Health Insurance VHI Renewal for my folks. Changing from HealthPlus Acccess to a Corporate Plan.

L

Lornzer

New Member
Messages
4
I can't believe how confusing VHI have managed to make choosing a plan. No wonder older people have been rolling over their plans for years and just accepting the increase in their premium! Their renewal is nearly 4.5K which seems way too much.
I've been looking at the following Corp Plans ( PMI 3513 @ €1366 and PMI 4115 @ €1519 From what i can deduce PMI 3513 is the same as 4115 but just with slightly higher excess on various claims.
I'm trying to figure out whether these plans have full orthopaedic cover but its not clear and also what Level 2 refers to within In-patient cardiac FPPs (Fixed Price Procedure) means. Is is that you're paying for a semi-private room? Both PMI plans cover FPPs Level 1 in Private 3 and 4 hospitals like the Beacon and Blackrock and paying for a private room is definitely not priority.
Both parents are 80 years old, one with early stage Dementia (seems to be covered perfectly within the Public System as he spent 4 weeks in the Mental Health Unit in Sligo a few months ago and all follow up care is free so i'm more concerned about small operations, hip replacements and strokes/heart disease.
Again any advise or signposting to another plan would be much appreciated.
 
Hi Lornzer,

Making sense of plans is confusing across the board, this mostly suits the insurance companies.

In terms of the confusing jargon I hope I can help. Firstly both those plans you mentioned provide 80% cover for the special orthopaedic procedures and opthalmic procedures (hips, knees, shoulders). Your parents would be billed the remaining 20%. In order to keep business after the recession it often used to be the case that private hospitals would waive this 20% fee but I'm not sure if this is still actively the case.

Fixed price procedure is a VHI term for what's often listed with the other insurers as special procedures. It's a large list that contains mostly the more complicated and expensive surgeries. Eg. Spinal surgeries, certain cancer removal procedures, brain surgery etc. Due to the more complicated nature of these procedures and the risk for complications there would have often been unpredictable billing due to extend stays at hospital, tests etc. As a result VHI agreed this list with insurers whereby the price for the procedure is fixed regardless of having to stay extra nights etc. I have previously requested this list and got it posted out to me and I believe as a VHI customer you do have the right to do so however some people on this forum have previously stated they were denied it.

In terms of FPP level 2, this refers to very specific Cardiac surgery that's done robotically. It's apparently very expensive and only used for people who are unsuitable for open surgery. It seems only the most expensive of VHI plans cover this. Just for clarity the FPP levels have nothing to do with the room type covered. That's covered in the top section of the table of benefits under private 1,2,3 or private 4 hospitals. Both plans fully cover semi private rooms and partially cover private rooms in private 1,2,3 hospitals. Private 4 hospitals are covered for day cases and partially covered for in patient stays.

At the age of 80 the problem becomes suitability for procedures. Private hospitals are great at elective care but not so amazing handling complex issues if there are complications etc. That said major private hospitals have ICU units these days but usually no trauma unit. Sometimes at this age the private hospital consultants refer you to get the procedure done in a public hospital anyway because of these extra services required. It can be hard to foresee this as it's very much on a case by case basis but going privately still usually ensures faster access to diagnoses/consultants on an outpatient basis so could still be very worth having for that.

If full cover is required for hip/knee operations it might be worth your while to look at Laya. A select number of their plans cover 5 common hip/knee procedures fully. They are vague about shoulder or opthalmic procedures.

Hope this helps understand things a bit better and fire away if you have any more questions.
 
Last edited:
Starrynights said:
Hi Lornzer,

Making sense of plans is confusing across the board, this mostly suits the insurance companies.

In terms of the confusing jargon I hope I can help. Firstly both those plans you mentioned provide 80% cover for the special orthopaedic procedures and opthalmic procedures (hips, knees, shoulders). Your parents would be billed the remaining 20%. In order to keep business after the recession it often used to be the case that private hospitals would waive this 20% fee but I'm not sure if this is still actively the case.

