Need a Plan for someone diagnosed with BRCA1

S

Seammy

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My wife has a family history of cancer and she was recently tested and learned she is carrying the BRCA1 gene. Although she has always been very healthy, the BRCA1 gives you an extremely high chance of cancer and she may be looking at some elective surgery, like Angelina Jolie. We currently have VHI Company Plan Plus Level 1, but I recently had to change jobs and my new employer doesn't pay anything towards healthcare and our VHI policy runs out at the end of the year. The VHI charges are very high and I was considering downgrading, but I'm concerned about my wife's health. I understand we don't both need to have the same coverage and I may get her a better policy and get a lesser policy for myself, we are in our early 50's, but fortunately I am also very healthy. I'm worried that just having the gene could be considered a pre-existing condition and I'm not sure what problems she might have if we change from VHI to another provider like Laya. Since we've never been hospitalised in the past, I'm also not too sure about the different types of coverage. Any advice would be greatly appreciated.
 
I was diagnosed with cancer in 2012. I did have health insurance in place. However, a friend was also diagnosed about 3 weeks after me and while we had different types of surgeries we had the same chemo and radiation treatment post surgery and she commenced her chemo a week after me, so the surgeries weren't that far apart either.We both had the same oncologist, I was private patient with him and she was public patient with him. Our appointments for chemo were both 8am and in some instances she was taken ahead of me, even though she was a public patient and I was private. I have maintained my health insurance but throughout the whole treatment plan the only benefit it gave to me was during in patient stays, where on two occasions i had a private room and on another I was in ward with 3 other patients. If your illness is serious you get the same treatment regardless in my experience. if you are having radical surgery there is a possibility that they may give a private room for privacy reasons. If you go down the route of reconstruction whether private or public, you will almost definitely be in a private room as the heat in the room afterwards has to be at such a high temperature that the nurses can barely tolerate it let alone other patients. That being said I still wouldn't cancel my health policy as it would be extremely difficult to get into a plan again in the future.
 
Hi Urn,
Thanks for your nice message. I understand sometimes there's no difference between private and public healthcare, but I'm certainly not going to cancel our health insurance, yet I may back-scale it a bit. After all, I don't really care about getting reimbursed for GPs, especially if I'm going to pay for it with higher premiums. The problem is, there are too many choices and it's hard to tell which is more important, particularly in my wife's case. Once again, any advice would be greatly appreciated.
 
I didn't really attend my GP very much at all and still don't, maybe 2 appointments over the course of treatment and once yearly now. I will have a look at some of the plans but focus on in patient benefits more so than day to day expenses. I'm on Be Fit 2.1 with Irish Life. As your wife is looking at preventative treatment you could scale yours back to basic and increase her premium to private patient etc. I would contact who you are with already, establish what or if there is a waiting period before upgraded premium kicks in and do this if you know she is planning to elect for surgery in 2018 or 2019 allowing for the waiting period for the upgraded cover. If you contact them they will help you establish what you need. Maybe look at hospitals either public or private that are close to home and perform such surgeries and then match cover to suit what best suits you. For example I attended St. James, so private room in public hospital would work where as if you want to go say Blackrock you need private cover in private hospital. You can always adjust back both policies after surgery etc.
 
Seammy,

The alternative options worth considering are as follows;
1. VHI PMI 44 16; price 1102; all public, private (including private room) + 3 hi-tech hospitals covered. Private/hi-tech excess is 150 per
admission or day case. Very limited day to day cover on this plan.

2. VHI PMI 43 16; price 1171pa; all public, private + 3 hi-tech hospitals covered. Private/hi-tech excess is 150 per admission and 50 per day
case. Good day to day cover included on this plan, NOTE; from 31/12/2018 changes will apply to the day to day cover - 50% refund for gp,
consultant visits etc.

3. Simplicity; price 1191pa; all public, private(including private room) + 3 hi-tech hospitals covered. Private/hi-tech excess 100 x 2 max per year for admissions, day case excess 50 per visit. Day to day cover included, the first 100 not allowed.

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The above plans have similar hospital cover to your current plan so there is no waiting as you are switching from like to like.
This range of plans are the cheapest which cover all 3 levels of hospitals - public, private and hi-tech.

Cheaper plans will have either a higher inpatient excess with cover for all 3 levels of hospital, or it will have just public and private hospital cover.
Examples;
1. Laya Control 300 Create; price 1042pa; all public, private and 3 hi-tech hospitals covered, private/hi-tech excess 300 per admission, day case
excess 125 per visit. Good day to day cover included.

2. VHI PMI 40 15; price 1049pa; all public, private and Beacon hospital covered, private excess 75 per admission and 50 day case. Limited day
to day cover.

3. VHI One Plan 250; price 916pa; all public, private and Beacon hospital covered, private excess 250 x 2 max per year. Day case excess 150 per
visit. Limited day to day cover.

4. Laya Essential Health 300; price 895pa;(from 1/1/2018) all public, private and Beacon hospital, private excess 300 x 2 max per year. Day case excess 125 per visit. Limited day to day cover.

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Regards, Snowyb
 
Hi Snowyb and all,

Thank you so much for the very valuable information and advice. One more question, am I interpreting it correctly, that we are allowed to have a lapse in health insurance cover for up to 13 weeks, without any penalties or waiting periods? I have no intention of waiting 13 weeks, but considering how close Christmas is approaching and there's a good chance VHI and Laya will be closed next week, if I'm correct, it would be nice to know I could take my time to pick the best options for us. Also we're in Galway, so I'm not sure if the private hospitals are as important for us, unless some of these plans include the Galway Clinic. Also, am I correct that there shouldn't be any difference in price if my wife and opt for two different plans or even two different companies?
 
Seammy,

Yes, you can lapse upto 13 weeks without waiting periods applying. But sometimes they can back date your premium to your renewal date.

Your current plan will automatically renew on your renewal date and you have 14 days after renewal date to change your mind if you want.

The first 3 plans quoted above include the 3 hi-tech hospitals which are all based in Dublin - Blackrock Clinic, Mater Private and Beacon hospital.
As you are based in Galway, these hospitals may not be important to you, but at the same time it is not a bad thing to have them included as
a back-up option if required.
Also included in these 3 plans are all the private hospitals, for example Galway Clinic, Bons Secours Galway etc. Sometimes the waiting lists in
the public hospitals are too long(ie 2 years +) for surgery and so its invaluable to have the private hospital option open to you if needed.
Lastly, all the public hospitals are also included on these plans.
I was thinking of your wife when quoting the first 3 plans as they tick all the boxes, and two of them also cover a private room in a private
hospital if required.

The second list of plans may suit you, to make savings overall.
You can both choose different companies if you want to suit your medical needs or to save money.

Regards, Snowyb
 
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