Health Insurance Are health insurers obliged to notify you of reductions to the cover provided?

Brendan Burgess

Brendan Burgess

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I just got my Laya renewal .

Flex 500 Explore which I have had for a few years. Great policy. Covers all the hospitals including the hi-tech hospitals. I choose a big excess - €500 per in-patient stay.

I was about to just let it renew automatically, when I decided to check the cover.

I see "Blackrock Clinic and Mater Private: No cover". Surely they should be obliged to highlight any reductions in cover?

I would be raging if I had renewed this automatically and then found I needed the Blackrock Clinic to see that it was no longer covered.

I don't think that the following letter covers it.

Brendan

upload_2017-12-22_11-55-10.png
 
If there is a change in wording to an endorsement on a motor or home insurance policy, or a new endorsement is added, you must be notified. I'm surprised (and not in a good way) that the same does not apply here.
 
Brendan


Regarding the renewal letter from Laya, the ombudsman was dealing with this type of issue, making sure the customer was fully informed
upfront on the relevant details and not having to dig deep to access information. One of the problems at the time was the provider
recommending an alternative plan which was not equivalent to the current plan. They were notified about this kind of behaviour towards the
unsuspecting customer. It seems they're up to their old tricks by not highlighting certain information directly to the customer.

Regards, Snowyb
 
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I got a similar email regarding my plan but when I logged in to read the renewal documents in the member area, there was a very clear flyer with the changes in terms of benefits/conditions etc. I agree it should be more obvious however.
 
Thanks Snowy

I have asked the Codes section of the Central Bank what obligations health insurers have.

I presume that they will respond "We can't discuss the affairs of regulated entities"

I think it may be in breach of the General Principle
2.6 makes full disclosure of all relevant material information, including all charges, in a way that seeks to inform the customer;
 
Hi Brendan,
When you login to see your renewal documents, is there a document that specifically calls out any wording changes since your last policy renewal?
 
Its penny-pinching. Or rather euro-pinching. Dr Pippa Malmogram (I think I have spelled it right) gives some account of it in her theory of 'shrink-flation', charging the same price for goods and services but reducing the amount of product or service, instead of increasing prices.
You know my views about the banks, the insurance industry is another chronically diseased sector.
 
TheBigShort said:
'shrink-flation'
Click to expand...

Good point. I will refer to this in my complaint.

It's one thing to find your Cadbury's Dairy Milk reduced from 140g to 120g, it's quite another to show up for a hi-tech medical treatment to find that you no longer have the cover you thought you had.

I think that this will cause them huge problems when people find that they no longer have the cover which they thought that they had.

If they have developed an illness in the meantime, will that mean that they will be limited in upgrading their insurance policy?

Brendan
 
Hi Bazza

I got the stuff by post rather than online.

I got the following documents:

1) A long two page letter, an extract from which is above. Look at the Important Information Box. No mention of a significant reduction in cover.
2) A one page membership certificate with the amount due
3) A two page Benefit Description Table - this does say "Blackrock Clinic and Mater Private" : No cover
4) A ten page Renewal Check-Up booklet - which you have referred to above. On page 3 under the heading "Benefit Changes" it lists out all the policies which no longer have cover for the Mater Private and Blackrock Clinic

In no 1) above and in no 4) , they highlight in colour the wonderful "New and Exclusive Benefit" called "Healthcoach"

A much more significant change is the fact that the two hi-tech hospitals are no longer covered and they should highlight this.

This is the most important information. Most people will miss it because they renew automatically. There are a total of 15 pages. That is information overload. I would consider the changes "buried" in this.

Brendan
 
This is just another example of abysmal regulation by the Central Bank. SBarrett has explained this many times. Shocking but not surprising.
 
Dan Murray said:
This is just another example of abysmal regulation by the Central Bank. SBarrett has explained this many times. Shocking but not surprising.
Click to expand...