Fixed price procedure is a VHI term for what's often listed with the other insurers as special procedures. It's a large list that contains mostly the more complicated and expensive surgeries. Eg. Spinal surgeries, certain cancer removal procedures, brain surgery etc. Due to the more complicated nature of these procedures and the risk for complications there would have often been unpredictable billing due to extend stays at hospital, tests etc. As a result VHI agreed this list with insurers whereby the price for the procedure is fixed regardless of having to stay extra nights etc. I have previously requested this list and got it posted out to me and I believe as a VHI customer you do have the right to do so however some people on this forum have previously stated they were denied it.

In terms of FPP level 2, this refers to very specific Cardiac surgery that's done robotically. It's apparently very expensive and only used for people who are unsuitable for open surgery. It seems only the most expensive of VHI plans cover this. Just for clarity the FPP levels have nothing to do with the room type covered. That's covered in the top section of the table of benefits under private 1,2,3 or private 4 hospitals. Both plans fully cover semi private rooms and partially cover private rooms in private 1,2,3 hospitals. Private 4 hospitals are covered for day cases and partially covered for in patient stays.

At the age of 80 the problem becomes suitability for procedures. Private hospitals are great at elective care but not so amazing handling complex issues if there are complications etc. That said major private hospitals have ICU units these days but usually no trauma unit. Sometimes at this age the private hospital consultants refer you to get the procedure done in a public hospital anyway because of these extra services required. It can be hard to foresee this as it's very much on a case by case basis but going privately still usually ensures faster access to diagnoses/consultants on an outpatient basis so could still be very worth having for that.

If full cover is required for hip/knee operations it might be worth your while to look at Laya. A select number of their plans cover 5 common hip/knee procedures fully. They are vague about shoulder or opthalmic procedures.

Hope this helps understand things a bit better and fire away if you have any more questions.
Click to expand...
Hi Starrynights,

I really appreciate the time you took to reply to my queries. It's really helpful and has confirmed my suspicion that most of the time they'll end up back in the Public Health System anyway. There is so little within these policies that they would ever actually use.

I suppose my follow up question would be, if i were to change to one of the PM policies what kind of money would they be charging in terms of the 20% for the likes of hip replacements. I can call VHI and see if they'd give me a ball park figure.

It also appears if you're prepared to up the excess here and there, it brings down the premium.

It really shouldn't be this hard to find what i want but clearly the insurance companies are burying the corporate plans among a a ridiculous number of plans leaving it time consuming and laborious to figure things out. It's no wonder that people are starting to pay consultants a fee to figure this out for them.

Thanks again.
Lorna
 
Lornzer said:
Hi Starrynights,

I really appreciate the time you took to reply to my queries. It's really helpful and has confirmed my suspicion that most of the time they'll end up back in the Public Health System anyway. There is so little within these policies that they would ever actually use.

I suppose my follow up question would be, if i were to change to one of the PM policies what kind of money would they be charging in terms of the 20% for the likes of hip replacements. I can call VHI and see if they'd give me a ball park figure.

It also appears if you're prepared to up the excess here and there, it brings down the premium.

It really shouldn't be this hard to find what i want but clearly the insurance companies are burying the corporate plans among a a ridiculous number of plans leaving it time consuming and laborious to figure things out. It's no wonder that people are starting to pay consultants a fee to figure this out for them.

Thanks again.
Lorna
Click to expand...
Happy to be of help. I'd still highly recommend to keep the insurance as they have presumably already paid into it for many years. They may still be able to get back a good bit out of the 50% cover for consultant fees, MRI/CT scan cover and maybe even physio etc. However 2.25k for each person appears excessive. Unfortunately those are the prices with VHI to keep full orthopedic or opthalmic cover.

It's difficult to pinpoint exactly what the 20% will cost however going by what I've read on this forum before it appears a unilateral hip replacement is around 11k - 15k and a bilateral hip replacement is around 20k - 25k. Someone mentioned before a 40k cost due to complications. So you can take it ballpark that 20% would be around €2200-€5000. A very substantial co-payment if the hospital doesn't waive it.

