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Friday 28 April 2017

Can we switch health plan after price rise?

Your questions answered

'In saying that, it is important to ensure that the provider you are moving to offers the same level of cover for the hospital you are attending' (stock photo)
'In saying that, it is important to ensure that the provider you are moving to offers the same level of cover for the hospital you are attending' (stock photo)

Barbara Sheahan - Head of health insurance with healthinsurancehelp.ie

Q: My husband and I are on Irish Life Health Plan 13. The cost has increased considerably this year. My husband is on chemotherapy and will be for the foreseeable future. We would like some advice on alternative plans, but want it to be much the same as what we have. My husband is worried a new plan would not cover everything. Ann, Drogheda, Co Louth

The key thing to remember here is that all insurers must give you full credit for all the time spent with another company - so if you are switching to an equivalent plan, you will be covered immediately. You cannot be penalised when you are switching just because you are undergoing treatment.

In saying that, it is important to ensure that the provider you are moving to offers the same level of cover for the hospital you are attending, that the procedures you are undergoing are covered, and that the consultant you are attending is listed with the new provider. Health Plan 13 is a very good plan that offers strong inpatient and outpatient cover. (Inpatient care is treatment which requires an overnight hospital stay; outpatient treatment doesn't require an overnight hospital stay).

I wouldn't recommend reducing any of your inpatient cover, especially when your husband is undergoing treatment. It is important to remain on the same level of hospital cover because if you decrease this, your husband would have to serve the "upgrade waiting period". All insurers have an upgrade rule, which means that if you reduce your cover and then increase it again from a future renewal date, the insurer will restrict your benefits to those offered by your previous plan for all existing medical conditions for the next two years. So, you will pay for the higher cover for the next two years but the additional cover that the new plan offers won't apply during that period.

A good alternative to the Health Plan 13 is Irish Life Health Plan 16.1. This offers the same inpatient cover and, furthermore, your excess (the first part of a claim you pay yourself) for private hospitals reduces from €125 to €75. However, due to your husband's medical condition, he will have to continue paying a €125 excess until he has served the two-year waiting period, at which point his excess will reduce to €75.

On your existing plan, you can claim back €35 for every day-to-day benefit (such as GP and dentist visits) - up to a maximum of seven visits per person a year. The Health Plan 16.1 offers €25 back per visit - up to a maximum of seven visits a year.

If you want to maximise your savings, you can opt for a plan with no day-to-day benefits. However, all of your savings would be wiped out if your bill for day-to-day medical expenses comes to between €150 and €200 a year.

Painless acupuncture cover

Q: What are the best private health insurance plans for acupuncture and reflexology - and what type of cover is provided?

Nuala,
Salthill, Co Galway

Each provider has many plans that offer money back on visits to alternative practitioners.

For example, Laya Healthcare's Complete Simplicity plan covers 50pc of the cost of 12 acupuncture visits a year. VHI's PMI 25 11 covers €40 of the cost of a visit to an acupuncturist, chiropractor, osteopaths, physical therapists or reflexologists - up to a maximum of 12 combined visits a year.

Irish Life Health's Best Ultimate 2 plan covers 50pc of the cost of 13 combined visits to alternative practitioners such as acupuncturists, chiropractors, osteopaths. Best Ultimate 2 also has a 'complementary therapy' package that can be added for free. This package gives an additional €25 back on three visits to each practitioner.

US health insurance switch

Q I AM living in the United States but considering moving to Ireland to look after my mother. I'm 47. I was born in the US and have an Irish passport. I have health insurance in the US through my job. I have a below-the-knee prosthetic but otherwise I'm in good health. I need to ensure I'm on a good private health insurance plan should I move back to Ireland in case I need further treatment on my knee. Would I be covered immediately for such treatment after buying insurance in Ireland?

Harry,
San Francisco

Unfortunately, you wouldn't be covered immediately. Anybody taking out health insurance for the first time must serve certain waiting periods with all insurers.

There is a 26-week waiting period for any new conditions that may arise, a five-year waiting period for any pre-existing conditions, and a 52-week waiting period applies for maternity benefits. All day-to-day cover, accidents or injuries you may have will be covered immediately at your age. There are allowances on certain plans for money towards prosthetics.

You should get up to speed on lifetime community rating. This means that anybody over the age of 35 who doesn't have health insurance in Ireland must usually pay a loading when they buy it. The loading is an additional 2pc per year for every year you are 35 or over. To avoid the loadings, get private health cover within nine months of your return to Ireland.

Is Copd covered right away?

Q: I have been years on VHI's old Plan B (Health Plus Access). I am in my late 60s. I have chronic obstructive pulmonary disease (Copd). I want to change to Laya Simplicity, but I wonder if that plan will cover me immediately for my existing conditions? Peggy, Crumlin, Dublin 12

All providers are required by law to give full credit for all time spent with another company, so if you switch to an equivalent plan you are covered immediately. If you have already served your waiting periods with your existing insurer, you don't have to serve them again. If you have not served all your waiting periods, you get full credit for the time served.

Both of the plans you mention offer quite similar levels of cover - however they do have a few differences. All public hospitals are covered fully on both, all private hospitals are also covered but with Laya Simplicity, there is a €100 excess on your first two overnight stays in a private hospital and a €50 excess per claim on day case procedures in private hospitals. So, if you are undergoing day case treatment in private hospitals, note that with Simplicity, you must pay this excess per visit to the hospital. You do not have this day case excess on your existing plan.

Simplicity offers stronger cover for certain cardiac and listed specialised procedures so if there is anything that would relate to Copd on this list, you would remain on the same level of cover that your existing VHI plan offers for two years - after which point you can use the increased cover offered on the Laya plan.

Another option from Laya is Simply Connect Plus. This has an excess of €150 on the first overnight stay in private hospitals only. You can also claim money back on day-to-day expenses straight away, whereas Simplicity has an outpatient excess which must be reached before you can claim money back.

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