Health Insurance Health Insurance advice for someone accustomed to NHS free healthcare

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PoundMan

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Good morning,

I currently work for the Civil Service in an Executive Officer grade role with the Department of Agriculture, Food & the Marine but I am due to take up new employment on June 14th with a local authority (County Council) in a Staff Officer grade role. Therefore I will remain in public service and intend to retain my existing membership with the Forsa trade union.

I am 32 years old and relocated to the Republic of Ireland from Northern Ireland 6 months ago. I am interested in learning more about Health Insurance options for public sector employees. Living in Northern Ireland meant I was registered with the NHS in the UK, so never had to worry about paying for healthcare. Therefore I am not accustomed to the idea of having to pay for private health insurance. I am currently living with my girlfriend in her parent's home, and their family are all with Laya.

I have heard about the likes of Cornmarket and Lyons so I'm confused by who actually offers advice to public sector employees on health insurance. Can you someone please point me in the right direction? There are simply far too many health insurance plans to choose from, so I need help as it is all very confusing for someone who has never needed to even consider the idea of health insurance before. But I can see that the waiting lists for public healthcare are extremely long here in the South, so I might have no choice other than to consider private health insurance.
 
Hi Poundman,

Hope all is going well since your relocation.

Indeed there are far too many plans on the market. The confusion works mostly in the favour of the providers. If you need or think you will require medical care I would highly advise getting a private plan. As you said yourself the waiting lists for non urgent and indeed some urgent care in Ireland can be very long and it has only gotten worse since covid.

Use the HIA website. It's an official comparison website of all plans. www.hia.ie

First thing you have to bear in mind is all pre existing conditions have a 5 year waiting period. Once you are on a plan and wish to upgrade cover, existing conditions at that time have a 2 year waiting period. Day to day cover has no waiting period

For a ballpark you can split the plans into a few sections.
1. Public plans, in general avoid these, only useful for a low cost way to use your waiting times.

2. Private plans for some private hospitals with an excess and no day to day cover eg VHI first care or enhanced care. Approx €800-1200.

3. Same as above with usually more hospitals covered or lower excess and day to day cover (GP, specialist consultants, physio etc) Approx €1200-1500. Eg. VHI Company plan plus level 1.3

4. Top plans, same as above but with no excess, more day to day cover etc. €1500 - €3000.

Best to list what medical care you anticipate needing, then use the HIA website to get shortlist of plans off each provider. Then ring them with the plans in hand and ask any questions you have or to run through it with you.
HIA also have a jargon buster section so you can learn all the lingo.

Best of luck!
 
Hi,

Starrynights has covered lots in their post but you will also need to bear in mind The Lifetime Community Rating so you need to ensure you take out insurance before you are 35.

If you find it all too intimidating as many do you could possibly pay a fee and get professional advice from someone like possibly Dermot Goode https://www.totalhealthcover.ie/fee-based_consultation_with_dermot_goode___total_health_cover


Lifetime community rating​

Lifetime community rating means that the amount you pay for health insurance does not depend on the age you are now but can be higher depending on the age you were when you first took out health insurance.

For example, a 50-year-old who has held insurance since they were aged 30 would pay the same as a 30-year-old, but a 50-year-old who purchases insurance for the first time would pay more than a 30-year-old.

Higher charges apply to people who are 35 years of age or older when they first take out health insurance. There is a 2% loading for each year over 34 years of age. So, for example, if you are 35 the cost is 2% higher than for a person aged 34 but if you are 44 then the cost is 20% higher (2% x 10).

If you previously had health insurance, you can be given credit for the time you were insured, reducing the number of years to which the loading applies.

If you have a break in cover of less than 13 weeks this will not affect your loading.

If you stopped your insurance cover for periods of unemployment since 1 January 2008, up to three years of credits can be provided.

If you live outside Ireland and move to Ireland, a loading will not apply if you get health insurance within nine months and continue to be insured.

For more information, see the HIA website section Lifetime Community Rating Explained.
 
Laya Simply Connect is a decent plan which gives refunds for "Everyday Medical Expenses" such as GP, physio visits.
You can get some money back on routine dental for checkups and cleaning & for prescription glasses - but not medical prescriptions.
It might be overkill for your needs in terms of hospital cover but it's something to factor in when comparing premiums.
A GP visit could cost €60 for example and you would get €30 rebate per visit.
I usually get back about €200 a year in everyday expenses refunds.
Some plans don't provide such refunds or have a high excess (e.g. so your first 3-4 receipts in the year don't earn any rebate).

If you do go with Laya, install their app, it makes it very simple to claim the refunds.
They also have a virtual doctor service "Care on Call" which is handy if you need a basic script for something like a chest infection.
Think the first couple of sessions with that service are free.
 