If you are looking to take on a little excess to reduce the premium whilst still maintaining ortho cover my advice would be to look at Laya Simply connect and Simply connect plus. They are around the same price as the VHI PMI plans you were looking at but cover the 5 Ortho procedures I mentioned before. Here is the link to the codes.

Orthopaedic | Your Member Benefits | Laya Healthcare Ireland

At Laya we look after your hips, knees & more. We are the only health insurance company in Ireland to offer specific Orthopaedic procedures.
www.layahealthcare.ie www.layahealthcare.ie
It appears they at least cover unilateral replacements, so one hip or knee at a time. You can compare them on the HIA website. When talking with Laya be sure to confirm with them about any cover they need including orthopaedic etc, they have to be open with you and assuming they've served the 5 year pre existing condition waiting period they can't penalise you for being up front in any way.

The main difference between these two plans is how much you can claim back on day to day expenses in a year. Simply connect is €500 ( so you have to spend €1000 @ 50% refund to hit that cap). Simply connect plus is €1000 max refund so up to a €2000 spend. Recently I've noticed most consultants have increased their prices. What was €200 for an initial consultation is now €250. What was €150 for a follow up is now €170. Some in demand specialists are even higher. Neurologists were €280-€350 for the initial consultation. Just to give an idea of outpatient costs surrounding surgery, you'd probably need to see the consultant once or twice before the surgery and once or twice after, with maybe a regular 3/6/12 month review afterwards.
 
Last edited:
Starrynights said:
Happy to be of help. I'd still highly recommend to keep the insurance as they have presumably already paid into it for many years. They may still be able to get back a good bit out of the 50% cover for consultant fees, MRI/CT scan cover and maybe even physio etc. However 2.25k for each person appears excessive. Unfortunately those are the prices with VHI to keep full orthopedic or opthalmic cover.

It's difficult to pinpoint exactly what the 20% will cost however going by what I've read on this forum before it appears a unilateral hip replacement is around 11k - 15k and a bilateral hip replacement is around 20k - 25k. Someone mentioned before a 40k cost due to complications. So you can take it ballpark that 20% would be around €2200-€5000. A very substantial co-payment if the hospital doesn't waive it.

If you are looking to take on a little excess to reduce the premium whilst still maintaining ortho cover my advice would be to look at Laya Simply connect and Simply connect plus. They are around the same price as the VHI PMI plans you were looking at but cover the 5 Ortho procedures I mentioned before. Here is the link to the codes.

Orthopaedic | Your Member Benefits | Laya Healthcare Ireland

At Laya we look after your hips, knees & more. We are the only health insurance company in Ireland to offer specific Orthopaedic procedures.
www.layahealthcare.ie www.layahealthcare.ie
It appears they at least cover unilateral replacements, so one hip or knee at a time. You can compare them on the HIA website. When talking with Laya be sure to confirm with them about any cover they need including orthopaedic etc, they have to be open with you and assuming they've served the 5 year pre existing condition waiting period they can't penalise you for being up front in any way.

The main difference between these two plans is how much you can claim back on day to day expenses in a year. Simply connect is €500 ( so you have to spend €1000 @ 50% refund to hit that cap). Simply connect plus is €1000 max refund so up to a €2000 spend. Recently I've noticed most consultants have increased their prices. What was €200 for an initial consultation is now €250. What was €150 for a follow up is now €170. Some in demand specialists are even higher. Neurologists where €280-€350 for the initial consultation. Just to give an idea of outpatient costs surrounding surgery, you'd probably need to see the consultant once or twice before the surgery and once or twice after, with maybe a regular 3/6/12 month review afterwards.
Click to expand...
Thanks Starrynight,

Again really appreciate your time and insights.

I'd never cancel their cover, but i know it would be big step to change providers as they've been with VHI since the year dot! I've heard about those specific plans you mention with Laya. My Mum had one of her hips done years ago and had a very mild TIA last year - when you mention serving a 5 year waiting period, would you mind clarifying what that would mean if i switched to Laya before their renewal date next month? Both parents in top tip physical health but obviously from 80 everything becomes unpredictable.


