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Saturday 25 February 2017

Your Questions: How good is the cover for premature births offered by private health insurers?

Barbara Sheahan

Premature births are treated the same as full-term births by private health insurers. The most important thing to do is to add your newborn to your policy straight away Photo: Getty
Premature births are treated the same as full-term births by private health insurers. The most important thing to do is to add your newborn to your policy straight away Photo: Getty

My husband and I are planning our second baby. Our first baby was very premature and had to be kept in hospital for some time. We didn't have private health insurance at the time and the costs that arose as a result of having a premature baby really put pressure on us financially.

We have taken out private health insurance since, but as we are now planning our second baby, we are concerned that I may go premature again - and the costs that would arise if so. So we are considering upgrading our plan - or changing to another provider if necessary.

What kind of cover do private insurers typically provide for premature births - and is there any plan you would recommend for premature births?

Roisin, Dundalk, Co Louth

Premature births are treated the same as full-term births by private health insurers. The most important thing to do is to add your newborn to your policy straight away.

People often mistakenly assume that their child will be automatically added to their health insurance plan - because the health insurer knows they are pregnant. However, this is not the case - and without a name and a date of birth, the insurer cannot do so.

The four health insurers - Aviva, GloHealth, Laya Healthcare and VHI - allow 13 weeks (after the birth) for your newborn to be added to the plan. If you do not add your baby within this time, the baby will unfortunately be subject to the waiting periods typically faced by new private health insurance customers.

Under those waiting periods, your baby would need to wait 26 weeks for cover for any new conditions that may arise (that is, illnesses that commence after your baby joins the plan) and five years for any pre-existing conditions (since May 2015, this is defined as any illness that existed up to six months before becoming insured on a plan). So it is very important that you add your newborn to your health insurance plan within 13 weeks of the birth. Accidents or injuries are not subject to any waiting period.

Regardless of whether you choose to go public, semi-private or private when having your baby, you can still add your baby to your health insurance plan after the birth - and the baby can then be treated as a private patient.

This means that your baby will not be subject to the fee of €75 per night. (The €75 nightly fee is typically faced by public patients staying in a public hospital - up to a maximum charge of €750 a year).

There is no need for you to get a private health insurance plan that is specifically designed for premature babies, as all plans offer the same treatment for premature births as for full-term births.

Some plans offer cover for 'parent accompanying child expenses', which can be used for travel expenses, parking in the hospital and accommodation costs if you are visiting your child in hospital. This is an excellent benefit for people who have premature babies. The benefit varies from one provider to another. Some plans offer up to €100 back per day, up to 14 days. This can be used for children of any age - not just premature babies.

I am currently a medical card holder and I have private health insurance. My husband and I feel it is a waste of money for me to be covered by health insurance, as I have a medical condition that entitles me to a medical card - and we are thinking of taking me off the health insurance plan. My only concern is that we are hoping to start a family over the next few years. Would it be a good idea to give up my private health cover?

Linda, Coolock, Dublin 13

The answer to me is very simple: if you can afford it, do not give up your health insurance. You mentioned you have an existing medical condition - this is a major reason to not give up your health cover. If you leave and want to re-join again in the future, your existing medical condition will not be covered for five years.

When it comes to maternity care, every expectant mother in Ireland is entitled to care under the Maternity and Infant Care Scheme - whether they have a medical card or not.

This scheme provides an agreed programme of care to all expectant mothers who are ordinarily resident in Ireland. It combines antenatal care provided by a GP of your choice and a hospital obstetrician. Patients usually attend their GP before the 12th week of pregnancy. The GP provides a further six examinations during the pregnancy. The first visit to the hospital antenatal clinic should take place by the 20th week. If the mother suffers from a significant illness such as diabetes or hypertension, up to five additional visits to the GP may be provided.

Under the scheme, the public health nurse visits the mother and baby at home during the first six weeks after the birth, free of charge. The GP who attends the mother also provides care for the newborn; they will provide two developmental examinations free of charge at two weeks and six weeks following the birth. The mother is also entitled to free in-patient, out-patient and accident and emergency services in public hospitals in respect of the pregnancy and the birth - and so she is not liable for any of the hospital charges. Treatment for other illnesses that you may have at this time, but that are not related to the pregnancy, are not covered by the scheme.

My husband and I are planning to have children in a couple of years. We would like to get on a good plan for maternity benefit first, though. What's the best private health insurance plan for maternity benefit?

Eibhlin, Co Donegal

The first thing to do is plan ahead - all health insurance providers apply a 52-week waiting period for maternity benefits. The next is deciding which care option you would like to choose - public, semi-private or private. If you choose to go public, it will make no difference whether you have health insurance or not as you will be fully funded by the State.

Should you choose to go semi-private or private, some health insurance plans offer stronger benefits than others. There are more than 350 in-patient health insurance plans (that is, plans that cover overnight stays in hospital) on the market, so it really depends on your budget. Some corporate options you could consider include Aviva's Health Plan 16.1, GloHealth's Best Smart plan (you must add the maternity 'personalised package' for free to get the full maternity benefits), Laya Healthcare's Simply Connect Plus, and VHI's PMI 36 13. These are all priced between €1,162 and €1,248.

There is a new maternity booster being added to GloHealth's Best Plan Ultimate Cash II at the end of this month. The plan, which is being reduced in price from this date to €1,593.76, provides a generous allowance for IVF in any treatment centre as well as €600 cover for consultant fees.

VHI's plan PMI 04 11 offers €5,000 for pre- and post-natal maternity care (consultant fees) should you choose to go private. This is the only plan on the market that will potentially cover the cost of private maternity. It is an excellent plan, albeit an expensive one, at €3,666 per annum.

Head of health and dental with www.healthinsurancehelp.ie and www.kindlon.ie

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