Maternity Cover

E

evil_g

Registered User
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Hi folks.

My wife and I would like to start a family and upon reviewing her current plan it's clear that her maternity cover is very poor. I'm hoping someone here can give us some guidance on the questions we should be asking and our our available options. (I've found some helpful threads using the search function but most are quite old).

She's currently on Laya Essential Assist, which as far as I can see offers little to nothing with regards to maternity cover. (It really looks like a terrible plan in most respects, but she's been on it since before I met her).

I know there'll be a 52 week waiting period for any change in cover, but we don't know how long it might take to conceive so I'd like to upgrade it immediately.

We haven't really discussed what type of benefits we require, but we're reasonably well off, and if it were up to me we'd pay for the best available care in the most comfortable environment.

Based on my reading of older threads, in order of priority my initial requirements would be:
  1. In the event of anything, big or small, going wrong at any stage, I'd like immediate and the best care.
  2. I think we'd like to chose our consultant if possible, but more importantly we'd like to deal with the same consultant throughout.
  3. I think my wife may opt for a c-section, which I understand would require a number of nights stay. This being the case I'd like if she could have a semi private room at a minimum.
My wife is 34, and we live in South Dublin if that matters.

So I think first we'd need to decide whether we want / need to go public or private. Based on my reading of older threads I think we might prefer private.

I think we could afford a plan costing €1,200 per year, and would pay more if this were sensible.

The questions I have then are as follows:
  1. If we change plan today and she becomes pregnant during the 52 week waiting period what are our options given that her current cover is so poor? Would it be all that bad to go public? Would the benefits of the new cover become available (semi private room, etc.) as soon as the 52 week period expires, even if she she is already in the public system. Should we consider entering the private system until the 52 week period expires? Or is that permissible?
  2. In addition to the priorities listed above is there anything else we should consider?
  3. Could anyone point me in the direction of a plan that would meet some or all our current requirements, in or around €1200 p/a? Just so that I can get a handle on whether it's realistic and what sort of excess we'd be looking at.
  4. My plan is to first ring Laya and ask what they can offer us. Then ring Cornmarket to see if there is anything better on the market. Is this a sensible approach?

As you can probably tell, I'm a bit green in this area, but I plan on reading up.

Thanks in advance.
 
Hi evil_g,

Firstly, all 3 maternity hospitals are public hospitals.
The following Laya plan is worth considering that covers the maternity private room. Details as follows;

Laya Simply Connect; price 1100pa; all public, private and 3 hi-tech hospitals covered, private/hi-tech hospital excess capped at 150 x 2 per year for all admissions, private/hi-tech day case excess 50 per procedure. Good day to day cover included, 50% refund for gp visits,
non-maternity consultants, etc - subject to a max refund of 500 per year. ( 50% of 1000 = 500)
Note; maternity expenses are not included in this '500' amount.

Regarding maternity cover, this plan covers 3 nights accommodation including the private room. If a longer stay is required for medical reasons
it will be covered, the consultant will authorise this with the health insurer, backed up with medical evidence report etc.
There is a maximum cover amount of 450 for outpatient maternity consultant visits on this plan. Maternity consultant visits are dealt with under
maternity cover only, seperately to other consultant visits under day to day cover. Even on the most expensive plans, the maximum refund is 600 per year for private maternity consultant visits so it is no advantage to pay more.

[broken link removed]

The 3 maternity hospitals have detailed information on their websites regarding going the private care route where you choose and see the same
consultant for all visits and delivery. There is no guarantee that the chosen consultant will be available for the birth, due to holidays etc. They also can't guarantee a private room as its based on availability on admission. Some hospitals are supposedly more likely to have a private room
than others, though never guaranteed.
Holles Street Hospital; private consultant costs from 3,500 to 5,000 depending on the individual consultant fees.
Rotunda Hospital; private consultant costs upto 3,900 depending on a particular consultants fees.
Coombe Hospital; private consultant costs 3,000 approx depending on certain consultants fees.

There is also information regarding the semi-private option and public route.

The most important part is knowing that neither private or semi-private will be covered until the 52 weeks waiting is fully served. Once the birth date is after 1 year on the new policy, the hospital part will be covered.

