Health Insurance Pre-existing Conditions & Policies

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djtonykirl

Registered User
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Hello,

My sister (who will turn 35 in November) has recently been diagnosed with a chronic illness. The precise diagnosis is a work in progress. She does not have any health insurance currently. Given the diagnosis and additional loading for over 35s, purchasing health insurance is a top priority. I am trying to understand the preexisting conditions aspect when purchasing health insurance policies.

As I understand it, all preexisting conditions (understandably) need to be disclosed as part of taking out a policy. Once purchased, there is a five year waiting period before claims can be made against a policy. Claims for the previous five years cannot be made retrospectively.

E.g. If my sister initially purchased a plan with e.g. €40 back per consultant visit in Year 1 and subsequently upgraded to a plan with €60 back per consultant visit in Year 5, there would be a 2 year waiting period beginning at Year 5 before the €60 claim could be made. In other words, it would be Year 8 before the enhanced cover would kick in.

Is my understanding above correct? I am trying to understand what the optimal way to purchase health insurance would be for her. Especially with the double whammy of paying out considerable sums of money for consultants and procedures whilst also purchasing health insurance.

Regards and thanks in advance,
Tony.
 
djtonykirl,

Just to explain, you are half right in your thinking regarding the 5 year waiting time so its not as bad as it seems overall.
The 5 year waiting time relates to hospital treatment only, in respect of any pre-existing illness or condition.
There is no waiting time applied to day to day expenses, for people under 50 yrs of age, even if the visits relate to a pre-existing illness.
So this part of the health insurance plan is allowable from the date she takes out the policy.
Likewise, if you change plans after a year or 2, any extra day to day cover is allowable straight away, no waiting applies for under 50 years,
there is no waiting for higher day to day cover with Laya plans regardless of age.
Day to day medical expenses include outpatient consultant visits, gp visits, dental, physio etc, etc. Prescriptions are not covered.
Any consultant attended must be on an approved list of registered practitioners which is available from each health insurance provider.

The way it works is that you pay upfront for the visits and keep all receipts throughout the year until renewal date comes around and then
send in an annual claim for a refund.
The consultant refund relates only to visits to their private clinic/room. It does not cover a consultants participation in carrying out a medical procedure either in the hospital or as a day case.

For all new customers, there is an initial six month waiting time for any new illnesses that occur after you start a new health insurance policy.
During this 6 months, just accidents and injuries are covered. After the 6 months, all new illnesses arising are fully covered, according to the
level of hospital cover on the policy. The 5 year waiting time is for hospital treatment/surgery only in relation to pre-existing illnesses.

Some plans indicate how many visits to a practitioner are allowed, for example 60 x 7 consultant visits per year with VHI.
Other plans for example some Laya plans allow 50% or 75% refund with no restriction on the amount of visits per year.

The following 3 plans are worth looking at, for a new customer starting off. You could work out a rough estimate of approx refund due based
on the details of each plan re day to day medical expenses, to see which one is best suited overall.
[broken link removed]

Note; both Laya plans cover 3 levels of hospital cover, public, private and 3 hi-tech hospitals.
Be Fit 1 does not cover Mater Private or Blackrock Clinic - it fully covers a first consultant visit and 50% of a further 7 visits per year.

Regards, Snowyb
 
Hi Snowyb,

Thanks very much for your response. I did not pick up on that very important distinction based on my earlier research.

Can you clarify what the situation is with Cash Plan policies please? I would assume that these are also subject to the 5 year rule/2 years for additional cover.

Regards and thanks,
Tony.
 
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