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Sunday 4 December 2016

Your Questions: Is there private health cover that will pay the full cost of maternity services?

Dermot Goode

Published 03/04/2016 | 02:30

Dermot Goode is a health insurance expert and broker at Totalhealthcover.ie Stock photo: PA
Dermot Goode is a health insurance expert and broker at Totalhealthcover.ie Stock photo: PA

Having recently been confirmed that we are expecting twins via ICSI (a step higher and more expensive than IVF), we were curious as to our cover. We have been with VHI for a number of years and paid an extra premium in the event we managed to get pregnant.

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However, on closer inspection if we choose to go private we would have to pay the consultants' fees (between €3k-5k), so in essence our cover doesn't do much. If we opt for semi private we still have to pay around €1,500 and if we opt for public then it's the same as not having private health insurance.

My question is... can health insurers offer cover when the clients are not capable of receiving full cover? Ideally we would go private - but seeing as we would have to find up to €5k on top of our health insurance premium, is there anything we can do?

Paddy, Rathfarnham, Co Dublin

This is a frequent question especially in relation to maternity services. Firstly, all plans have to include some level of maternity benefit due to Minimum Benefit legislation. This is why all members, both male and female, are covered for maternity-related services regardless of age.

Secondly, if your plan covers a particular service or treatment, it doesn't automatically guarantee that this is available. For example, thousands of members are covered for private rooms - but if these are not available on admission and they have to be accommodated in a semi-private or public ward, there is nothing the insurer can do about this.

The same applies to maternity services. Since the closure of Mount Carmel, there is now no private maternity hospital in Ireland. For private patients, they now have to rely on the public maternity hospitals such as the Coombe or the Rotunda hospitals and while private and semi-private rooms are available, there is no guarantee you will be able to access them when admitted.

Often patients might spend their first night in a public ward and then transfer to a private room as soon as one comes available.

Another point to note about maternity services is that it is treated differently by all insurers, as maternity is to a degree 'foreseeable'. No health insurance plan - regardless of how much you're prepared to pay - covers the full cost of maternity services.

If you were fortunate enough to get a private room, the insurer will pay approx €3,000 towards your hospital costs (usually full cover) and approx €850 towards your consultant's fees. Given that you can get this cover for approximately €80-€900 per adult on some plans, it's still good value.

 

I read recently that Aviva are being bought out by Irish Life. I have just renewed my policy with Aviva, so what will this mean for me now? More important, in the event I have to claim over the next few months, will it be paid?

Sheila, Cork City

In short, existing Aviva and GloHealth members can be confident that their policies will remain as is and all claims will continue to be paid as normal. At this stage, nothing has really changed. Subject to regulatory approval, Irish Life will be taking over Aviva Health in Ireland and also GloHealth. Over time, it is likely that they will be combined into one single entity, but full details on the likely new entity are not available yet.

When the new entity is fully operational, their new products and services will be offered to all Aviva and GloHealth members at their next renewal. As always, all consumers will have the choice to either renew with the new provider or switch to an alternative insurer.

 

I'm 38 and I took out health insurance for the first time last April to make sure I got in on time for the Lifetime Community Rating deadline. At the time I just bought the cheapest policy I could find.

However, I've realised now that my plan barely covers me for anything - no doctors or dentist expenses, etc. I think I should get a better policy this year… can you advise?

Emma, Bettystown, Co Meath

Over 100,000 consumers joined the health insurance market last March/April to beat this LCR deadline - and we estimate that about half of these purchased entry-level plans, which sounds like the one you chose. As these cover public hospitals only, they are extremely limited in cover. If you want reasonable quality health cover, you need to be spending approx €850 per adult. These plans will give you access to all public and private hospitals. This means that you should be covered regardless of which hospital facility you're referred to for treatment.

For those who remain on an entry-level plan and try to upgrade when an existing condition is diagnosed, they will be faced with a two-year upgrade rule before the new benefits will kick in. People who want cover for routine medical expenses such as GP, physiotherapy, dentists' fees and so on should expect to pay approximately €1,200 per adult.

 

At 32, I'm still relatively young by health insurance standards, but am quite involved in sport and while I've been lucky injury-wise, I'd like to ensure that I have some cover for physio, acupuncture and other remedial treatments should I get injured.

I have a basic policy with Glo and would hope not to increase the premium too much. Can you advise?

Jack, Bellahy, Co Sligo

This is the conundrum faced by many young people in relation to health cover - do you take the plunge now and take out a quality health insurance plan which can be expensive, or do you hang in there a bit longer as you're still young and healthy and have other priorities with a limited disposable income.

The answer for me is simple! If you get injured, you will be admitted to a public hospital where you're going to pay €75 per night up to €750 in any 12-month period (assuming you don't have a medical card). For €815, you can purchase a good health insurance plan that covers all public and private hospitals. Given that you're sporty, you should be covered for hospital facilities such as Beacon Hospital, Hermitage Clinic, Bon Secours hospitals or the Santry Sports Clinic.

If you join a health insurance plan after sustaining an injury that is highly likely, then all hospital treatment relating to this injury will be excluded for five years (pre-existing exclusion).

If you want to be covered for all routine medical expenses - physiotherapy, acupuncture, physical therapy, etc - you will need to consider one of the many corporate plans on the market which are available from all insurers starting from €1,170 per adult. As well as covering all public and private hospitals, these give guaranteed refunds on all routine medical expenses with no excess to pay first.

 

Email your questions to lmcbride@independent.ie or write to 'Your Questions, The Sunday Independent Business Section, 27-32 Talbot Street, Dublin 1'.

While we will endeavour to place your questions with the most appropriate expert to answer your query, this column is a reader service and is not intended to replace professional advice.

Dermot Goode is a health insurance expert and broker at Totalhealthcover.ie

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