Laya High Excess Inpatient w/ good everyday expense reimbursement

NY_Resident

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Hi all

My family's health insurance is up for renewal shortly and I've been doing some research on different plans. We are two adults and 3 kids (ages between 4 and 8). We're all very healthy but still manage to consistently clock up over €2,000p.a. in GP, dental, consultants, physio etc. We're currently insured under VHI's One Plan Family. This is mainly an in-patient plan, with very limited outpatient (not unless someone gets very sick given the high excess and the low reimbursement per visit limits under the plan). Our thinking in selecting this plan a few years ago was that we don't really need insurance for day to day expenses (we can afford it), and it's really the big in-patient stuff that we need insurance against.

Now, re-evaluating 3 years later, our thinking has changed. I am thinking, based on the premium pricing of different plans, that we would be better off with a plan that gives us access to the right hospitals (incl. Hi-Tech, though i'm not convinced why) in the event of the lower probability events, but also a plan which gives us better reimbursement on the high frequency events (everyday medical expenses). We would be comfortable going with a high excess on the in-patient as a way of keeping the overall premium broadly unchanged, and also recognising the lower frequency of in-patient events (that would not be in public hospitals).

Laya's Control 600 Create plan looks attractive to me. The hospital access is just as good and includes Hi-Tech. The outpatient benefits would result in successful claims for our family in excess of €1,000 per annum. The premium for the family comes to approx €2,600......net of claim refunds brings it down to €1,600 (ignoring lower Med 1 tax relief). Big downside is of course the higher excess for private hospitals of €600.....which I am ok with, but could become expensive if someone in the family needed repeated admissions to a private hospital. (Note, I live in Cork city and the main hospitals such as CUH and Mercy are public......only private hospitals are Bons and Mater)

Even if one of us needs to be admitted to hospital, there is a high likelihood of it being either CUH or Mercy where no excess applies. If it's the Bons or the Mater, we have no financial concerns with a €600 excess (even if we had multiple admissions)....albeit the hindsight of knowing that we would have been financially better off that year with a lower excess plan.

So, I have two questions for this esteemed group:

1. Please challenge me on my conclusion/logic above. What am I missing?

2. In the event of one of us getting seriously ill possibly resulting in a higher likelihood of repeated admissions to a private hospital, we could always change to a lower excess plan at the next renewal (but with broadly the same benefits except the excess). Would this be classed as an upgrade to which waiting periods would apply, or not?

3. Are there any other plans similar to this high excess plan which i should consider?

4. One alternative may be to adults on the high excess plan, and put the kids onto one of Laya's plans which offer free 2nd and 3rd children. Haven't considered this yet but would appreciate any thoughts. Prob no outpatient refunds but lower overall premium could perhaps equate to the same result...

Thanks all.
 
NY_Resident,

Your logic is correct, the only thing now is to choose suitable plans.
An alternative option to 'Control 600 Create' is 'Control 300 Create' price 1079pa per adult.

The ideal type of plan is one that has a capped max inpatient excess. So, this maximum excess stays the same, regardless of the number of private/hi-tech hospital admissions you might have per year.
The following 2 plans have this feature, worth considering;

1. Laya Simply Connect; price 1100pa; all public, private and 3 hi-tech hospitals covered; private/hi-tech excess capped at 150 x 2 max per year
for all admissions. Day case excess 50 per procedure. No excess to pay in any public hospital. Good day to day cover, 1 euro excess, refund of
50% for gp, consultants, etc - but subject to a max refund of 500 per year per person. (50% of 1000 = 500).

2. VHI PMI 07 10; price 1188pa; all public, private and 3 hi-tech hospitals covered, private/hi-tech excess capped at 150 x 1 max per year for all
admissions. Day case excess 50 per procedure. No excess to pay in any public hospital. Good day to day cover, 1 euro excess, refund of
50% for gp, consultants, etc.

3. Laya Control 300 Create; price 1079pa; all public, private(including private room fully covered), and 3 hi-tech hospitals covered,
private/hi-tech excess 300 per admission and day case excess 125 per procedure. No excess to pay in any public hospital.

