Organization : The Health Insurance Authority
Type of Facility : Fixed Health Insurance Cash Plan
Country: Ireland
Website : https://www.hia.ie/consumer-information
Fixed Health Insurance Cash Plans:
These plans provide fixed monetary amounts for a range of medical events, but unlike inpatient private health insurance plans, the benefits payable are not linked to the costs incurred in hospital as a private patient.
Related : HSE Health Service Executive Apply For Medical Card Ireland : www.statusin.org/7166.html
For example, a cash plan might provide you with an amount per day spent in hospital, but this amount will not be linked to the costs incurred whilst in hospital.
Some plans provide:
** Monetary amounts for out-patient expenses such as GP or physiotherapy visits.
** Monetary amounts per day spent in hospital.
** Some policies may provide personal accident cover.
Rules surrounding waiting periods, switching and upgrading of your plan are governed by the same legislation that applies to inpatient health insurance plans. See our Consumer Information section for more details.
Benefits and prices of all health insurance cash plans available on the market can also be easily compared on our comparison tool at www.healthinsurancecomparison.ie
Please see the following FAQs for further information:
Who can provide me with a health insurance cash plan?:
As of 1 January 2014, HSF Health Plan, Laya Healthcare, GloHealth and Vhi Healthcare.
Will my age affect my insurance premium?:
No. The health insurance system applying in Ireland is called community rating. In a community rated system everyone pays the same premium for a given health insurance plan, except in the following circumstances:
** Children, where the premium must be no more than 50% of the policy holder’s premium.
** Full time dependant students under the age of 23, where the premiums may be reduced. The reduced premium must not be more than 50% of the adult policy holder’s premium.
** Members of group schemes, where the premium may be reduced by up to 10%.
Will my health insurance cash plan cover my consultant’s fees?:
Health insurance cash plans allow the consumer to claim for a proportion of some expenses, such as GP and physiotherapy visits and consultant’s visits on an out-patient basis. Consultant’s fees incurred as part of a hospital stay are not covered by health insurance cash plans. Consumers should check their policy to determine the extent of cover offered by their policy.
What kind of maternity benefits should I expect?:
Cash plans may provide benefits such as:
** A monetary amount per day spent in hospital
** A birth/adoption grant
You will not normally be able to claim under the maternity section of your contract until you have served a waiting period.
How do I work out my claim for out-patient expenses?:
For all insurers you will have to pay for the treatment first, keep a receipt and claim either at the end of your policy year or during the policy year depending on your policy’s terms and conditions. Features of this cover often include the following:
** There is often a maximum level of benefit that is paid in relation to out-patient cover.
** Usually, you can only claim for a portion of the cost of the visit to your practitioner. This is called the ‘allowable expenses’. For example, a GP’s visit may cost €50 but you may only be allowed to claim €20. The €20 is the allowable expense.
What is an exclusion?:
Health insurance cash plan contracts normally have a list of exclusions, which are circumstances under which the insurer may not pay a claim. For example:
** Treatment received during waiting periods.
** Treatment arising from self-harm of self inflicted injuries.
** Treatment which, in the view of the insurer’s Medical Director, is considered experimental or not medically necessary.
** Plastic surgery.
The above is not a comprehensive list of exclusions. Your contract may include some or all of the above, which will be set out in your contract details. You should review these carefully.
What kind of cover do I want?:
Most health insurance cash plans offer significant out-patient benefits. Monetary amounts towards stays in hospital and personal accident cover may be offered. Out-patient benefits are also provided by some plans that cover hospital in-patient costs, so it may be useful to also consider these plans. If you already have a health insurance plan from Aviva, Quinn or Vhi you may wish to check your current level of hospital and out-patient cover to ensure you are not duplicating your cover.
How much could I benefit?:
Sometimes it can be difficult to gauge the value that a benefit can provide, especially when it involves excesses, allowable amounts and maximum claim amounts. It might be useful to consider how often you would expect to make a claim under a particular benefit and work out whether it makes financial sense to opt for this benefit in your policy, based on the number of times you would claim.
How much risk am I willing to accept?:
You may choose a policy with a small amount of cover, thereby taking the risk that you will not require an unusual amount of visits to say, your GP or physiotherapist, but allowing you to pay a lower premium.
Can anyone buy a health insurance cash plan?:
Yes. All applicants for health insurance cash plan cover must be accepted by the insurer, regardless of ther health status or age. However waiting periods may apply before benefits can be claimed.
Which product offers the best value for my circumstances?:
After considering all of the above, as well as any other factors you feel are relevant, you should look at all the plans that you consider are suitable for your circumstances. You should then consider the differences between the plans and decide whether the differences in benefits provided are worth the differences in premium.
Can an insurer refuse to sell me a particular plan?:
No. An insurer must sell you the policy you request.
I have a medical condition. Do I have to serve additional waiting periods before I am covered for this?:
If you are taking out a health insurance cash plan for the first time and have a pre-existing condition, the health insurer may impose a waiting period in respect of cover for treatment of this condition.
Currently HSF Health Plan apply the following pre-existing condition waiting periods:
** 5 years, for a person who is under the age of 65 years.
** 10 years for a person who is 65 years or over.
These waiting periods may apply from the date of policy commencement. It should be noted that whether or not a condition existed at the time that an insured person began serving a waiting period is decided on the basis of medical advice. Whether or not the insured person was aware that they had the condition at the time that they started serving the waiting period may be considered not to be relevant by the insurer. If this matter is important to you, you should consider clarifying it with your insurer.