Friday 21 September 2018

Your Questions: What is the best cover for a back condition?


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Barbara Sheahan - Health insurance expert with

Q I have had back problems for the last few years. I am now looking at changing my health insurance provider, but I'm worried they won't cover my existing back condition. Will I be penalised for changing provider and is there any policy you would recommend for people with back troubles? Peggy, Inchicore, Dublin 8

A This is the most common misconception about health insurance. People avoid switching health insurer as they are afraid they will have to re-serve waiting periods or that existing conditions will not be covered if they move provider. It is a legal requirement that insurers give you full credit for the time you served with previous providers. So, if you have not broken your cover for a period of longer than 13 weeks and are staying on an equivalent level of cover, you will be on cover immediately with the new provider. This is assuming you have served your initial waiting periods.

Most corporate plans offer good day-to-day benefits - so these are the ones that may be the most suitable for you. When you are speaking to your insurer or adviser, outline how many physio or chiropractor visits you have and ask them to find you a plan which will give you the maximum refund on these visits.

Each of the providers have strong day-to-day plans. There are many policies that will cover up to seven or 12 visits to a physiotherapist a year - if you have more visits than this, make sure you opt for a plan without a cap. Irish Life Health is the only provider to offer a 'Back-Up' programme (which provides advice, treatment and rehabilitation for people with back and neck pain) so this insurer may be worth considering for this reason.

'Back Up' connects you directly with a case manager, who clinically assesses your problem, and then develops a treatment plan. This may be as simple as giving you an exercise programme. If medically necessary, members can receive up to eight physiotherapy sessions a year for a once-off fee of €50. Irish Life Health's 'Best Ultimate Active' plan is a very competitively priced plan which includes 'Back Up' and also gives a 75pc refund on up to 26 physiotherapy visits a year.

Getting cover for Canada job

Q My son is going to Canada for two years on a working visa. I have always had him covered on my health insurance. VHI has quoted me almost €1,000 a year for international cover while he is there. Its backpacker policy is only a couple of hundred euro. Is it a good idea to break my cover for him while he is in Canada and then start again when he comes back, or should I pay for the international cover? He is a very healthy person. Cathy, Dundrum, Dublin 14

A International health insurance is specifically designed to offer a comprehensive level of healthcare to Irish residents who are relocating from their home country for a period of six months or more. It is designed for people who are studying or working abroad, and it recognises and protects any waiting periods the member has served to date. It suits all the customer's medical needs while away from home - be it routine day-to-day expenses or emergency cover and advice.

Backpacker insurance, on the other hand, is geared towards providing cover for emergency treatment while you are in another country for a limited period. It may have limits in terms of medical cover. This is more of a worst-case scenario policy - the aim of which is to get you well enough to return home. Cover ceases once you arrive back to Ireland and these plans do not protect your waiting periods.

If you would like comprehensive medical cover for your son while home and abroad, international health insurance would be the best option.

If the domestic cover is with VHI Healthcare, it will allow you to transfer to the international policy and then back to the domestic policy again - with no break in cover when your son returns from Canada. If you place him on the backpacker plan and he was in an accident or diagnosed with anything while living abroad, he would face a five-year waiting period before he is covered for this condition on his return to Ireland.

Public versus private patient

Q Is there any difference between a public patient and a private patient in a public hospital? I have health insurance which covers me for a private room in public hospitals, but these don't seem to be available. Is there any policy which will guarantee access to a private room in a public hospital? Aengus, Longford town

A Unfortunately, there is no plan which will guarantee access to a private room in a public hospital - it all depends on availability. Private rooms in public hospitals are available but are very scarce. The charging structure for public versus private patients is very different and it is extremely important that you know the difference. All Irish residents are entitled to treatment in the public system. The statutory charge of overnight and day in-patient services is €80 per day - up to a maximum of €800 per year. You have already paid for this through your contribution to taxes, PRSI and the Universal Social Charge.

The introduction of public health charges in the 2014 legislation meant charging private patients up to €813 a day to stay in a public hospital bed, often regardless of whether or not they are given private facilities or a choice of consultant.

Previously your health insurer was only charged a higher rate than that charged to the general public if you were accommodated in a semi-private or private room. Now, health insurance customers can be charged over 10 times the normal rate, despite the fact they are receiving the same treatment.

To make things worse, the private rate of €813 a night is capped at 180 nights whereas the €80 charge is capped at 10 nights in any 12-month period. The disparity of cost between the two is extraordinary - and this is having a direct impact on the premiums which holders of private health insurance pay.

If you are admitted to a public hospital through A&E, you will be asked to sign a 'Private Insurance Patient' form. By signing this form, you waive your rights to public treatment in a public hospital. Unless you are guaranteed a semi-private or private room, you have the right to refuse to sign the form - and you will receive the exact same treatment.

You may be thinking why would you want public care when you're paying so much money for insurance for private care? The reason you may want to ignore the form is the discrepancy in price between the two. Unless you know that you can be guaranteed a private or semi-private room, the treatment you will receive is exactly the same. You will pay private rates for public treatment. The vast majority of people don't realise they are being hit twice - once through taxes and once through health insurance premiums.

Another worrying aspect is that the form itself reads: "I understand that where my insurer does not cover any or part of the charges, I will be invoiced and liable for this amount". This means you may end up having to pay charges if the charges are not covered under your policy.

Remember, there's no obligation to sign the waiver form. If you have insurance and you are being offered a private room, faster treatment or a private consultant, declaring as a private patient makes sense as you are getting an additional service. However, if health insurance members continue to sign these forms without querying why they are being charged, we can expect more premium hikes to cover the cost.

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