Thank you.
Lorna
 
Lornzer said:
Thanks Starrynight,

Again really appreciate your time and insights.

I'd never cancel their cover, but i know it would be big step to change providers as they've been with VHI since the year dot! I've heard about those specific plans you mention with Laya. My Mum had one of her hips done years ago and had a very mild TIA last year - when you mention serving a 5 year waiting period, would you mind clarifying what that would mean if i switched to Laya before their renewal date next month? Both parents in top tip physical health but obviously from 80 everything becomes unpredictable.


Thank you.
Lorna
Click to expand...
The 5 year waiting period is only for new customers to private health insurance in general. It refers to any conditions that existed within the 6 months prior to taking out insurance and for these there is no cover for 5 years. If your parents have been with VHI for more than 5 years, which seems to be the case by the sounds of it, than this is irrelevant. Each insurer must honour insurance cover with any other provider eg provided you've had continuous insurance cover, it's once off rather than per company.

A waiting period that may apply when switching plans, whether with the same insurer or a different company, is a 2 year upgrade period. This refers to pre existing conditions ( before switching) only and essentially means that any benefit in the new plan that is better than the previous plan you had, is not applicable for 2 years. However the benefit does apply for new conditions immediately at switching. Eg. Say your parents switched and needed to get a procedure for an existing issue from some time ago. The benefits of the new plan would be compared to the benefits they have on HealthPlus Access and anything which is better on their new plan wouldn't apply for 2 years. In that case the benefit they get would refer back to what they had on HealthPlus Access. Of course if any benefit is worse on the new plan, this does not work in reverse sadly.

From a legal perspective there are protections so that Laya can't do anything against the rules, in theory making switching easy and safe. However it's difficult to know exactly what procedure codes and treatments are covered and not covered with each provider as there are so many and often, for the expensive stuff, they'll tell you it's on a case by case basis. Best we can do is cover the big ticket items like the obvious 20% copay on orthopaedic procedures etc. As for the customer service, claim experience etc with Laya I can't say as I've never been with them. You might be able to find out a bit more about that searching on this forum. But price being equal, it appears they are offering the better cover.
 
Starrynights said:
The 5 year waiting period is only for new customers to private health insurance in general. It refers to any conditions that existed within the 6 months prior to taking out insurance and for these there is no cover for 5 years. If your parents have been with VHI for more than 5 years, which seems to be the case by the sounds of it, than this is irrelevant. Each insurer must honour insurance cover with any other provider eg provided you've had continuous insurance cover, it's once off rather than per company.

A waiting period that may apply when switching plans, whether with the same insurer or a different company, is a 2 year upgrade period. This refers to pre existing conditions ( before switching) only and essentially means that any benefit in the new plan that is better than the previous plan you had, is not applicable for 2 years. However the benefit does apply for new conditions immediately at switching. Eg. Say your parents switched and needed to get a procedure for an existing issue from some time ago. The benefits of the new plan would be compared to the benefits they have on HealthPlus Access and anything which is better on their new plan wouldn't apply for 2 years. In that case the benefit they get would refer back to what they had on HealthPlus Access. Of course if any benefit is worse on the new plan, this does not work in reverse sadly.

From a legal perspective there are protections so that Laya can't do anything against the rules, in theory making switching easy and safe. However it's difficult to know exactly what procedure codes and treatments are covered and not covered with each provider as there are so many and often, for the expensive stuff, they'll tell you it's on a case by case basis. Best we can do is cover the big ticket items like the obvious 20% copay on orthopaedic procedures etc. As for the customer service, claim experience etc with Laya I can't say as I've never been with them. You might be able to find out a bit more about that searching on this forum. But price being equal, it appears they are offering the better cover.
Click to expand...
My wife and I are in our mid seventies and have been with VHI for up to 40 years. For the past 5 yrs we are on the Health Access plan. We hear a lot about not remaining on a plan for too long as we are ending up being overcharged. Our health is generally good and we dont have medical cards. We were advised to look at PMI3613 as an alternative. We find all the terminologies etc very confusing and would be grateful for your insight as to the advisability and if our existing cover would be seriously reduced.
 
