Thursday 17 August 2017

Your Questions: Should my parents cancel their health insurance after qualifying for medical card?

The message for older health insurance members is simple: never cancel your cover unless you have no other alternative (Stock picture)
The message for older health insurance members is simple: never cancel your cover unless you have no other alternative (Stock picture)

Dermot Goode

My parents have just qualified for a medical card and are thinking of cancelling their private health insurance cover. They are in their early sixties. Is this a good idea? Helen, Raheny, Dublin 5

Absolutely not! Whilst having a medical card has its advantages, there is no real overlap between this and private medical insurance.

The medical card qualifies you for free treatment in public hospitals, free GP cover, and limited costs for prescriptions - to name a few. However, for those concerned about waiting lists in the public system, you will still wait just like every other patient irrespective of whether you hold a medical card or not.

Unfortunately, the only way to avoid waiting for treatment is to have either a very healthy bank balance or to have quality health cover in place. Too many older members look to cancel their cover when they qualify for medical cards in the mistaken belief that one is a substitute for the other. They are then faced with reserving their waiting periods if they look to rejoin health insurance in the future - regardless of how long they were insured previously.

The message for older health insurance members is simple: never cancel your cover unless you have no other alternative. Should you be struggling to afford your private health insurance, look to reduce your costs by switching provider; taking on an excess (the first part of a claim you must pay for yourself); giving up the cover for a private room; or taking on a co-payment (where you foot some of the bill for certain procedures - such as orthopaedic or ophthalmic treatment).

My daughter is insured on an excellent corporate health insurance plan through her job. Can I join this plan as well - or can you only join a corporate plan through a company work scheme?

Paul, Sligo Town

Corporate plans, and indeed every health insurance plan on the market, are available to everyone. Irrespective of the plan name, if you like the benefits and the price tag, all insurers will make these plans available to you if you request them by name.

Corporate plans are attractive because they're targeted at the most lucrative sector in the market and so they are very competitive in terms of price and benefits. For example, most quality corporate plans cover up to semi-private in all private hospitals; include full cover for certain listed cardiac procedures in the likes of the Mater Private and Blackrock Clinic; and give you guaranteed refunds on your everyday outpatient expenses - with no excess to pay first. (Excess is the first part of a claim you must pay yourself; outpatient expenses typically arise from treatment which doesn't require an overnight hospital stay).

Most plans at this level cost between €1,200 and €1,375 per adult, or between €1,435 and €1,600 per adult if you'd like cover for a private room in a private hospital. However, these plans do not suit everyone so before buying one, be sure to review the benefits in detail to ensure that your needs are met.

For example, there may be an excess for every admission to a private hospital or a shortfall on cover for certain orthopaedic procedures. Typical corporate plans in the market now include the PMI range from VHI; the Simply Connect schemes from Laya and the Health Plans from Irish Life Health.

I can't afford private health insurance but am hearing a lot about health cash plans - which are much cheaper.  Are they worth considering for a young family of two adults and two children with no health insurance in place at present?

Jack, Trim, Co Meath

Cash plans are definitely worth considering either on a standalone basis, or to complement existing private health cover, if you are looking for good coverage for your everyday outpatient (treatment which doesn't require an overnight hospital stay) expenses. They are available from most health insurers. However, the main provider is HSF Health Plan (HSF) and it offers a range of plans to suit individuals and families.

Cash plans are not a substitute for private medical insurance as they do not provide full cover for inpatient (treatment which requires an overnight hospital stay) expenses. However, for those looking to cover outpatient costs, they provide excellent overall cover. Most cash plans cover expenses such as GP, physiotherapy, dental, optical, consultants' fees, alternative treatments, radiology and pathology tests to name a few. For certain benefits such as GP, dental and optical, there is no pre-existing exclusion - that is, if you join today and you have treatment immediately after joining, you can submit a claim for such treatment after three months.

The HSF products are very simple and easy to understand. You can claim as-you-go and there are no annual contracts. One of their most popular family plans is the Family Direct A (FDA) scheme, which costs €746 for the year for the entire family. On this plan alone, you can claim up to €500 for any dental or optical expenses; up to €190 for GP visits; €680 for specialist consultations; €350 for physiotherapy and €440 for medical tests. The FDA scheme also gives cash allowances for day-case procedures (surgery completed during the day) and overnight stays in hospital.

My dentist has advised me that I will need extensive dental treatment over the next two to three years. Is there any policy that I can join to cover these costs?

Niamh, Dingle, Co Kerry

Everyone knows just how costly dental treatment can be and that limited coverage is available on most health insurance policies. For this reason, we now see more and more consumers opting for dental plans.

The two main providers of dental insurance are DeCare Dental and Vhi Healthcare with DeCare being the only specialist dental insurer in Ireland.

Both offer a selection of plans for consumers and company schemes - with DeCare offering the broadest choice of products. VHI offers an additional discount on its dental cover if you already have your health insurance with them.

A typical quality dental plan will provide the following coverage: full cover for two dental exams per person per year; 70pc cover for basic treatments such as fillings and extractions; 60pc cover for major treatments such as root canal, dentures and crowns (though limits apply here); and limited cover for orthodontics (though there is usually a lifetime benefit payable once only per person on the policy).

As with all insurance, waiting periods apply. The cover for dental examinations is immediate with no waiting periods whatsoever.

Basic treatments are usually covered after three months; major treatments after 12 months and there is normally a waiting period of up to two years before the orthodontic benefit commences. Both providers have a network of dentists where the benefit will be paid directly to them on your behalf.

Some plans you could consider include DeCare's top level 4 Health Smiles plan (which costs €1,100 a year for a family of four) or VHI's Dental Plan Plus (which costs the same family €1,006 - excluding any loyalty discounts).

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.

Health cover analyst at Totalhealthcover.ie

Sunday Indo Business

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