Thanks for that feedback guys, really appreciate your input. I have no idea how much I should be budgeting for such an expense as I've never needed health insurance in my life before. I've been searching online for advice but cant really find any resources or rules of thumb in terms of how much to budget in order to afford health insurance e.g. never spend more than x% of gross/net salary on health insurance.
 
1,000 for an adult, after tax relief, will get you a reasonable plan.

Not a Rolls-Royce plan, the "hi-tech" hosps will likely be excluded: Blackrock Clinic, Beacon, etc.

Also, you won't get much day-to-day cover, e.g. GP fees, etc.
 
As a trade union member, I reached out to FORSA for advice on health insurance. They put in touch with a number of brokers (Lyons, Cornmarket, Keaneys, etc.) all of whom seem to be recommending the Irish Life '4D Health 2' plan so I'm guessing it is a good option. The consensus seems to be that I should purchase cover for up to Semi-private care in a Private hospital. But I'm wondering if all these brokers have some kind of financial relationship with Irish Life, as I was surprised not to see any recommendations for plans from Laya or VHI.

I am living and working in Westmeath so need a plan that covers all local public/private midlands hospitals as I wouldn't want to have to travel too far. But I will also be travelling up to Northern Ireland regularly to visit family in County Derry, so it would be nice to have a plan that would cover me for any medical treatment/emergencies that would ever occur when I was up in the North.
 
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PoundMan said:
As a trade union member, I reached out to FORSA for advice on health insurance. They put in touch with a number of brokers (Lyons, Cornmarket, Keaneys, etc.) all of whom seem to be recommending the Irish Life '4D Health 2' plan so I'm guessing it is a good option. The consensus seems to be that I should purchase cover for up to Semi-private care in a Private hospital. But I'm wondering if all these brokers have some kind of financial relationship with Irish Life, as I was surprised not to see any recommendations for plans from Laya or VHI.

I am living and working in Westmeath so need a plan that covers all local public/private midlands hospitals as I wouldn't want to have to travel too far. But I will also be travelling up to Northern Ireland regularly to visit family in County Derry, so it would be nice to have a plan that would cover me for any medical treatment/emergencies that would ever occur when I was up in the North.
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I compared LAYA Simply Connect with Irish Life 4D Health 2 and I would say the LAYA one is superior and cheaper (if you sign up before 1st June).
Unless you are getting some employer discount with Irish Life I would opt for LAYA plan.

I hope this link works from HIA site:

Health Insurance Comparison Tool | HIA

Compare health insurance plans across a wide variety of providers in Ireland. You can also compare your current health insurance plan with other plans available.
www.hia.ie www.hia.ie
 
So I recently organised a consultation with TotalHealthCover.ie who have recommended the following 4 plans for me based on the fact that I didn't really want to spend much more than €100 per month:

3 mid-level plans:
  • Laya Signify
  • VHI EnhancedCare 250
  • Irish Life Health BeneFit

They also recommended that I consider a corporate plan:
  • Laya Inspire

I would be interested to get some feedback or opinions from you guys in order to help me decide what direction to go towards.
 
PoundMan,

Its very much a personal decision and I would recommend using the www.hia.ie website and run a comparison on the plans. Go through them carefully and you should be able to reach a decision then.

Personally I have only ever dealt with VHI and would prefer to stick with them. I know plenty of people who use the others and don't have any problems. With the VHI policy Enhanced Care 250 the day-to-day expenses does not appear to be great and I prefer PMI 0710 that I have. I think at last renewal it was around the €1,200 per person.
 
I don't want to bring this thread off-track so apologies if this is too tangential to the central theme.

What healthcare plan provides decent cancer cover? What I mean precisely is what level of plan must one have to be confident that if you get cancer you will be covered for appropriate treatment?

The reason for this question is that there are new cancer drugs coming out regularly. Often these new, let's call high-tech, drugs are very expensive (say, in excess of, €50k p.a.). The problem is that the HSE can be very slow in approving these drugs so there can be a gap between what the oncologist recommends and what the state supports. How does one insure this gap? The last thing one wants to face when going through cancer treatment is to be told that there is very good medication out there for you...….but only if you have deep pockets and can afford it!
 
SGWidow said:
I don't want to bring this thread off-track so apologies if this is too tangential to the central theme.

What healthcare plan provides decent cancer cover? What I mean precisely is what level of plan must one have to be confident that if you get cancer you will be covered for appropriate treatment?