onlyonpaper said:
My wife and I are in our mid seventies and have been with VHI for up to 40 years. For the past 5 yrs we are on the Health Access plan. We hear a lot about not remaining on a plan for too long as we are ending up being overcharged. Our health is generally good and we dont have medical cards. We were advised to look at PMI3613 as an alternative. We find all the terminologies etc very confusing and would be grateful for your insight as to the advisability and if our existing cover would be seriously reduced.
Click to expand...

Hi @onlyonpaper

Understand where you are coming from but just wondering who actually advised you i.e. was it a friend, VHI or possibly a company like www.totalhealthcover.ie?

Personally I prefer VHI and in light of the customer service issues mentioned above would prefer to stay with them if I can.

Are there specific things that you don't understand? :)

There appears to be a difference of €524.61 between the plans x 2 people = €1049.22 so not be sneezed at or at the same time rushed into until you clarify your needs and the cover being provided on either plan.

Doing a comparison of the two plans you mention on the www.hia.ie gives this.

I would not be anywhere near as knowledgeable as some of our other contributors but a quick look at the comparison above would show that the room cover is similar but you would need to discuss with VHI about the 90% cardiac cover and 80% orthopaedic only in certain hospitals. That appears to apply to both plans not just one. There was talk some years ago that you could strike a deal yourself on the 80% ortho difference with places like Blackrock and they would provide the procedures with full cover i.e. they would take the hit on the 20% difference. Not sure if this still applies but you could check this out also with VHI.

The excess (the sum that you pay yourself on claims) generally appears to be €125 on the Health Access Plan and €75 on the PMI3613.

Generally the day-to-day cover (bills for consultants, doctors etc.) does appear to be better on the PMI3613 plan. There is a €100 excess on Health Access and only €1.00 on PMI3613.

Hopefully @Starrynights will wander over :) to this thread and correct me if I am wrong on any of the above. Best of luck with your move as it can be a worrying time.
 
Sue Ellen said:
Hi @onlyonpaper

Understand where you are coming from but just wondering who actually advised you i.e. was it a friend, VHI or possibly a company like www.totalhealthcover.ie?

Personally I prefer VHI and in light of the customer service issues mentioned above would prefer to stay with them if I can.

Are there specific things that you don't understand? :)

There appears to be a difference of €524.61 between the plans x 2 people = €1049.22 so not be sneezed at or at the same time rushed into until you clarify your needs and the cover being provided on either plan.

Doing a comparison of the two plans you mention on the www.hia.ie gives this.

I would not be anywhere near as knowledgeable as some of our other contributors but a quick look at the comparison above would show that the room cover is similar but you would need to discuss with VHI about the 90% cardiac cover and 80% orthopaedic only in certain hospitals. That appears to apply to both plans not just one. There was talk some years ago that you could strike a deal yourself on the 80% ortho difference with places like Blackrock and they would provide the procedures with full cover i.e. they would take the hit on the 20% difference. Not sure if this still applies but you could check this out also with VHI.

The excess (the sum that you pay yourself on claims) generally appears to be €125 on the Health Access Plan and €75 on the PMI3613.

Generally the day-to-day cover (bills for consultants, doctors etc.) does appear to be better on the PMI3613 plan. There is a €100 excess on Health Access and only €1.00 on PMI3613.

Hopefully @Starrynights will wander over :) to this thread and correct me if I am wrong on any of the above. Best of luck with your move as it can be a worrying time.
Click to expand...
Thank you so much for your reply and analysis. We dont plan to leave VHI which narrows the options. A friend of mine said that she saw PMI3613 recommended in an article in a newspaper. I will check HIA.ie for comparison but my wife in particular is wary that there is a "trap" in the terminology which reduce our cover as we are not getting any younger
 
onlyonpaper said:
A friend of mine said that she saw PMI3613 recommended in an article in a newspaper.
Click to expand...

