VHI out-patient claim: apply within 3 months of the end of the insurance year.

[Lane7]

I recently submitted out-patient claims for 2009 and 2010. I have received a letter to say that they will not process them as I did not apply within 3 months of the end of the insurance year. Unfortunately I didn't read the Member's Handbook. Is there any way around this?

[Sue Ellen]

Never heard of this before. What plan do you have and where does it state on their terms and conditions that one needs to apply within 3 months.

[NovaFlare77]

Originally Posted by Sue Ellen

Never heard of this before. What plan do you have and where does it state on their terms and conditions that one needs to apply within 3 months.

Rule 9(e) of their terms for Hospital Plans and Lifestage Plans sets out how to make an out-patient claim and says it must be done within 3 months of the end of the year (i.e. membership year). The oldest rule book I can find online, from April last year, has this but I know it's been there for a while, and there's a post on boards.ie from March 2009 from someone on HealthSteps having the same problem.

OP, can I ask when your VHI renewal is? I don't think there's anything that can be done for the 2009 expenses at this stage. But if you're just outside the three month limit for 2010, then maybe you can ask them to reconsider as a once off. Can I also ask what your plan is? If it's one with a high out-patient excess it may not be worth your while chasing it up, especially if it's only a few receipts.

In any case, if you're a PAYE worker, you'll be able to claim tax relief on certain medical expenses going back 4 years.

[Sue Ellen]

Perhaps I was confusing it with the tax relief but I can't recall ever rushing myself with the claim or having it turned down. 3 months seems such a tight timescale for claiming.

[pj111]

I can remember VHI used to pay claims going back a couple of years and I would imagine most subscribers or potential claimants are unaware of this worrying development.

Not sure about Quinn but Aviva will allow claims going back a couple of years.

Patrick

[chrisoz5]

Originally Posted by Lane7

I recently submitted out-patient claims for 2009 and 2010. I have received a letter to say that they will not process them as I did not apply within 3 months of the end of the insurance year. Unfortunately I didn't read the Member's Handbook. Is there any way around this?

I got this letter from them too much to my horror, anyone have any luck with getting them to accept the recipts?

My insurance is up for renewal with them next week too.

[pj111]

Try calling them up and cancel your policy. Say you are switching to Aviva or Quinn and tell them why. If they want your business, they might pay the claim.

All the insurance companies are tightening up their t&c's.

VHI do not let you change plan, cancel plan and insist on claims to be made within 3 months of renewal date (or cancellation at renewal date).

Word of warning, start reaing the small print of the rules pertaining to your plan.

One further thing is that if you have always sent in receipts later than 3 months you could mention that to them - although not an excuse I know.

Let us know how you get on

Patrick

[suzie]

Good to know,

As I've jumped from provider to provider, from remember:

Aviva: Within the 3 months
Quinn: No timeline (though I'd say within reason)
VHI: as per above it seems (3 months)

S.

[pj111]

Aviva: Day-to-day claims

If you are making a claim for

day-to-day benefits you
will need to settle directly with your doctor or health
care provider. You must retain your receipts. At the
end of your policy year you must call us to register
your claim. After this call you must send all receipts to
us to ensure that we can reimburse you for all eligible
treatment.
Please ensure that all original receipts state:

•

the full name of the member receiving treatment,

•

the type of practitioner that you attended,

•

the date the treatment was received and

•

the name, address and qualifications of the
practitioner providing the care on the practitioner’s
headed paper.
In the case of claims for prescriptions please provide
a copy of the form marked ‘prescription claim form’
issued by your pharmacist.
All receipts must be sent to Aviva Health Insurance
Ireland Limited, PO Box 764, Togher, Cork, within 3
months after your renewal date.

Please note:

a benefit cannot be claimed as both an

out-patient benefit

and a day-to-day benefit.
Receipts used to claim day-to-day benefits will not be
returned following assessment of your claim.
Therefore we recommend you retain copies of your

receipts.

VHI: Day to day claims: The benefit payable for each treatment type is outlined in your Table of Benefits sent to you at renewal and in accordance with the Rules - Terms and Conditions available at

www.vhi.ie or on request.

Your claim must be submitted within 3 months of the end of your annual contract.

Please note that an annual excess will be applied to each member’s claim. The amount of the excess deducted will depend on the cover

held by the member at the renewal date prior to treatment.

QUINN DAY TO DAY CLAIMS: How do I claim?
It's easy, please complete an out-patient claim form and return it with your original receipts to - QUINN-healthcare, Eastgate Road, Eastgate Business Park, Little Island, Co. Cork.

[askU]

Re: VHI Company plus:

e) Day-to-Day Medical Expenses cover
• We will pay benefits for eligible expenses listed in Sections 9 and 10 of your Table of Benefits which are subject to an excess as a lump sum at
the end of each year. However, if you have large expenses during the year, you may submit up to a maximum of one claim per quarter (based
on your renewal date and subject to the relevant waiting period). We will only pay the benefits when you send us a claim form which you have
completed and signed, together with receipts. You must do this within three months of the end of the year.

https://www.vhi.ie/pdf/products/comp...ules_Apr10.pdf

It doesn't say 'at the end of your contract'; so I presume that its ok to submit during Jan, Feb, March ?

[huskerdu]

Originally Posted by askU

Re: VHI Company plus:

e) Day-to-Day Medical Expenses cover
• We will pay benefits for eligible expenses listed in Sections 9 and 10 of your Table of Benefits which are subject to an excess as a lump sum at
the end of each year. However, if you have large expenses during the year, you may submit up to a maximum of one claim per quarter (based
on your renewal date and subject to the relevant waiting period). We will only pay the benefits when you send us a claim form which you have
completed and signed, together with receipts. You must do this within three months of the end of the year.

https://www.vhi.ie/pdf/products/comp...ules_Apr10.pdf

It doesn't say 'at the end of your contract'; so I presume that its ok to submit during Jan, Feb, March ?

that is interesting. on the claim form and on other documents, it clearly states "within 3 months of the end of your contract".

Sounds like a error on their part to use ambigous language. You could use it as evidence to try to get them to pay a claim , but I dont know if legally they would have to pay it.