The reason for this question is that there are new cancer drugs coming out regularly. Often these new, let's call high-tech, drugs are very expensive (say, in excess of, €50k p.a.). The problem is that the HSE can be very slow in approving these drugs so there can be a gap between what the oncologist recommends and what the state supports. How does one insure this gap? The last thing one wants to face when going through cancer treatment is to be told that there is very good medication out there for you...….but only if you have deep pockets and can afford it!
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VHI are out on their own on this. For the past few years they have been covering certain new cancer treatments not yet approved by HSE.
It’s all on a case by case basis so you can’t get a breakdown on what’s covered etc. New treatments get eu approval regularly as you say so it’s a dynamic situation.
It’s the only reason I switched back to VHI from Laya.
The costs of these drugs can be huge and many are not aware of this key point of difference that vhi has.
 
fizzy said:
It’s all on a case by case basis so you can’t get a breakdown on what’s covered etc.
Click to expand...

Hi fizzy,

You're right but it's a bit mad that people don't know if they are covered for treatment or not.

fizzy said:
many are not aware of this key point
Click to expand...

Agreed - and by the time they become aware, it's too late. Completely unacceptable position.
 
OP...You can compare all four of the consultants recommended plans together on the HIA site and decide which suits you best. If you have high day to day expenses such as GP and dentist visits then VHI Day to Day might suit because of the €1 excess but if you think you'll need better hospital cover then maybe Laya Inspire is best - they're all very similar and it comes down to what you think you'll need more.
I look at private hospital cover more for non-emergency illnesses etc., which, hopefully, shouldn't be an issue for you for many years. However, if you have an accident, that might change. The problem here is if you do have an accident you're probably going to be taken to A&E and put into the public system anyway unless you tell them about your private insurance - chances are you won't care where you are as long as you're being taken care of.
I think you need to have a look at the HIA site and see all the swings and roundabouts.

FYI... I'm 54 and with Laya, Control 300 Create. It's €100 odd more than Inspire but my outpatient cap would be €6500 versus €1000 for Inspire. As time moves on I'll increase hospital cover and reduce the excess for day cases and hospital procedures. I would hope I'd never reach €1000 let alone €6500 of outpatient claims in a year but between GP, dentist, optician, consultants etc., it's easy to reach €1000 in a bad year for someone my age so that's why I went for higher outpatient cover.
Good luck.
 
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Smaug~~°w°~~ said:
I'm 54 and with Laya, Control 300 Create. It's €100 odd more than Inspire but my outpatient cap would be €6500 versus €1000 for Inspire. As time moves on I'll increase hospital cover and reduce the excess for day cases and hospital procedures.
Click to expand...

Fair enough but what will you do if you need high-tech drugs? Say, for example, you get cancer and the existing treatment has lost efficacy and the oncologist says that there is a new drug which is covered by the health systems in other European countries but not in Ireland - and that this new "high-tech" drug is likely to be beneficial but the problem is that it costs €5k or €10k per month. What then?
 
SGWidow said:
Fair enough but what will you do if you need high-tech drugs? Say, for example, you get cancer and the existing treatment has lost efficacy and the oncologist says that there is a new drug which is covered by the health systems in other European countries but not in Ireland - and that this new "high-tech" drug is likely to be beneficial but the problem is that it costs €5k or €10k per month. What then?
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Smaug's comment was to the OP - I really think for your query you'd be better off creating a new thread.
 
To the OP I'm wondering would you be better off going for a minimal scheme here as you are likely to retain eligibility to the NHS service in Derry?
 
dereko1969 said:
To the OP I'm wondering would you be better off going for a minimal scheme here as you are likely to retain eligibility to the NHS service in Derry?
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I'd agree and comparisons should be done regardless of the level. Also the 2% loading doesn't start till you're over 34.
 
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SGWidow said:
Fair enough but what will you do if you need high-tech drugs? Say, for example, you get cancer and the existing treatment has lost efficacy and the oncologist says that there is a new drug which is covered by the health systems in other European countries but not in Ireland - and that this new "high-tech" drug is likely to be beneficial but the problem is that it costs €5k or €10k per month. What then?
Click to expand...
I've no idea but whatever is approved and available with the HSE should be covered by health insurers. You can be sure that both insurers and the HSE are not going to fork out for unapproved chemo/experimental treatment without a very good argument from an oncologist or even a bunch of them but I think they'd have a better chance arguing with the HSE than a private health insurer. But what do I know - any doctors in the house?

My mother had to go on a drug that wasn't covered by the drug payment scheme but her doctors made arguments to the HSE and within 2 months it was covered - the drug is now standard. We were told back then that a case has to be made, for new drugs/treatments, on an individual basis to begin with and over time the 'drug' may get added for general use.
 
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