Health Insurance Attention Laya customers: Laya has introduced 20% and 40% shortfalls on many renewals

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charlie007

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Specified Orthopaedic & Ophthalmic Procedures 40% shortfall

The above is coming in for LAYA Prosper Advanced on 1st. April
There has been NO shortfall up until now.
Anybody who took on this (up until now) excellent policy should certainly look for alternatives on their next renewal date.
Indeed the sense in paying so much extra for 0% shortfalls should be closely examined by everyone, if it can be increased like this in a stroke?
 
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Sue Ellen said:
BTW a 20% shortfall is mild compared to some of the VHI policies this year which have dropped the cover from 80% to 60%
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odyssey06 said:
It really shouldn't be allowed to introduce such a significant change on an existing plan.
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Yeah, I had mentioned it as above in June, 2024 that quite a number of the VHI policies had dropped from 80% to 60%. Definitely wrong for Laya to drop suddenly from 100% to 60% in one go :(
 
I have just been checking out the Laya website and it looks like it is still just a 20% shortfall on the Signify plan. My renewal comes up on the 1st of April.
I assume this information on the shortfall would be correct for renewals in less than a month?
 
Thank you for that, Charlie 007.

I delved into my current plan, the Essential 300, and now see it is going to have a shortfall where it never had one before! 20% in this case for orthopedic. I could easily have been caught out by this one... Just goes to show it is important to examine renewals very closely.
 
Looks like Control 600 Total now states for 20% Shortfall in Ortho and Eyes as well. I never noticed that change being introduced.

After years of chasing the 100% cover for Ortho and eyes, there seems to be no point anymore.
Just accepting a 20% shortfall might give more scope for cheaper plans.

According to our friend AI:
"Laya Healthcare introduced a 20% shortfall (ortho cover restriction) on specified orthopaedic and ophthalmic procedures in private and hi-tech hospitals for several plans, including those in the Control range, effective 1 July 2020.

Key details regarding this change include:
  • Effective Date: The changes applied to new and renewing customers on or after 1 July 2020.
  • Impact: A 20% shortfall applied to specified orthopaedic and ophthalmic procedures in Private and Hi-Tech Hospitals.
  • Plan Context: The Control 600 Total and related Control plans were affected by these types of benefit adjustments during that period. "
Laya plans which have full cover listed below:

 
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@sadie thanks for posting this list, I have been trying to find out which procedures they are talking about in these types of exclusions. I looked up the codes and they are:

  • 3660: Arthroplasty of the hip using prosthesis (Unilateral).
  • 3661: Revision of total hip arthroplasty (acetabular and femoral components).
  • 3666: Metal on metal hip resurfacing arthroplasty (Unilateral).
  • 3910: Prosthetic replacement (total) of the knee joint (Unilateral).
  • 3911: Revision of total knee replacement.
So hip and knee replacements.

For eyes, I couldn't find the Laya list but here is the Irish Life one: https://irishlifehealth.ie/mediafiles/pdfs/consumer/Co-Payment-List.pdf
  • 2675 Repair of retinal detachment, retinopexy with scleral buckling, scleral resection or scleral implant, etc. (for diathermy, cryotherapy or photocoagulation use code 2665)
  • 2676 Vitrectomy – including prophylaxis for retinal detachment (e.g. retinal break, lattice degeneration), one or more sessions cryotherapy, diathermy, or photocoagulation/laser
  • 2677 Complex repair of retinal detachment, retinopexy with scleral buckling, scleral resection or scleral implant, includes vitrectomy, claimable only when membrane dissection is also involved – including prophylaxis of retinal detachment (e.g. retinal break, lattice degeneration), one or more sessions cryotherapy, diathermy, or photocoagulation/laser (I.P.)
  • 2795 Lens extraction
  • 2800 Intacs for members suffering from keratoconus (I.P.)
  • 2801 Corneal cross linking (I.P.)
  • 2802 Cataract extraction plus insertion of artificial lens (includes phacoemulsification, etc.) – monitored anaesthesia care/nerve block/local/regional anaesthesia
  • 2803 Cataract extraction plus insertion of artificial lens (includes phacoemulsification, etc.) – general anaesthesia
  • 266835 Implantation of iStent
  • 668261 Left and right eye, same day cataract extraction plus insertion of artificial lens (includes phacoemulsification, etc.) – monitored anaesthesia care
  • 668262 Left and right eye, same day cataract extraction plus insertion of artificial lens (includes phacoemulsification, etc.) – general anaesthesia
  • 668280 Insertion of artificial lens and extraction of cataract and the insertion of a trans-trabecular micro-stent for aqueous drainage
The eye ones are much less common than the orthopaedic ones and if you need to pay an excess or even cover yourself fully they would not be as expensive as the joints. So if you have to choose coverage for one, I would try to keep as much ortho cover as possible.
 
