Query: I'm in my early 30s and have ongoing back problems and so need to go to a physiotherapist regularly. However, the cost is adding up. I don't have private health insurance, but figure it would be wise for me to buy it. Is there an affordable plan which offers good cover for physio care - and would I be covered for my physio trips immediately? Aoife, Dublin 14
Answer: Irish Life Health would be a good option, as it is the only provider which offers the Back Up Programme - a programme designed to help people with back pain. You are assigned a case manager, who clinically assesses your problem and develops a treatment plan.
This may simply be an exercise programme, or it could involve physiotherapy. Members can receive up to eight physiotherapy sessions for a once-off fee of €50, if medically necessary. This can be used twice per policy year as long as there is a four-month gap in between each use.
Some good options from Irish Life Health would be any of its 4D Health plans which range from 1 to 5 (that is 4D Health 1 to 4D Health 5). If it is within your budget, Irish Life Health's Best Ultimate 2 has excellent physio cover also.
Laya Healthcare has a physio-line which gives access to a physiotherapist for expert advice. Simply Connect, 360 Care Select and 360 Care are all good options from Laya. PMI 07 10 and PMI 02 10 are two VHI plans which have very strong physiotherapy cover.
Heart condition options
Query: I'm a 35-year-old man and about a year ago I had a major health scare as a result of a heart condition which had never been detected before. I regularly need hospital treatment now as a result. I took out private health insurance a few years ago, but it's a very basic plan with a high excess. Can you recommend a reasonably-priced plan that has either no excess - or a low excess, which covers most public hospitals and some private hospitals, and which would suit someone who has a heart condition? John, Co Kildare
Answer: As you already have health insurance, you are on the health insurance ladder and therefore avoiding any lifetime community rating loading for being over 35. (Lifetime community rating is a system where those aged 35 and upwards may pay more for their premiums if they did not have private health insurance before May 1, 2015).
A good affordable plan which fully covers listed cardiac procedures in the high-tech hospitals is Laya Healthcare's Essential Health 300. VHI's One Plan 250 and Irish Life Health's Benefit plan are also affordable options which cover all public and private hospitals. It's important to note that you may have to serve a two-year upgrade waiting period. This applies when you are increasing any element of cover that relates to a pre-existing medical condition.
If you are in and out of hospitals as an outpatient (treatment which doesn't require an overnight stay), it would be worthwhile considering a corporate plan which will help toward the costs of these visits. The most competitive corporate plans available at the moment are Laya Healthcare's Simply Connect, VHI's PMI 07 10 and Irish Life Health's 4D Health 2.
Cover for couple in mid-50s
Query: My wife and I are in our mid-50s. Our private health insurance plan has quite a high excess of €500 - and excludes cover for the likes of the Blackrock Clinic and the Mater Private. At this stage in our lives, we would like to upgrade our cover to a plan which covers both the Blackrock Clinic and Mater Private - and which has a zero, or low, excess. What are the best plans with a zero or low excess and do any of these cover the Blackrock Clinic and Mater Private? Declan, Co Dublin
Answer: Cover for hi-tech hospitals falls under four categories. These are day cases, cardiac procedures, listed specialised procedures and inpatient stays (that is, overnight stays in hospital) for other procedures. If you are paying €1,200 or more per year, you should at a minimum have full cover for day cases, cardiac and listed specialised procedures. To have full cover for inpatient stays for anything else, you need to be on the highest level of cover available. These plans are extremely expensive, with the most expensive plan on the market costing over €8,000 per member per year. There is no need to pay these type of premiums - I would strongly recommend anybody paying over €1,800 a year to review their cover.
The Beacon Hospital is covered as if it were a private hospital on a number plans, as is Blackrock Clinic. Blackrock Clinic has an excellent facility called cover-check available on its website which will tell you what accommodation you are covered for there - and if there are any shortfalls in cover. While this is a great and very helpful tool, it is extremely important to ring your broker or insurer before arranging any procedures.
You will have to confirm that your procedure code and consultant are fully covered by your insurer. It's also a good idea to confirm waiting periods to make sure there are no surprises.
If you have a shortfall on cover for the Mater Private, the maximum it charges is €260 a night. This is capped at 10 nights a calendar year for oncology treatment. If you want a plan which will cover private hospitals without an excess and give certain cover for high-tech hospitals, consider Irish Life Health's 4D Health 5 or Best Ultimate 2, Laya Healthcare's 360 Care Select or 360 Care and VHI's Company Plan Extra Level 2 or PMI 42 15.
Breast cancer diagnosis
Query: I've just been diagnosed with breast cancer and have been told that I will need a mastectomy. I have no private health insurance. Do I need to get private health insurance to help me cover the cost of this surgery? Gemma, Limerick City
Answer: When you are diagnosed with a serious illness such as cancer, you will be treated as priority regardless of whether or not you have private health insurance. The advantages of health insurance is it gives you control over your treatment plan, you can select the hospital you would like to attend and the type of room you would like to be in, and it would also allow you to choose your own consultant. If you were to take out private health insurance now, unfortunately this procedure wouldn't be covered as it would be deemed as a pre-existing condition.
When you are taking out private health insurance for the first time, there is a 26-week waiting period for any new conditions that may arise, a five-year waiting period for anything pre-existing, and a 52-week waiting period for maternity. The waiting periods for day-to-day expenses vary depending on age and which provider you choose.
If you wanted to fund yourself as a private patient, this is also an option. The cost of getting a mastectomy in a private hospital as a private patient can be anything up to €10,000. It could cost €400 for the initial consultation, €4,500 for the procedure, €1,000 for the anaesthetist and €2,500 for a two-night stay in a private hospital.
If you are in the public system, a hospital and consultant will be assigned to you. Public patients are charged a statutory fee of €80 per night. This charge can accumulate to a maximum of €800 in a 12-month period.
Sunday Indo Business