A thread to try to clarify some of the jargon used in private health insurance documentation.
I'll kick it off with the following.
- "Co-payment" - what is this? Another name for an excess that the policyholder has to foot? Or is it a fixed amount that the insurer pays towards a particular procedure?
- "Certain orthopaedic procedures" - I've seen #1 mostly mentioned in relation to these but could never ascertain what these were.
- "Special procedures" - what are these?
I'm not sure but don't think so because gender reassignment is usually dealt with explicitly elsewhere in the summary of cover/benefits.Might 3 include the costs of what is now called gender reassignment?
Thanks. But on the HIA site I see several policies which say things like "co-payment of €2k applies to certain orthopaedic procedures". I.e. nothing about percentages. What does that mean?1) a copayment is where the insured pays a percentage of the cost of the claim (eg insured pays 20% and the insurance company pays 80%). An excess is where insured pays the first €x euro.
[Where] do insurers clarify what the mean by "certain ... procedures"? I couldn't find anything in my Irish Life documentation when I was due to go in for surgery. And the IL help desk was no help either. I had procedure codes and asked if any of them were "special" but they couldn't/wouldn't tell me.2) certain orthopaedic procedures are a list of surgeries such a hip and knee replacements.
Again who defines this list and where?3) Special procedures are a list is common procedures performed in high tech hospitals for which the insurers have negotiated a fixed price. (So the insurance company has limited its exposure to high cost claims from very long lengths of stay in expensive private hospitals)
I've been thinking, if you did have a pre-existing condition, and there's meant to be a 5 year waiting period, can you not just sign up for a cheaper package for a year and then move to a higher one. It seems that there's a 2 year waiting list for upgrading your health insurance so is that a way to cut it to 3 years in stead of 5? Or am I missing something?Don,t be frightened by "pre existing conditions".It only means a new condition IN THE PREVIOUS 6 MONTHS.[learned this from Laya].Cheers.
At far as I know insurers will ask for evidence of previous cover when deciding if the 5 year waiting period has been served. I very much doubt that the shorter "upgrade" waiting period trumps it.I've been thinking, if you did have a pre-existing condition, and there's meant to be a 5 year waiting period, can you not just sign up for a cheaper package for a year and then move to a higher one. It seems that there's a 2 year waiting list for upgrading your health insurance so is that a way to cut it to 3 years in stead of 5? Or am I missing something?
How do you quantify this. For example. Laya offer a free cardiac screening to it's customers. If I take this up and they notice an irregular heartbeat or similar during the consultation....do I now have a "condition"?and a condition had developed in that previous year,
Yes. If you look at the t&c's document that compliment the table of benefits you'll find the full definitions. It's usually something like if any "signs or symptoms existed". This essentially means as soon as you state you have a symptom or sign to a doctor and they write it down, it's now written on your record. It doesn't have to be a full diagnoses either, just a symptom which is very likely associated with what you got diagnosed in the future. This paper record is all they have access to when checking claims. So it matters whether it's been written down or not.How do you quantify this. For example. Laya offer a free cardiac screening to it's customers. If I take this up and they notice an irregular heartbeat or similar during the consultation....do I now have a "condition"?
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