If you went the private route and the birth date was before 52 weeks even if you switch plans, you would be billed for all hospital costs. A private room costs 1000 per night, while a shared room costs 813 per night. Delivery fee normal 300approx, C section 500approx, Epidural 300approx plus ultrasound 110 to 140 and bloods (pathology) 125approx. Essential Assist would cover just 400 towards costs.


The question I would ask Laya is in relation to the 450 consultant visits cover - Does the 52 weeks waiting time apply to that part of the cover?
The reason I ask, is because there is no waiting time applied to normal day to day cover i.e gp visits, non-maternity consultant visits, dental etc.
These are all allowable straight away.
The maternity hospital cover upgrade waiting time is set in stone, 52 weeks.

Regarding switching from public to private, it doesn't work like that as you have to pre-book a private consultant at the start, some consultants
could be booked up fairly quickly. Its a full package to go the private route, from start to finish.

Another important thing to note, is make sure the chosen consultant is a participating consultant with Laya Healthcare.
This can be checked out on Laya healthcare website;
https://www.layahealthcare.ie/hospitals/#/hospitals?planID=97&view=consultants

I've no personal experience of using these services. Its a case of what care option will suit your budget.

Switching to Simply Connect is a wise move as Essential Assist plan, as you say, is very poor cover across the board.
On a positive note, its lucky she's with Laya as they allow switching to another plan at any time. VHI would not allow switching plans, only at
renewal date.
Hope this helps with your decision making process, there's a lot of food for thought.

Regards, Snowyb
 
Wow. Thank you so much for taking the time to put all that together. So much helpful information in one post. I've read it a few times and I get more from it each time.

I think we'll be upgrading to Simply Connect immediately. Even without our other plans, upgrading to that or an equivalent policy seems like a no brainer, given that we're currently paying ~66% for next to nothing.

Then taking our other plans into account, the fact that Laya will allow us transfer before her March renewal date is a strong incentive to stay with them.

After that the decision to go public or private will depend on more research, and will also to an extent depend on timing. Regardless, we need better cover anyway.

A final question I have relates to:

snowyb said:
The most important part is knowing that neither private or semi-private will be covered until the 52 weeks waiting is fully served. Once the birth date is after 1 year on the new policy, the hospital part will be covered.

If you went the private route and the birth date was before 52 weeks even if you switch plans, you would be billed for all hospital costs. A private room costs 1000 per night, while a shared room costs 813 per night. Delivery fee normal 300approx, C section 500approx, Epidural 300approx plus ultrasound 110 to 140 and bloods (pathology) 125approx. Essential Assist would cover just 400 towards costs.


The question I would ask Laya is in relation to the 450 consultant visits cover - Does the 52 weeks waiting time apply to that part of the cover?
The reason I ask, is because there is no waiting time applied to normal day to day cover i.e gp visits, non-maternity consultant visits, dental etc.
These are all allowable straight away.
The maternity hospital cover upgrade waiting time is set in stone, 52 weeks.

Regarding switching from public to private, it doesn't work like that as you have to pre-book a private consultant at the start, some consultants
could be booked up fairly quickly. Its a full package to go the private route, from start to finish.
Click to expand...

If I understand you correctly, there are two elements to the private service, namely, (a) the consultant costs, which must be booked at the start of pregnancy and are delivered over the course of the pregnancy, and (b) hospital costs, which appear to relate primarily to the birth itself, but must also be requested early in the pregnancy.

If we were to go public, we will be allocated a different consultant as and when required, and if and when my wife is admitted she would be allocated a bed in a a public ward. This would all be mostly free no matter what insurance cover she has.

If we go private (or semi private) things are more complicated and I need to read the hospital websites and talk to our insurance company.

But a lot of the above quote hinges, on the "birth date" rather than the due date.

Leaving aside consultant costs, which I need to talk to Laya about, what would the implications be if we (a) upgrade cover in month 1, (b) are lucky enough to conceive in month 6, and (c) choose early in the pregnancy to go the private route on the basis that the due date is after the 52 week period?

Could we then cover the consultant costs ourselves, and expect that the hospital costs incurred at the time of delivery would be covered?

