Health Insurance Switching - potential pre existing condition.

G

GingerH

Registered User
Messages
35
I am a life long VHI customer (58) currently on Company Plan 1.3 (along with wife and two grown up college age children) - renewal is in February. My wifes company is now offering to pay for her health insurance through Laya (Prime) as well as 10% reduction for myself and kids on that scheme.

On the face of it it makes sense to change (particularly for my wife) as it is a better scheme than what we have and there will be cost savings. It appears there is no penalty for breaking the contract (because it is a company scheme) - however I am risk averse and a typical loyal VHI member. I have a number of relatively minor health issues which I have been treated for years and are under control and do not cause issues.
More recently I have had discomfort in my right hip which has restricted my ability to run (which I like doing) but is not currently a major issue. I had a scan done and there currently appears to be no major problem over and above 'what could be expected for my age'. I have had an injection for this and am doing physio etc. I am uncertain what way this will develop - the treatment may work or it may progressively worsen with age . My concern is that given this uncertainty could this be considered a pre existing condition that may hinder my ability to get cover for hip replacement etc at some future date. Any advice appreciated.
 
Hi,

All pre existing conditions are covered after 5 years of continuous insurance so you're covered there. If you change plans or insurers with like for like cover there is no waiting period for existing issues. If cover is downgraded then you get the new lower cover. If you upgrade your cover during the switch then there is a 2 year waiting period to use the improved cover on the pre existing condition only. During those 2 years you are covered for the pre existing issue based on what your old plan provided, in this case it would be Company plan 1.3.

Insurers cannot impose penalties for pre existing issues so you can always ask them directly what the level of cover they provide is. My advice would be to look at the cover provided by Laya for your existing conditions. If you are unsure based on the table of benefits ask them directly. If you decide to switch, keep a copy of your VHI Company plan 1.3 table of benefits handy somewhere incase you want to reference it after a claim in the future.
 
@Starrynights

Sorry to intrude but when you say covers "like for like" does that mean the old and new policy are exactly the same for everything or just say like for like on what the cover for the pre existing condition eg. both cover 80% on mri scans ?
 
Orlaith1 said:
@Starrynights

Sorry to intrude but when you say covers "like for like" does that mean the old and new policy are exactly the same for everything or just say like for like on what the cover for the pre existing condition eg. both cover 80% on mri scans ?
Click to expand...
No worries at all. The two policies don't have to be same for everything. Every section of the two policies will be compared on their own depending on whether the issue is new or existing.

Taking your own MRI scans example say policy 1 offered 80% MRI scan cover. Policy 2 offers 100%. A person switch's from policy 1 to 2. They fall off a bike the week after and need an MRI for a new injury. As the injury is new they only need look at Policy 2's document which states 100% MRI cover. Then a month later an old illness resurfaces and they need an MRI for that. They look at the policy 2 table of benefits and it says 100%. However as it's an old illness and it's less than 2 years since they switched, they are within the 2 year upgrade waiting period. The new policy will have to be compared with the old policy. As the old policy states 80% and this is worse than the new policy's 100%, 80% cover will apply until the 2 year period is served.

Unfortunately this does not apply in reverse if the new policy is worse than the old policy. In that case, say the new policy offers 60% MRI cover, then the worse cover will apply to both new and old conditions.
 
Last edited:
You must log in or register to reply here.
Back
Top