VHI Treatment time limits for VHI

Early Riser

Frequent Poster
I'm asking this on behalf of a friend. She has a family member in hospital for several months with complicated medical issues - of a physical nature. It looks like he will need ongoing treatment for some considerable time. He is in a private hospital (not one of the hi-tech ones, if that matters) and is under VHI.

Is there a time limit on VHI cover ?
 

Curlyfella

Registered User
It looks like it depends on what plan you have.


The one below has 180 days per year.


What is the plan name?



5) Benefits The following benefits and associated terms and conditions are only relevant where they are included in the Table of Benefits applicable to your plan. You must consult your Table of Benefits to ensure that a benefit is covered and the appropriate level of cover, if any. 1) General Conditions We will pay benefits for in-patient and day-patient treatment, side room procedures, out-patient procedures and Vhi HomeCare treatment for a maximum of 180 days per customer in any calendar year, less any days treatment within the same calendar year which has been paid under any other health insurance contract (for benefit in respect of psychiatric treatment and addiction treatment, please refer to Rules 5(21) and 5(22)
 

Early Riser

Frequent Poster
Thanks. It looks like 180 days so - which is nearly up. I'll have to check with friend re specific plan to see if there is any better news.

Edit : I note that it is 180 days per calendar year - so up until 30th June this year it would seem. Time prior to the 31st December is discounted?
 
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Curlyfella

Registered User
It may be when the policy began/renewed - which would need to be checked?

Eg - the policy was renewed in March this year - 180 days from then -


Read the bold below -

5. Benefits The following benefits and associated T&Cs are only relevant where they are included in the Table of Benefits applicable to Your Plan. You must consult Your Table of Benefits to ensure that a benefit is covered and the appropriate level of cover, if any.


1) General Conditions We will pay benefits for In-patient and Day-patient treatment, side room procedures and Out-patient procedures for a maximum of 180 days per person in any calendar year, less any days treatment within the same calendar year which has been paid under any other health insurance contract (for benefit in respect of psychiatric treatment and addiction treatment, please refer to T&Cs 5(21) and 5(22)).

2) The benefits which We will pay will depend on the terms of Your Policy on: (i) the first day of a hospital stay; or (ii) the date of the treatment if You are not staying in hospital.

3) If the benefits do not cover the full cost of the treatment, You are responsible for any balance.

4) We will pay the actual amount You are charged or the benefits payable under the Policy, whichever is lower.

5) If You use hospital accommodation (including ICU) which requires a higher level of cover than You hold under Your Plan, the level of benefits payable, if any, will be as outlined in Your Table of Benefits. This includes transfers to hospitals, including transfers to ICUs in hospitals which require a higher level of cover than You hold under Your Plan, the level of benefits payable, if any, will be as outlined in Your Table of Benefits. Where a hospital is not listed in the Directory of Hospitals (and Treatment Centres), no benefit will be payable or where a hospital is listed in the Directory of Hospitals (and Treatment Centres) and not covered by Your Plan, no benefit will be payable.
 

Early Riser

Frequent Poster
Thanks Curlyfella.

I don't off hand know the details of the Policy. I do know that it fully covers the treatment (and hospital stay) he has been getting. It must be about 6 months continuous now. If it is 180 days in a calendar year it would mean cover continues until about the end of June. When checking in with my friend I will suggest that she speaks with the hospital administration, as recommended by huskerdu.
 

Tebbit

Frequent Poster
This is interesting - I never knew there was a limit. I thought just like a public patient it would take as long as the illness took.
Can the person transfer to being public once insurance has run out?
 

Curlyfella

Registered User
Exactly, I would never have assumed there would be a limit either! who would?!
I would doubt that one could transfer, seeing as they love to separate private and public.
 

Curlyfella

Registered User
As per layas - generic rules

The maximum number of days of in-patient
treatment and day-case treatment
combined for which we shall pay benefits for
any person in any calendar year shall be 180
less the number of days of such treatment
received by that person during the same
calendar year for which any payment has
been made or is payable under any Health
Insurance Contract. In the case of anyone
who joins or cancels during the year, their
number of eligible days for in-patient or day
case
treatment will be calculated on a pro
rata basis.
 

Curlyfella

Registered User
Irish life - also 180 days! It's not just vhi


https://www.irishlifehealth.ie/IrishLifeHealth/media/Irish-life-Health/pdfs/handbooks/ILH-Health-Plans-Handbook-Jan-2019.pdf

HOW LONG ARE YOUR HOSPITAL COSTS COVERED FOR? You can claim hospital costs under your In-patient Benefits for a total of 180 days in a calendar year (the “Maximum Period”). This Maximum Period includes the number of days for which you can claim hospital costs as a psychiatric patient. The number of days that you can claim as a psychiatric patient is shown in the psychiatric treatment benefits in your Table of Cover. Please note that the Maximum Period includes any days for which you have already claimed hospital costs (including hospital costs as a psychiatric patient) under another plan with us or with another health insurer in a calendar year.
 

Tebbit

Frequent Poster
Has this ever happened to anyone, that you ran out? As we all pay the health levy and taxes possibly you could transfer to the public system? Perhaps under a different consultant?
180 days is not long if you have a serious illness
 
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