This would of course depend upon the pregnancy going full term. If there were complications in month 11 we would probably be on the hook for considerable private hospital costs?

The answer to these questions would greatly influence the public / private decision to be made when the time comes.

Thank you again for your very detailed response. And don't worry if you don't have time to answer these follow up questions. You've given us more than enough to work with.
 
evil_g,

evil_g said:
This would of course depend upon the pregnancy going full term. If there were complications in month 11 we would probably be on the hook for considerable private hospital costs?
Click to expand...

I came across this relevant information today on the Health Insurance Authority website which seems to answer your question above about complications in pregnancy arising in month 11, or any injuries or illnesses that happen during pregnancy that need hospital treatment. According to the HIA, you will not be on the hook for considerable private hospital costs, as an admission like that would be covered under the 'hospital part' of your contract. So, under Essential Assist she would be covered for a semi-private room. Once the bed is covered, all treatment is covered.

I would go a step further than that, to say that she would also be covered for a private room, if it was available(not that it matters), on Simply Connect plan.
When you switch plans and upgrade hospital cover, the 2 year upgrade waiting time for extra hospital cover only applies to any pre-existing
illnesses or conditions that you already have at the time of switching. So, in your wife's case, she has no pre-existing illnesses, not pregnant at
switching time. All new illnesses/conditions arising after switching are fully covered on the new plan straight away including all the extra
upgraded hospital cover, no waiting applies.

The only concern/issue would be if a delivery was required in month 11 as a result. That part would probably not be covered. Its all
hypothetical of course but its important to try to cover all angles as much as possible. Maybe conception in month 7 or 8 would reduce the risk
considerably.

You could contact the HIA regarding the relevance of their information in light of your situation. They are very helpful with answering questions and explaining the finer details back to you. The following link shows the question and answer number 6, question; What kind of maternity benefits should I expect?
https://www.hia.ie/consumer-information/selecting-a-health-insurance-plan

What kind of maternity benefits should I expect?
Treatment received in respect of illnesses, injuries or complications during pregnancy, if covered, would be considered as part of the hospital cover part of your contract. Routine treatment received during the course of a normal pregnancy and delivery would be covered under the maternity section of your contract. Often this section will provide full cover for a limited stay in hospital and a fixed amount for the consultant care in the hospital. Some policies also provide some cover for outpatient consultant care. You will not normally be able to claim under the maternity section of your contract until you have served a waiting period of 52 weeks. This only applies if taking out health insurance for the first time, if you are upgrading your policy to a higher level of cover or if you have allowed your health insurance to lapse for more than 13 weeks.


I would agree with your overall assessment and thinking regarding the 'private care option, ie covering the consultant costs yourselves and
then the hospital stay/delivery is covered on Simply Connect outside the 52 week waiting time. As you say it all hinges on timing and trying to
assess the risk involved as best you can.

Lastly, the public system is free to everyone, regardless of what health insurance plan you have. Health insurance doesn't come into play at all.

Regards, Snowyb
 
Thank you. That answers precisely what I was asking and more.

We'll upgrade today, and then the public / private decision can be made if and when the time comes.

It seems that no matter what cover we have going private would leave us considerably out of pocket; and from reading around it seems that the benefits over the public system may not be worth the €3-5k they would cost.
 
As others have posted on the health insurance side of things, I'll focus on maternity. My wife is pregnant at the moment with #2 so it's a topic close to home!

Even with a health insurance policy in place, if you go "non-public", you will have out of pocket expenses to pay. For semi-private it's approx 1k, for private it's between 3.5k & 5k (less 20% via MED 1).

A friend of ours is a mid-wife, recently had her first and I'll give you the advice she gave us, either go public or private, semi-private is near-identical to public (save for a ward with fewer beds at the end).

My wife went public with #1, but via the Domino scheme which is a mid-wife led programme for normal/low risk pregnancies in certain areas. Aside from cost, the main advantage is that you visit an out-of-town clinic during your pregnancy with short waiting times. You see a team of mid-wives who track your progress through to delivery (in Holles St in our case), and there was good continuity of care. Downsides are the same as in the regular public system, i.e. in a ward with about 7 or 8 other women (& their newborns!) so there's not a lot of privacy, and as you can expect it's noisy, but you couldn't fault the care she received.

