Can my health insurance in Malta refuse to cover a pre-existing condition?

Yes, insurers in Malta generally do have the ability to assess pre-existing medical conditions when underwriting a private health insurance policy, and depending on the specific condition and insurer's risk assessment, this can result in a range of outcomes including a specific exclusion for treatment related to that condition, an increased premium reflecting the added risk, or in some cases a full decline of coverage, since insurance underwriting is fundamentally based on assessing and pricing risk, and this is generally permitted under Maltese insurance regulation connected to the Insurance Distribution Act, Chapter 487 of the Laws of Malta, provided the insurer is transparent about how they're treating your disclosed condition. It's important to carefully and accurately disclose your condition as required on the application, since failing to properly disclose a known pre-existing condition could result in a future claim being invalidated entirely on the grounds of non-disclosure, which would be a considerably worse outcome than accepting an exclusion or increased premium upfront. Given that different insurers can genuinely take different approaches to the same disclosed condition, it may be worth using an insurance broker to compare how multiple insurers would actually treat your specific condition, since this comparison could meaningfully affect both your coverage and cost.