Copied from another thread to highlight - Brendan


Alert for people who have Laya 600 Connect

From 1 April this year, they have introduced a 20% shortfall on Specified Orthopaedic and Ophthalmic Procedures.

This replaces the other excesses and shortfalls.

Laya told me over the phone that this tends to cost the patient between €1,500 and €2,000 per claim.
 
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"Alert for people who have Laya 600 Connect

From 1 April this year, they have introduced a 20% shortfall on Specified Orthopaedic and Ophthalmic Procedures.

This replaces the other excesses and shortfalls.

Laya told me over the phone that this tends to cost the patient between €1,500 and €2,000 per claim."

My Laya 600 Connect policy is due for renewal next month. I am considering switching from the Laya 600 connect to Laya Prime. The extra cost is about €7 per month. However with the Laya Prime the shortfall for Orthopaedic and Opthalmic is 40% compared to 20% with Control 600 Connect.

The Prime policy seems to be a better policy than the 600 Connect except for the Orthopaedic and Opthalmic shortfalls. Is this correct?

I would be interested to hear views on my observations and reasons not to switch. Both myself and my wife are on the 600 Connect policies and in pretty good health. My wife has Osteoarithitis but not a major problem.

I feel that I am focusing too much on the Orthopaedic shortfall and I am concerned that I am missing out on the other benefits of the Prime policy compared to the lack of benefits on the Control 600 Connect policy.
 
I am also with Laya and their Connect 600 policy. I am beginning to think that this policy has been left behind by Laya and better policies have been introduced.

Is the Prime policy a good alternative?

Both in our mid 70's with GB card.
 
IsleOfMan said:
Is the Prime policy a good alternative?
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Premium for Prime appears to be expensive enough at €2,257.56 and yet it still has a shortfall of 40% on ortho and ophth cover which is not great. The main hospital cover seems to be for the Beacon and some of the excesses are quite high @ €325 per night for Blackrock and Mater!

The day-to-day cover does appear to be good with a limit of €7,650 which is very high compared to other policies.

Laya recommended Simply Connect to a friend recently and it is €2,780 but it provides 100% for ortho and ophth but the day to day cover IMHO is very poor.

So suppose you really need to decide which is more important to you. Dermot Goode's company show this also.
 
Did the Control 600 Connect policy always have this shortfall per night or was this introduced in recent years? Excluding the excess.

"Semi-private/private room stays in Blackrock Clinic or Mater Private incur a €325 shortfall per night"

So, If I spend 3 nights in one of the above hospitals after a standard procedure do I have to pay 3 x €325 per night on top of the once off excess of €650. (as well as my annual insurance of €2120).
 
Bronco Lane said:
Did the Control 600 Connect policy always have this shortfall per night or was this introduced in recent years? Excluding the excess.
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These shortfalls have come about over the last couple of years and range from 20%, 40% and more recently 60%. From what I have read on AAM the shortfall has come about recently on the Control 600 Connect policy.
Bronco Lane said:
So, If I spend 3 nights in one of the above hospitals after a standard procedure do I have to pay 3 x €325 per night on top of the once off excess of €650. (as well as my annual insurance of €2120).
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That would appear to be the case but best to check that out with Laya to confirm. It does appear to be restricted to Blackrock or Mater Private who are the most expensive hospitals. That's why I prefer Beacon.

I understand that Blackrock only have private rooms. Even if you do have enough cover for private room in Beacon it can on busy occasions be hard to be able to get one. If you were in for any length of time they might provide semi-private and if you push enough they might move you when one becomes available.
 
Blackrock clinic often waive the private room supplement when staying there. Both my parents have had knees replaced in BC and in both cases room was covered even though they are only entitled to SP room
 
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