For #2, she's going private, and honestly speaking it's a luxury, but something important to my wife as she's 3 years older, can see the same person throughout the pregnancy, and will have a quieter post-natal ward (she may get a private room but it's not guaranteed). Only time will tell whether it's measurably better than going public but we're happy with the choice.

If you want to know more, feel free to PM me.
 
Its a steep learning curve all the way, but your in a better place insurance wise and a lot stronger position information wise to make decisions
whenever it needs be. Its opened up the discussion and shone a light on the maternity cover subject on this thread, in a way that hasn't been done in a long time. I'm sure its been an interesting read for many other posters in a similar position.

On another note, its highlighted the need to ensure you have a proper level of health insurance if considering using maternity cover or if you
need private hospital cover.
It should be a big wake up call for the many people who maybe took out a basic plan in 2015 to avoid the LCR loadings at the time.
They simply do just that, avoid the loadings, but as regards hospital cover they're inadequate.

All the best with everything!
Regards, Snowyb
 
So we called up Laya this afternoon and moved onto Simply Connect immediately.

Surprisingly, the lady we were talking told us that, so long as my wife isn't currently pregnant, the 52 week waiting period does not apply to either the maternity consultant or hospital cover. Both will be available at any time from Feb 1st.

That said, I'm not even sure we want / need to go private. Plenty more to think about (and threads to read on Boards) in that regard. Thanks for your insight Mojoask.

But for the sake of 25 quid a month, upgrading makes sense even if we don't need the maternity cover.
 
For what it's worth, I have done private and public and to be perfectly honest, private maternity takes advantage of parents natural nervousness and desire to make sure everything is perfect. If there was a guarantee about better more comfortable accomadation I might say something but there isn't. We had the same consultant all the way through but on the day of the delivery, we had a different consultant because it was her day off and it ended up in an emergency section. Now the new consultant was brilliant and everything was fine but it just made all the money we paid just to see the same the consultant a waste since when we really needed her, we got someone else. The accommodation we were given ended up being a public ward for 4 nights and then a private room for the last night is hospital. Again, not worth the money. The ward was what it was. We couldn't wait to get out of there but the same would probably be the case if we had the private room. We went public with the second and couldn't fault it. We were told to expect hanging around waiting rooms for hours for appointments but that did not happen once. We did pay for private scans though (peace of mind). I would suggest save your money that would spend going private and go on a little break somewhere when the baby is born and settled.
 
Can I tag a query in relation to my wifes maternity cover. Shes due in August with 1st baby and would like high level of private care (not based in Dublin so will go to local hospital)

Current policy is Irish Life Net Most 500 with enhanced maternity selected as an option.

It appears from reading previous threads that she cannot move provider now, is there a better maternity package from Irish Life?
If yes, will they accept claims without the 52 week waiting period?

Thanks !
 
Hi 8till8,

You can switch plans mid-year but only to another Irish Life plan.
The following plans are worth considering with maternity consultant visits @ 300 and 400 respectively.
1. 4D Health 1 plan; price 1045pa; maternity consultants 300pa

2. 4D Health 2 plan; price 1213pa; maternity consultants 400pa.
[broken link removed]

As regards if the 52 week waiting time applies to maternity consultants visits etc - I'm sorry I don't know the answer to this.
I posed this question earlier in this thread, no reply yet. There is no waiting time applied to upgraded day to day outpatient expenses
for anyone under 50 years, I'm not sure if the same applies to maternity consultant outpatient visits.
You will have to query this with Irish Life directly. The 52 week wait will apply to any upgraded hospital cover.
So she does not have full cover for a private single room in a public hospital on Net Most 500 plan.
She is covered upto a semi-private room. The difference in price is 187 euro per night for a private room.

Regards, Snowyb
 
8til8 you can switch mid year but you will not get the full day to day benefits like maternity consultant visits (there are no wait times).
It depends on your renewal how much you will get back. They will work it out pro rata.

Eg Say your renewal was 1st sept and you changed mid policy on 1st feb to 4d health 2 which gives you €400 back. You can only claim 7/12 of €400 (€233) that is how long you will be on new plan.
 
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