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Child Options

1. Laya Control 300 Create; price 257pa per child; all public, private(including private room fully covered), and 3 hi-tech hospitals covered,
private/hi-tech excess 300 per admission, day case excess 125 per procedure. No excess to pay in any public hospital. Good day to day cover,
1 euro excess, refund of 80 per consultant visit, 30 per gp visit, etc.

2. Laya Control 450 Secure; price 261pa per child; all public, private(including private room fully covered), and 3 hi-tech hospitals covered,
private/hi-tech excess 450 per admission, day case excess 125 per procedure. No excess to pay in any public hospital. Good day to day cover,
1 euro excess, refund of 100 per consultant visit, 40 per gp visit, etc.

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The following 3 plans are included in the special offer for children, whereby you pay for the first child and the rest are free.

1. Essential Health 300; price 234pa(for all children), all public, private and Beacon hospital covered. Private excess 300 x 2 max per year for all
admissions. Day case excess 125 per procedure. No excess to pay in any public hospital. All childrens hospitals are public but the Beacon hospital
Dublin offer a list of childrens surgery fully covered on this plan.

2. Essential Connect Family; price 250pa(for all children), all public, private and Beacon hospital covered. Private excess 300 per family for all
admissions and day case procedures. No excess to pay in any public hospital. All childrens hospitals are public but the Beacon hospital Dublin
offer a list of childrens surgery fully covered on this plan.

3. Flex 125 explore; price 343pa;(for all children) all public, private and 3 hi-tech hospitals covered, Private/hi-tech excess 125 per admission, day case excess 50euro per procedure. No excess to pay in any public hospital. All childrens hospitals are public, but the 3 hi-tech hospitals cover a range of childrens surgery fully covered on this plan. These hospitals are Mater Private Dublin, Blackrock Clinic Dublin and Beacon hospital dublin.

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NOTE; If you choose a Laya plan for the children, at least one adult needs to also choose a Laya plan.

I'm not sure what family members incur the most medical expenses but you can choose different plans according to each persons
individual medical needs. The special offer for the children is worth considering, to make savings.

Regards, Snowyb
 
Thanks a lot Snowyb

Some great info here for me to dig into. Quick question on the upgrade waiting rules — do waiting periods generally apply to reductions to in-patient excesses?
 
Regarding upgrade waiting rules, yes there is a 2 year waiting time applied to reductions to in-patient excesses but only in relation to any
pre-existing illnesses. So, if you change to a plan with a lower excess, for any new illnesses arising after the switch, the lower excess will apply straight away, no waiting.

Also, re child option in your original post, 'Control 600 Create' price 232pa per child, if this is still under consideration, for 5 euro extra there is
'Control 600 Secure' price 237pa per child with extra day to day cover. Refund of 100 per consultant visit, 40 per gp visit. etc.
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Regards, Snowyb
 
Thanks Snowyb - I was just about to pull the trigger on moving to Control 600 Secure and called Laya to find out more about waiting periods etc. I have only been with VHI for 3 years and prior to that, spent many years in the USA. VHI waived the 5 year waiting period for preexisting conditions under a group arrangement with my employer. Laya won't replicate this benefit, nor will they recognise the many years of comprehensive insurance I had in the USA, prior to moving to Ireland. So looks like I would not be covered for preexisting conditions for another 2 years if I moved to Laya. So looks like I may need to stay with VHI for another 2 years.

My question for this group is:

1. Are there any VHI plans similar to the Control 600 Secure (plans like VHI's PMI 07 10 but ideally w/ higher in-patient excess and better outpatient reimbursements)?

2. Anybody have any other ideas to navigate around this pre-existing condition requirement? I understand the why, but feels harsh given that I have plenty of documentation to support my (comprehensive) insured status prior to moving to Ireland.

