Health Insurance Leya Control 150 secure Help please

N

november16

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Hello renewal time again
The wonderful Snowyb had given great advice previously. which proved invaluable. Such a great resourceful person

I have spent weeks on this also last year had the same experience with leya helplines!.

Ref policy Control 150 secure is now nearly 1,900 I asked Leya re a more economical policy with same or similar benefits and did not get satisfactory answer very frustrating in fact.

H.I.A site very difficult to extract helpful information from.

I'm also looking to change ref flex 500 control 924.00 apprix per year paying that for two others separately.

Ortho cover preferable, day to day med expenses and excess of 1 preferable on day to day.
Would ye have suggestions please. I have to decide by tomorrow I think if leaving Leya
 
Hi November,

Control 150 is an expensive plan as it fully covers a private room in a lot of hospitals. If you would be happy to downgrade that to full cover for a semi private room then you could save quite a bit of money. It's worth noting a private room is not guaranteed and is usually provided based on need.

If you want full cover for orthopedic procedures at a cheaper price then you'll have to stay with Laya. Only a few expensive VHI plans cover this fully. It's often 80% cover or €2000 co pay with Irish Life. However it is worth noting that hospitals often waive this copay but this is done on a case by case basis and cannot be guaranteed.

Simply connect could be a good option to take a look at. At €1362 you'll save over €500 and it covers the 5 special orthopedic procedures. Good day to day cover but limited to €500 back a year ( ie you have to spend €1000 if most costs are covered 50%). If this isn't sufficient then take a look at Simply connect plus where it's up to €1000 back (€2000 spend).

Hope this is helpful.
 
Hi November 16

The following plans from LAYA come in cheaper than Control 150 Secure (€1825) and all cover orthopaedics. No excess applies to 5 orthopaedic procedures (hip and knee replacement) in 12 private hospitals

1. Control 300 Create at €1309
2 Simply Connect at €1361
3. Connect Simplicity at €1463
4. Simply Connect Plus at €1470

Control 300 Connect and Connect Simplicity cover a private room in a private hospital while the other two cover up to a semi-private room in private hospitals.

The inpatient excess in a private hospital is €300 per claim on the Control 300 Create plan. The excess is €150 on the three other plans.

There is a €1 excess on everyday expenses on all these plans.

The above plans offer good value compared to €1825 for Control150 Secure and are worthy of serious consideration.

Please be aware that you have a cooling off period of 14 days when you renew, so do not feel that you have to make a panic decision by tomorrow.

I hope this is helpful
 
Thanks very much Riomhaire. I'm practically cooled off as on the 13th day and tomorrow is d day.
Simply connect plus seems good option probably choose that checking 1,000 day to day cap.
I was previously plan b vhi for decades so paid my dues prior to premium community rating.
Kind Regards November
 
Just to add to the knowledge Bank here

I was on Simplicity for a number of years and found it a very good plan (thanks to Snowby who gave brilliant advice to so many here)
I favored it for the private hospital and private room cover and also The Beacon Hospital cover
Also had good Day to Day
(was very hard to get something comparable with other providers)
Simplicity is currently €1581.52 / year or €131.79/ month

I have been trying to evaluate as best I can comparable more cost efficient plans ( The HIA site is still complex)
After quite a bit of evaluation I'm nearly sure I'm going to Control 300 Create € 1348.37 / year € 112.36 / month

I'm making a €233 saving upfront and getting practically the same level of care (OK there is a marginal higher excess but my saving is a gamble towards that)

Interestingly Everyday Medical Expenses only have a €1 excess on Control as opposed to €100 on Simplicity so another potential saving

Another slight variance:
Everyday Medical Expenses are capped at "Up To an Amount as opposed to 50%"
e.g 50% of costs for a consultant on Simplicity compared to "up to €80 per visit" but all in all give or take a few Euros it matches up and again blended in the saving

Hope this Helps
Thanks to all the contributors that share their knowledge here
 
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Re Orthopaedic cover seems like some specific knee and hip procedures are fully covered on some plans but I can't find info on shoulders on the plans mentioned.

Thanks Starrynights and Thanksinadvance re informative posts.

I phoned leya again re queries on orthocover ref possibly shoulder op cover. I Had injury 5 yrs ago and there was a query re replacement.
Without a consultant code they could not tell me if either control 150 or simply connect plus cover shoulder Orthopaedic operations..I can't get a definitive code as the operation is not planned. I was hoping it would be covered. This is a minefield.
 
It's at times like this where you may actually get some more useful info from the hospitals themselves than the insurers. It might be worth your while giving a hospital you'd actually consider getting future surgery in a ring and seeing if their billing department has some insight. I know Blackrock used to be fairly on the ball with these things as they often waive copays.


The fact they have this dedicated section of their website to check cover gives hope they might be able to give more info. From what I understand it's the hospital that will play ball with the insurer by selecting the code that has cover for your particular insurer.

Insurers are almost useless in figuring this out as they often won't divulge their list of procedure codes which they class as intellectual property and therefore require you to manually check with them for every code. VHI have previously given me a list of all their FPP codes though. And Irish life seem to publish their codes online here:

Schedule of Benefits 2024 - Irish Life Health

Schedule of Benefits & Procedures for Professional Fees
www.irishlifehealth.ie

Therefore the hospital maybe of more help by being able to tell you what the likely codes could be and they also have the ability to check live on their system cover with a policy number & procedure code.

Orthopaedic | Your Member Benefits | Laya Healthcare Ireland

At Laya we look after your hips, knees & more. We are the only health insurance company in Ireland to offer specific Orthopaedic procedures.
www.layahealthcare.ie

Laya list the 5 orthopedic codes that they cover fully on certain plans. Shoulders are not mentioned which is odd so outside these codes perhaps the cover is only 80%. Hard to know with Laya as they don't make reference to special procedures other than orthopedic/opthalmic as one section and cardiac as another. Whereas Irish life reference orthopedic as one section and then a catch all category of special procedures as another. You could use the link above to see what is exactly included in those special procedures. Similarly VHI break it down to normal procedures as one section, orthopedic/opthalmic as another and FPP ( fixed price procedures) as another section which they further break down into cardiac, non cardiac and chemo/radiotherapy but tell you the cover you have for each case on the table of benefits. With laya it seems like you're almost guessing if you are covered for special procedures. Or maybe the fact that they don't make special mention to these procedures should be taken automatically to mean full cover. Something to possible query with them on the phone.
 
Thanks very much for taking the time to answer. I really appreciate your assistance. I was in CompanyCare Plus which covered orthodopaedic fully about 7 years ago. I had left V.H.I as they did not have great policies in that area at the time. I did ask the question of Laya and was given the run around again 3rd time on the phone. I would definitely consider leaving a company which cant disclose such basic information. How is that a transparent system. I will check various codes re procedures with black rock, maybe Santry that is a better solution as they are professional in their approach.
 
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