This may be the article but it dates back to 2016 so things may have changed since then.

onlyonpaper said:
I will check HIA.ie for comparison
Click to expand...

The comparison is already shown above in my previous post. See here

For peace of mind it might be worth your while to pay the fee and have a chat with possibly totalhealthcover.ie or another similar company. Best to check it out carefully or arrange a review well before your renewal date. I've heard in the past that they and VHI can be extremely busy around renewal time which for a lot of people appears to be January.
 
Hi onlyonpaper,

Health Access at €1864 is an expensive plan. However it offers full cover for certain orthopaedic and ophthalmic procedures. The "trap" referred to by your wife is that these procedures have 80% cover on plans like PMI 36 13 or PMI 53 10. If full cover for these procedures are important for you I would proceed with caution.

If they are not an issue for you I would give serious consideration to PMI 53 10

Sue Ellen has suggested you seek advice from totalhealthcover.ie or another similar company. I think that is a very good idea particularly if you want to retain full cover for these orthopaedic and ophthalmic procedures.

I hope this is helpful
 
onlyonpaper said:
My wife and I are in our mid seventies and have been with VHI for up to 40 years. For the past 5 yrs we are on the Health Access plan. We hear a lot about not remaining on a plan for too long as we are ending up being overcharged. Our health is generally good and we dont have medical cards. We were advised to look at PMI3613 as an alternative. We find all the terminologies etc very confusing and would be grateful for your insight as to the advisability and if our existing cover would be seriously reduced.
Click to expand...
Hi,

The choice here is not a simple one as the answer. Which is the best value plan for you depends on your own health risk factor for each area of cover. Health Access is more expensive but actually has lower cover in some areas than PMI 3613. I'll try break it down.

Fixed Price Procedures:
Cardiac Level 1: HA full cover only for day case. 90% for inpatient. 3613 has full cover for both.

Cardiac Level 2: HA 90% cover. 3613 no cover.

Non Cardiac FPP: HA full cover only for day case. 90% for inpatient. 3613 has full cover for both.

Orthopedic and Opthalmic: HA full cover. 3613 80% cover.

Jargon buster:

Cardiac Level 2 refers to specialist robotic heart surgery that is only carried out for those who would be unsuitable for open heart surgery. If this relevant to you then do not move from HA. Apparently this surgery is one of the most expensive in Ireland and even a 10% shortfall will be significant but better than 0%. However for most people nearly the entirety of cardiac procedures are covered under level 1.

Orthopedic and Opthalmic refers to cataracts, hips/knee/shoulder replacements. For the later they work out at around €10-20k per replacement, therefore the 20% shortfall is around 2-4k. If you think you will need this surgery within the next 7 years do not switch to a plan with no a shortfall. The cost saving of 3613 is €524.61. It could take the guts of 3-7 years to cover the shortfall of 1 procedure.

In terms of day to day 3613 is in general superior. Especially for consultant cover as it's 50% vs €60. Initial consultant visits average around €250 these days. 50% GP cover too is better, as you don't have medical cards. It has a €1 excess vs €100 on HA. This means that if you do actually claim on day to day stuff HA can be an additional €100 more expensive than 3613 making the annual price difference €624.61 per person. 3613 has better inpatient cover for cardiac and non cardiac level 1 then HA despite being cheaper. It also has lower hospital excess €75 per claim then €125 per claim.

To try summerise:
If in the next few years you are likely to need eye, hip, knee, shoulder surgery or highly specialized robotic heart surgery, than it wouldn't be wise to switch. However, perhaps you've already had a joint replaced. Or another factor to consider around your age bracket is if you are a suitable candidate for these surgeries. Sometimes doctors reckon the risk of surgery outweighs the benefits but this depends on your own health status. If it's unlikely you'll need them than €624.61 per person is no small amount to disregard. At €1,249.22 annually, you could save it for 3 years, have nearly 4 grand in a shortfall pot between the two of you and be free to enjoy the savings in the years after on yourselves.
 
Last edited:
You must log in or register to reply here.
Back
Top