Thanks
 
NY_Resident,

VHI do not have similar plans to Control 600 Secure. Their plan with a high excess does not include hi-tech hospital cover or day to day cover.
It is very cheap in price and may actually suit, as the hi-tech hospitals are all Dublin based. Details as follows;

1. VHI One Plan 500; price 715pa per adult; all public and private hospitals covered. Some Beacon hospital hi-tech cover included.
Note; Mater Private Corkis classed as a private hospital for health insurance purposes and is fully covered on this plan, subject to the
inpatient excess capped at 500 x 2 max per year for all admissions. Likewise for all other private hospitals covered on this plan including
Bons Secours Cork. Day case excess 150 per procedure in private hospitals. No excess to pay in any public hospitals. Very limited day to day cover, but the overall savings will cover a lot of medical expenses.

https://www.hia.ie/comparison-tool/...Mb2NrIjpmYWxzZSwicGxhbl9kZXRhaWxfaWQiOi0xfX1d

Another plan with high day to day cover, has no inpatient excess, worth looking at to compare plans.
2. VHI PMI 38 14; price 1661pa per adult; price 530pa per child; all public, private and 3 hi-tech hospitals covered; no excess on this plan; very good day to day cover on this plan. Refund of 130 per consultant visit, 40 per gp, etc.

https://www.hia.ie/comparison-tool/...jayI6ZmFsc2UsInBsYW5fZGV0YWlsX2lkIjotMX19XQ==

VHI PMI 07 10 is a very good in between plan for adults that ticks a lot of boxes across the board.

For the children, VHI plans such as One Plan 150 - price 184per child, One Plan 250 - price 179per child, One + Plan - price 209 per child.
are worth considering. Capped excess on first two options, option 3 includes hi-tech hospital cover. Limited day to day cover.

https://www.hia.ie/comparison-tool/...Mb2NrIjpmYWxzZSwicGxhbl9kZXRhaWxfaWQiOi0xfX1d

Cover in other countries is never taken into account with any health insurance providers. VHI are waiving the 5 year wait for pre-existing
conditions as a concession as part of a group scheme.

Regards, Snowyb
 
This is really good info Snowyb - thanks a lot for sharing your deep knowledge on this subject! The One Plan 500 ticks many boxes for me. The only areas I'm not fully up to speed on are:

(1) What risk am I exposing my family to by not having access to the Dublin Hi-Tech hospitals? i.e., what are examples of conditions/illnesses/injuries which cannot be accessed within the public/private ex-hi-tech system, either at all or within a reasonable period of time?

(2) The One Plan 500 covers 60% of certain specified Orthopaedic and Ophthalmic procedures in private hospitals. From research, I think the rationale is because these services are readily available within the public hospital network, and this plan design feature is really just a way of encouraging VHI customers to use the (cheaper) public hospitals. Is this correct, or should I be more concerned here if, for example, Ophthalmic procedures are procedures which are relevant to my family?
 
1. Regarding the hi-tech hospitals, I don't know if there are any procedures or conditions which cannot be accessed within the
public/private system.
Note; there is some Beacon hospital cover on One Plan 500.
The use of the hi-tech hospitals is an advantage if you live in Dublin. If a person attends a consultant who works in both a public and hi-tech
hospital, there is the option to have surgery/procedure in the hi-tech hospital if the public hospital waiting list is too long.

This option is also available if a consultant works in both a public and private hospital.

2. The 60% cover for certain Orthopaedic procedures specifically refers to a hip, knee or shoulder replacement surgery.
The cost of this type of surgery in private hospitals is 15,000 approx so the shortfall would be 6000 on this plan.
This surgery would normally apply to older folk but I know people in their forties+ that have had it done.
The ophthalmic surgery specifically relates to cataract surgery. Again this would normally occur in older folk but there are always exceptions
to the rule.
Note; the public hospitals are not 'cheaper' than the private regarding costs. The public hospitals charge 900 per night for accommodation if
the health insurance company is paying the bill. The problem using the public hospitals is the lengthy waiting lists ie 2 years for cataract surgery.

You know what pre-existing illnesses relate to your own family. I would say you would be safe enough for the next 2 years regarding the
60% cover for ortho and cataract surgery.

Hope this helps.

Snowyb
 
I've decided to go with One Plan 500 for both adults and also for our child who is 4 (and has free GP), and the PMI 07 10 for remaining two kids....where outpatient claims have typically been high/er (and extra premium v outpatient reimbursement looks like a good deal). Thanks for all the help!
 
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