Laya Advice please on "pre existing condition"

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redwood park

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Hi. My husband went for a health check 14 years ago. He had no symptoms. It was discovered he had small blockage in artery. He was sent to heart Consulant who prescribed Lipitor which he takes every day. He has had no problems with his health since. He went for check up this week to the same consultant. He had a stress test which consulant was not happy with. He is arrranging an angiogram and may or may not have to have a stent inserted. This will be done in Blackrock.

We have SIMPLICITY plan with Laya since December 2016. Before that we had ZEST STAR with Glo Health.

My question is, even though he has had no problem at all in 14 years, will this be treated as a pre existing condition.

Zest star does not show on HIA so I presume it is discontinued. I cannot compare cover in Blackrock.

Thank you for your time
 
redwood park,

The following links show both Simplicity and Zest Star plans.

[broken link removed]

[broken link removed]

Under hi-tech hospital cover(Blackrock Clinic) heading, both plans are similar re cardiac cover.
So, if the stent procedure is done, as an inpatient(no excess) or day-case(50 excess), this is fully covered on both plans.

I'm not sure if an angiogram is carried out as a day case procedure or under radiology heading, you would need to clarify this with Laya re cover.

There is no waiting involved as the two plans have similar cardiac cover in hi-tech hospitals, so it makes no difference if it is a pre-existing
condition or not.

Snowyb
 
Snowyb.

Thank you so very much for your very prompt reply.

The angiogram is a day procedure and fully covered. If a stent is required he will be in overnight. There will be an excess charge of 175 Euro per night. I will negotiate that with Blackrock.

We need to renew on 1/12/2017. We are thinking of staying with Simplicity or would you advise otherwise?

Thank You
 
Blackrock Clinic have a very good waiver system in place, whereby they don't pass shortfall charges onto the patient for a wide range
of surgeries. For example, some plans have a 2000 co-payment for cardiac and orthopaedic surgeries which Blackrock Clinic don't charge
the patient. I know someone who had major heart surgery recently, in Blackrock Clinic, and the shortfall 2000 was waived.
I don't see any problem in that regard.

Simplicity would still be best option at the moment.

Regards, Snowyb
 
Hi Snowyb. Me again.

Thankfully everything worked out well for my husband. He did not need to have the stents so he was just a day patient.

I now have a question about myself. I was diagnosed with Osteoarthritis in 2015. I have been attending a consultant in Santry Sports Clinic occasionally since then. I had Zest Star insurance with Glo Health at that time. We switched to Simplicity with Laya December 2016 and renewed in Dec. 2017.

My knee has deteriorated and needs to be replaced very soon in Santry Clinic. I see from the details of Zest Star, which you sent me, that Orthopaedic had an excess of 100 Euros per night plus 2000 Euros co-payment.

Simplicity has full cover for orthopaedic. Am I right in thinking I will be liable to pay extra charges as it is only 1 year since we switched and is also a pre existing condition Do you know if they have a waiver system in Santry Clinic.? Any advice would be appreciated.

Regards,
Thank you.
 
redwood park,

Regarding Santry Sports Clinic, I have heard of people having hip or knee replacement surgery and not being charged the 2000 co-payment.
I'm not 100% sure at the moment what their policy is in this regard.
It would be well worth enquiring about the upto date position, mention that you know of people who were not charged or that you are
considering Blackrock Clinic for a second opinion as they don't charge the 2000.
Strictly speaking, they can charge the 2000 co-payment as you must be 2 years on the new plan to avoid it but its at the discretion of
the hospital whether they waive it or not.

Best of luck,
Snowyb
 
Thank you Snowyb. I rang and I was told to put in my request for waiver in writing. I am awaiting a reply. Regards
 
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