Laya 70year old woman switching to Laya from VHI

bigtom71

Registered User
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My mother is with VHI for many years and her policy is up for renewal in mid-March 2016. She has a Healthplus Excess policy and was quoted €1650 or thereabouts for the next year. I have done some research, on this site and others as well as hia.ie, and it seems that Laya offer a much better deal for far cheaper. I am just trying to find out where the pitfalls are if there are any.

What I am seeing is that the Laya simplicity scheme offers better cover pretty much all-round (slight differences in excesses, where VHI charge a flat €75 per hospital stayover and Laya charge €50 for daycase and €100 for overnights, which is not a deal breaker). As I understand it, the better cover offered by Laya - e.g. private room in a private hospital - doesn't all manifest for 2 years, but even taking that into account it is €600 a year cheaper for the same cover, and she would also have the benefit of better outpatient cover (lower excess and more of).

Looking at the Simplicity plans in Laya, I also cannot see how they are comparable. Again unless I missing something or was misinformed by Laya themselves, the basic Simplicity plan is about €1090. The Complete Simplicity plan is €350 dearer, yet the only difference seems to be a €99 drop in the overall outpatient excess. If that is the case, then the basic simplicity plan offers much better value for money. She is likely to see consultants, the dentist, etc. for outpatient but is now getting free GP care so the outpatient is not a huge deal.

My mother was in hospital over a number of issues last year and got stents and such like in the Mater Private and spent time in Bon Secours too. She has a worry that pre-existing health issues will not be covered and I need to be assured that this would not be the case. She is obviously concerned with switching but for the money involved I feel obligated to check it out further.

Is there any risk in switching or is it like changing gas providers?
Am I missing anything? Any help would be most appreciated.
 
bigtom71,

You're reading it correctly, spot on. The Simplicity basic is best value for money.

There is one difference between Healthplus Excess and Simplicity plan in relation to cardiac cover.
Healthplus Excess has 90% cover for a TAVI procedure. This is specialised valve replacement surgery by keyhole if a person is otherwise not
suitable for full open heart surgery. Note; there is very strict criteria applied to this surgery, whereby the consultant has to make a strong case
on behalf of the patient based on a case history, age, other health complications etc to get authorisation. This surgery is not done just because
a person has the cover. It is a relatively new procedure, which was added to the Healthplus range of VHI plans in 2012.
It is referred to as 'Inpatient cardiac FPPs Level 2 in the Table of Benefits.

There is no cover for TAVI procedure on Simplicity plans.

Any pre-existing conditions would be covered straight away, no waiting, as its switching from like to like cover.
Hope this explains things more clearly.

Snowyb
 
bigtom71,

You're reading it correctly, spot on. The Simplicity basic is best value for money.

There is one difference between Healthplus Excess and Simplicity plan in relation to cardiac cover.
Healthplus Excess has 90% cover for a TAVI procedure. This is specialised valve replacement surgery by keyhole if a person is otherwise not
suitable for full open heart surgery. Note; there is very strict criteria applied to this surgery, whereby the consultant has to make a strong case
on behalf of the patient based on a case history, age, other health complications etc to get authorisation. This surgery is not done just because
a person has the cover. It is a relatively new procedure, which was added to the Healthplus range of VHI plans in 2012.
It is referred to as 'Inpatient cardiac FPPs Level 2 in the Table of Benefits.

There is no cover for TAVI procedure on Simplicity plans.

Any pre-existing conditions would be covered straight away, no waiting, as its switching from like to like cover.
Hope this explains things more clearly.

Snowyb
Thanks for the quick reply. Looking at the two schemes side by side on the HIA site, there appears to be a shortfall per night on the Laya scheme for "Special procedures" but I have not had any success in finding out what these procedures might be and how restrictive the scheme is as a result. Have you any knowledge on that front?
 
Special procedures includes orthopaedic surgery - hip, knee and shoulder replacement surgery, which are all fully covered on both plans.
Apart from that information, its a very grey area to define. VHI don't give specific details, just a vague suggestion.
The brokers may have access to that kind of detail.
Aviva and Glohealth publish their special procedure lists on their websites.
Examples as follows; cover for these procedures would be subject to the details of a particular plan etc.
http://www.avivahealth.ie/privacy-and-legal/schedule-of-benefits/Special-Mater-List-1.pdf
http://www.avivahealth.ie/privacy-and-legal/schedule-of-benefits/


Then there is the waiver concessions in the Blackrock Clinic and Mater Private.
Both hi-tech hospitals have a waiver system in place since 2008, which means they are fully covering different types of surgery.
In other words, they are not passing any shortfalls onto the patient.
Blackrock Clinic would cover most surgery under this waiver system, while Mater Private would have a less extensive waiver in place.

Its as clear as mud.

Regards,
Snowyb
 
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