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Your personal finance questions – How can I avoid shortfalls on my health insurance scheme?


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Q I am on the Laya Care Select scheme and am due to renew shortly. I see I now have a 20pc shortfall on certain major orthopaedic and ophthalmic procedures. Is there any way of avoiding this?

A The shortfall can be avoided, according to Dermot Goode of Totalhealthcover.ie. The renewal cost will be €1,591 per adult. Mr Goode said this is still a good private room corporate plan but may no longer suit if the member wants to keep full cover for these procedures. He recommends contacting Laya and checking out the alternative Simplicity scheme, costing €1,535 per adult. This is a similar plan covering the same hospitals, up to private-room accommodation, but there are no 20pc shortfalls on these procedures on this plan. The out-patient refunds will be subject to an annual excess going forward which the reader would need to be happy with before switching. If the member does not mind taking on a slightly higher excess for a private hospital admissions, there is another alternative scheme called Connect Simplicity costing €1,415 per adult which is also worth considering.

Q I am in the process of applying for a retrofit home loan through my credit union. I read that they can help finance home energy upgrade projects. I’ve been awarded my Sustainable Energy Authority of Ireland (SEAI) grant of 35pc and I have my quote from my contractor. Must I borrow the full amount, or can I use some of my savings to offset my monthly repayments?

A There is no problem contributing some of your savings towards your upgrade costs and this is a great way to get your monthly repayments to a manageable level, according to the chief executive of Credit Union Development Association Kevin Johnson. If you are part-financing your home upgrade through your credit union, low-rate loans are available to you through the ProEnergy Homes Scheme. This is a scheme where homeowners can avail of grant finance of up to 35pc for a range of retrofit measures, including attic insulation, external wall insulation, the installation of solar panels, boiler upgrades, and upgrades to windows and doors, with the remaining cost financed either by savings, by a low-cost loan finance from your credit union (if participating in the scheme), or a mix of both. Some credit unions offer loan rates as low as 4.25pc, particularly where you have savings to “pledge” as security against your loan. For participating credit unions, an interest rate of under 7pc applies to amounts over €20,000, whereas a slightly higher rate applies to smaller borrowings. For example, if after contributing savings towards the cost, you borrowed €5,000 at 10.48pc over five years, your monthly repayments would be just €107.42, Mr Johnson says.

Q I have just taken out dental cover with DeCare Dental. Do I have to use the dentists listed on its direct pay network, or can I use any dentist? I also have health insurance and am wondering if am I over-insured?

A You do not have to rely solely on their direct-pay network, according to Mr Goode of Totalhealthcover.ie. You can attend any dentist for your treatment but the advantage of using their network is that your benefit will be payable directly to the dentist and you only have to pay the balance. If you attend a different dentist, you must pay the full amount and then claim your refund directly from the insurer. On the question of over insurance, no health insurance plan provides any cover towards major dental treatments such as orthodontics, root canal, crowns etc, Mr Goode said. If these benefits are important, he recommends you maintain some level of dental cover in addition to your health insurance plan.

Q I sent in my out-patient claim to Irish Life Health but some receipts were excluded as they weren’t submitted in time. Is this correct?

A All Irish Life Health members have a six-month window after their renewal date to submit all eligible out-patient expenses for the previous insurance year, according to Mr Goode. These receipts can be submitted either in one overall claim at year-end, or they can be submitted online using their “scan and send” facility. However, if claims are not submitted within the six-month window, they will be declined, Mr Goode said. 

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