Will my wife get maternity cover after returning home?
Your questions answered
Q My wife and I emigrated to Australia four years ago but will be returning to Ireland next month. We had private health insurance with VHI before we left but, as we've been away since 2015, we haven't had private health insurance for about four years now.
My wife is in the early stages of pregnancy and so we want to return to Ireland to have our baby there. If we take out private health insurance in Ireland when we return, will we be covered for maternity for our first child? Also, I was recently diagnosed with a heart condition which will require regular hospital and medical attention when I return home. Again, if I take out private health insurance when we return to Ireland, will I be covered right away, given that I was with VHI for many years before we left for Australia? This treatment is necessary but expensive. If my VHI doesn't cover it, will the public system?
John, Co Kildare
If your private health insurance lapses by more than 13 weeks, then all insurers in Ireland will treat you as a new member again on rejoining - irrespective of how long you were insured previously.
The waiting period for any services relating to maternity is a year and, given that your wife is already pregnant, she will not be able to use private health insurance for this pregnancy.
However, she can still use the public health system for maternity services and while there will be no private accommodation or choice of consultant, the care is good and she will incur no charges. Also, any newborn child can then be added to your private health insurance policy from the date of birth free of charge (until the next renewal date of the policy) and the child will be on cover immediately with no waiting periods to serve.
On the question of the existing heart complaint, there is no good news here either as all insurers will apply a five-year restriction to any pre-existing conditions present on you signing up to private health insurance when you return home.
Depending on the plan selected, you may be entitled to reclaim between 50pc and 75pc of any outpatient costs such as consultants' fees, GP costs and so on, even for the pre-existing condition.
During this five-year period, you will still be entitled to access medical treatment in our public hospitals for the heart condition - but you will be prioritised or triaged based on medical need, which could mean being placed on a waiting list for non-essential treatment.
Q I have been on private medical aid in South Africa for many years. If I move to Ireland, will I still have the five-year waiting period for my pre-existing conditions? I had breast cancer six years ago and need annual mammograms, scans and other tests. I also have a few other things that need six-monthly blood tests and so on - and if I have to pay for all that, I will not manage. I don't think I will qualify for a medical card.
Cindy, South Africa
Unfortunately, the full five-year pre-existing restriction will apply to any inpatient (where you stay in a hospital overnight) or day case treatment (where you don't stay in hospital overnight) for any medical condition that is present on you joining private health insurance in Ireland.
As insurers here are not permitted to apply a risk rating to a premium when underwriting a new member, the only protection they have under our community-rating system is these waiting periods.
Even if a new member holds 'gold-plated' cover while abroad, the health insurers here are not required to recognise this to provide continuity of cover.
The only possible exception is where reciprocal arrangements exist - most insurers will recognise cover through VHI International, Bupa International may be recognised by Laya Healthcare and Allianz Worldwide Care may be recognised by Irish Life Health.
On a positive note, this five-year restriction does not apply to outpatient expenses such as scans, consultations and other diagnostics. (Outpatient treatment is where you don't have to stay in a hospital overnight.)
If you join a good corporate plan, you may be able to reclaim between 50pc and 75pc of these costs immediately on joining or after six months (depending on the insurer), even for pre-existing conditions.
Q I will soon be emigrating to Dubai for a few years to take up a teaching post there. I'm worried about the impact which this could have on my private health insurance when I return. I'm in my mid-30s now and have had private health insurance since I was 25. Is there anything I can do to avoid getting hit with private health insurance loadings - or long waiting periods for cover - when I return to Ireland in five years? I've heard that some of the Irish insurers offer international plans - can I escape the loadings and avoid reserving waiting periods by getting one of those plans?
Sorcha, north Co Dublin
The good news is that you should be able to avoid any age loadings or waiting periods on your return to Ireland.
On the issue of age loadings, these will normally apply to any person who is over the age of 34 and rejoining Irish private health insurance. However, as you held continuous cover since you were 25, you will get full credit for this on your return, which should offset any loadings that may apply.
Even if you held no cover previously, there is a clause in the legislation which will give you credit for time spent abroad which can be offset against any age loadings - but only if you take out private health insurance within nine months of returning to Ireland.
On the issue of waiting periods, you may be able to avoid these on your return by switching to an international healthcare policy which is recognised by the insurers here - as long as you do this prior to emigrating to Dubai.
Essentially, you would be transferring from your domestic healthcare plan to the international plan and then switch back to an equivalent domestic plan on your return to Ireland. For example, VHI members can transfer to a VHI International plan which I understand is recognised by all health insurers here. Irish Life Health members may be able to avail of continuity of cover by transferring to Allianz Worldwide Care. Laya members may be able to do likewise with Bupa International.
While these international healthcare plans offer excellent overall cover, they may be more expensive than a domestic policy. Therefore, it is essential that all terms and conditions of the international policy are checked with the insurer prior to joining - especially regarding the continuity of cover guarantee on returning to Ireland.
Dermot Goode is a health insurance expert with totalhealthcover.ie
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