I can only agree 100%

I remember trying to get the detail of what my health policy covered in terms of specific operations covered, and I could never get anything other than generalizations from them. Same with getting a breakdown of hospital charge to the insurance. Same with getting charged as a private patient when admitted as a public patient (this was before the rules changed).

I was also advised to treat the health insurance plan much like car insurance in that you need to re-examine it each year as if its a new plan.
 
I just wonder how many people out there could possibly have the time to read the 15 pages of blurb sent out to customers each year let alone attempt to understand it. I check the benefits section with OH and highlight pen in hand to track the shrink factor.

Now the next thing is do we decide to try to hold or upgrade the benefits we have but I cannot predict the future. I have a complete blind spot where health insurance/health services are concerned and have only ever had 3 very minor claims in my life, so I depend on a very helpful and wiser friend to guide me.

There must be a better way to give us the updates in brief in layman's language
 
Even their agents can no longer advise without referring to their computer system. Its too complicated even for them, and there are too many plans to choose from.
 
Hi Brendan. Thanks for highlighting this change. I had not spotted in the renewal paper work and would have just done renewal.

Laya offer a control 600 connect on member renewal and its cover Mater and black. rock.

I got through to Laya and they confirmed that I retain Mater and black rock going to control 600 connect. It’s more expensive and higher excess but I would rather keep cover.

I expressed disappointment at the change and that it was not flagged clearly and your post was only reason I was aware but it will no doubt fall on deaf ears

Regards
 
Hi Zenith

Glad you are noticing it now, and not when you are going to make a claim only to find you are not covered.

It might be worth sending them a formal letter of complaint and cc'ng it to the Central Bank.

This serves no one. Laya will face a barrage of complaints to the Ombudsman when people are refused cover.

Maybe they calculate that the cost of complaints will be less than the claims cost saved.

Brendan
 
I got this reply from the Central Bank

The General Principles of the Consumer Protection Code 2012 provide that a regulated entity must ensure that in all its dealings with customers and within the context of its authorisation it “makes full disclosure of all relevant material information…in a way that seeks to inform the customer”. Provision 4.1 of the Code provides that “key information must be brought to the attention of the consumer” and that “the method of presentation must not disguise, diminish or obscure important information”. ‘Key information’ is defined in the Code as “any information which is likely to influence a consumer’s actions with regard to a product or service”.


The issue has been passed to our Insurance Supervision teamin the Consumer Protection Directorate for consideration.


It is worth noting that in 2016, the Central Bank undertook a themed inspection of the renewal of health insurance plans. The themed inspection found that annual renewal notices do not provide sufficient information to consumers to make informed decisions about their health insurance. As a result of the inspection, the Central Bank introduced a number of additional protections for consumers when renewing their health insurance policies. Health insurance providers are now required to:

· Encourage consumers to make contact with the provider to ensure the provider assesses if there are more suitable policies available, and

· Clearly explain to consumers that their policy will auto-renew if they do not contact their insurer prior to their renewal date.


Health insurance providers must now include an information box in their renewal notification letter to encourage customers to contact their health insurer and discuss their health insurance needs each year rather than let their policy auto-renew.
 
That's the Important Information box you pasted at the top?
Every year I hear the experts on the radio telling us to switch plans & save and every year I contact my insurer to ask what other plans have comparable cover. And every year they tell me that there's no better option than the one I'm on :rolleyes:
So encouraging customers to contact them has proved fruitless for me anyway. I get more info on here!

Will be interesting to see if the Insurance Supervision team agree think that Laya provided the key information clearly about Blackrock Clinic & Mater Private cover being dropped
 
It wouldn't be rocket-science to list changes on an A4 page from one contract to the next, with a heading like 'what's changed?' This way Laya & consumers could avoid misunderstandings going forward. One would have to wonder why companies don't do the right thing up front, perhaps for a short-term gain. In motor insurance (not sure if it applies to health) the customer is bound by a principle of 'utmost good faith' to disclose all relevant information which might affect the rating or acceptance of the contract. This obligation surely should cut both ways, and should apply to this critically important contract.
 
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