Health Insurance – the Basics!

Every day we advise clients across the country, and as a result we see first hand the confusion that exists around Health Insurance. Confusion reigns as consumers are researching the market coming up to renewal date, to make sure you are on the correct plan for your own needs and getting the best value for money. We often also hear confusion in relation to your existing plan and the benefits available to you. So here are a few basic points about Health Insurance that you should be aware of.

What is private health insurance?

Private health insurance is insurance that covers all or part of any medical and hospital costs that you might incur. Other benefits may also be provided as part of your policy. For example, you may qualify for money back on day-to-day benefits such as G.P, dentists and physiotherapists. You may also be covered for maternity benefits and to cover the cost of the likes of MRI, CT and PET-CT scans.

There are a few main benefit areas of Health Insurance, which are explained below.

In-patient Cover

This is treatment that is received during an overnight stay in hospital, or treatment received during a hospital stay in a day care bed that does not include an overnight stay.

In these cases, there is a direct settlement agreement in place between your insurer and the hospital. This means that all you have to do is complete a claim form and the hospital will send the claim to your insurer who then pays the hospital directly. If your plan carries an excess or a shortfall, you will be required to pay this to the hospital yourself on the day of treatment.

It is very important to make sure you contact your insurer prior to having the procedure carried out to make sure you are covered. They will also be able to advise if an excess or shortfall will apply.

With well over 300 plans now available in the Irish market and all of them offering different benefits, it has become very difficult to know what you are covered for if you need to have a procedure carried out. So check with your health insurer or call LFS before you go to the hospital.

Health Insurance plans start at a basic level offering cover in public hospitals only. Some people opt for mid-range plans that will give you cover in a private hospital, while some choose “gold plated” plans that will cover hi-tech hospitals, for example the Beacon Hospital, Blackrock Clinic & Mater Private. The higher up the levels you go, the greater the cost of your Health Insurance.

The majority of policyholders tend to be on mid-range plans. Although these do not offer full cover in all areas, they do however provide a certain level of cover in public hospitals, private hospitals and hi-tech hospitals.

Over the years we have seen the Health Insurers becoming more and more competitive and introduce new and innovative plans. In order to ensure these plans are more competitively priced and are a lot more affordable, excesses are a feature on many plans and in some cases cover is restricted to selected hospitals to keep costs down.

It is important to be aware of the benefits attaching to your chosen plan, and what you risk losing if you decide to switch your cover. Don’t make your decision on price alone, instead talk to us before making any decision so that we can make sure your plan will continue to offer you the cover you need.

Out-patient Cover

This is treatment which does not involve an in-patient stay in hospital or day care procedures, and includes the likes of consultations, radiology and pathology etc.  You pay these fees to the hospital directly and then send the receipts to your insurer at your next renewal date. Your insurer will refund you a portion of these fees once you have reached your out-patient excess. Again this cover varies between plans, so talk to us before you switch plans so that you fully understand any changes in your benefits.

Day-to-day benefits

This benefit covers medical expenses incurred when seeing a doctor/specialist in their own rooms or practice e.g. physiotherapy, GP visits or osteopathy. If your plan includes day-to-day cover, usually you can only claim for a portion of the cost of the visit to your practitioner. For example, a GP’s visit may cost €55 but you may only be allowed to claim €20. Again an excess will often apply and again this benefit varies from plan to plan so talk to an expert before switching your cover.

As you can see from this brief overview, there are lots of moving parts to finding the right health insurance plan for you and your family. But that’s what we’re here for. We understand all the plans in the market and can guide you safely through the maze to find the right plan at the right price for you.


26th August, 2014

Posted In: Health, Insights