laferla.com.mt/claims/health-insurance-reasonable-fees to understand the principles of Reasonable Fees and also to access our Schedule of Reasonable Fees for treatment in Malta. The principles of Reasonable Fees are applied by health insurers in many countries where surgeons' and anaesthetists' fees in a private healthcare setting are not set by legislation. The scope is to control costs and keep healthcare and health insurance policies affordable to all consumers.

In case of Out–Patient Treatment (Doctor visits / Specialist Consultations / Diagnostic Tests and Procedures)

In order to claim for expenses related to Out-Patient Treatment, we will require the following documents:

• Completed Claim form which should be filled in by you (section 1-3 and signature at the end of the form) and the doctor(s) providing your treatment (section 4 or 5 as applicable).
• Originals receipts.
• A copy of all Medical Reports, Referral Notes and Diagnostic Test Results / Reports (including Blood Tests, X-Rays, Ultrasounds, MRI/CT Scans, etc.).

To facilitate an accurate assessment, it is imperative that you provide a comprehensive claim file. This includes all relevant supporting evidence, such as:

• Original itemized invoices and official receipts.

• Detailed medical reports or prescriptions related to the treatment.

• Any supplementary diagnostic results or referrals.

Language Requirement: Please note that all documentation must be submitted in English. If your original documents are in another language, they must be accompanied by a certified English translation to be eligible for review.

Digital Submission via the Laferla Portal

For your convenience and for faster processing, all claims should be submitted digitally through our dedicated web application at https://www.laferla.com.mt/.

Once you have successfully registered and completed the identity verification process, your active policy portfolio will be accessible within your dashboard. From here, you can utilize the intuitive "Submit a Claim" feature to upload your documents directly to our system.

Laferla prides itself on industry-leading efficiency. Once a complete and eligible claim has been submitted and approved, we commit to issuing your reimbursement within seven business days. Utilizing the web portal ensures that your file enters our workflow immediately, allowing us to maintain this high standard of service.