VHI PLAN .... Annual Excess

B

bgengine

Registered User
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Hi,

This is a quick question on claiming annual Outpatients expenses... I've already contacted VHI but I want to know if anyone here has claimed back Outpatients expenses under the above policy and how the annual excess comes into play.

Example:

IN the year my family had the following expenses:

GP visits 2 @ € 60 each = €120
Consultants Visits 2 @ €80 each = €160
Osteopath Visits 15 @ €60 each = 900

Total I spent was €1,180

VHIs PLAn B says that I could claim €13 back per Visit. Assuming I could claim the €13 for each of the visits above ( 19 visits - including GPs, consultants and Osteopaths) Thats a Total of €247...

My question is where or how is the Annual excess ( in my case - €500) worked into this what would I expect to actually get refunded ?
What is epoples understand of Annual Excess ?

thanks
 
Is it not covered in T&Cs of that policy? We're on Family Plan Plus and the annual excess for day to day claims is €1. So other than the first claim when €1 is deducted we get €20 back on each GP visit, €60 on each consultant visit, €60 (?) for A&E admission charges etc. For what it's worth you can also file multiple day to day medical expense claims throughout the year as the expenses arise rather than waiting until the year end. Obviously the relevant excess is only deducted once in any one (policy?) year.
 
Thanks Clubman ... just to clarify

By your explaination of your Family Plan annual excess ( €1)
Then if you had 3 visits to a GP @ €60 each

how much would expect to be refunded ?
 
What plan are you on? You get more per visit to consultants and also Ostepaths rate is different. Ring up the VHI - the people they've on the phones are very helpful and can talk you through it
 
I'm on Plan B ... my query is how the Annual excess is calculated..
The annual excess is €500 ( for family)

Ignoreing the consultants visits ( to keep it simple) I can claim back €13 per visit to GP and Ostepath Visits ( both are classed the same ) but this is subject to the annual excess ...
Between GP and Ostepaths I have paid €1,020 in expenses..
By the definition I thought annual excess meant I would have to pay in excess €500 (which I was - I paid €1,020) before I was eligable to claim expenses.


From what I'm told ( by VHI) I'm not eligable to claim any of this back because it does not exceed the excess... When I asked for clarification on the term Annual Excess they said it is the total sum of "eliglable" claims ( ie: 13 X no of visits). My total falls far short of the €500 .. even if I add in eligable claim for the 2 consultants visits.

So In theroy I would have to vist the GP 39 times ( 39 X €13) in the year (spending over €2,300) before I meet the eligable annual excess €500) and could make a claim.

Who goes to a GP 39 times a year and if they did their refund per visit is be very small (€13) ... Plan B seems a very poor plan for outpatient cover

Am I correct or am I making a mistake - can anyone clarify ?
 
bgengine said:
Who goes to a GP 39 times a year and if they did their refund per visit is be very small (€13) ... Plan B seems a very poor plan for outpatient cover

Am I correct or am I making a mistake - can anyone clarify ?
Click to expand...

VHI Plan B is mainly a hospital cover plan, covering in-patient expenses. Its not designed for good outpatient day-to-day medical expenses. You would need a plan specifically designed for day-to-day medical cover such as Lifestage choices, HealthManager (Quinn) or a cash plan from HSF. These plans usually have no excess.
 
bgengine said:
Thanks Clubman ... just to clarify

By your explaination of your Family Plan annual excess ( €1)
Then if you had 3 visits to a GP @ €60 each

how much would expect to be refunded ?
Click to expand...
3 x €20 - €1 = €59 for the first claim in the relevant year on Family Plan Plus anyway.
 
bgengine said:
Hi,

This is a quick question on claiming annual Outpatients expenses... I've already contacted VHI but I want to know if anyone here has claimed back Outpatients expenses under the above policy and how the annual excess comes into play.

Example:

IN the year my family had the following expenses:

GP visits 2 @ € 60 each = €120
Consultants Visits 2 @ €80 each = €160
Osteopath Visits 15 @ €60 each = 900

Total I spent was €1,180

VHIs PLAn B says that I could claim €13 back per Visit. Assuming I could claim the €13 for each of the visits above ( 19 visits - including GPs, consultants and Osteopaths) Thats a Total of €247...

My question is where or how is the Annual excess ( in my case - €500) worked into this what would I expect to actually get refunded ?
What is epoples understand of Annual Excess ?

thanks
Click to expand...

This is how your out-patient claim would be assessed on Plan B:

GP Visits: €13 x 2 = €26
Consultant visits: €39 x 2 = €78
Osteopaths: €13 x 15 = €195

Total Claimable: €26 + €78 + €195 = €299
Less out-patient excess of €500

Refund: €0.00

Plan B covers €13 per visit for GPs and osteopaths and €51 per visit for consultants, subject to the out-patient excess. Two things about osteopaths, they must be recognised by VHI and VHI will only allow a max of 12 visits per person in the year. I'm presuming the 15 visits were for 2 or more people but if not, it would reduce the amount claimable. Not that it really matters in this case I guess, but no harm being thorough.

As you say yourself, Plan B (and the competitor equivalents) is a poor plan for out-patient cover. You might be better off with VHI's Family Plan Plus/Company Plan Plus or QUINN's CompanyCare/FamilyCare. Hibernian also have a combined hospital/out-patient product called biz plan plus. It does depend on your own circumstances though and the kind of hospital cover you want as well, because not all of these are identical to Plan B. (And despite what the names might imply, anyone can join any of those plans).

Don't forget though, if you're a PAYE worker, you can claim some tax relief back on the GP and consultant costs,
 
Thanks Guys for the explaination and clarification.....

I have already switched to Family plan plus this year .... the expenses I mentioned were for last year - when I was on Plan B.
I am also in the process of reclaiming some tax relief on these expenese but thought I might get some few pence from the VHI .. but was stunned when I got nothing.... Personally I think the way the "excess" is calculated is unecessarily confusing and could be misleading ... It would be better and less complicated to have the excess represent the minimum expense incurred before being eligable to a refund... this is the way I interpeted it at first (and most other prople I spoke to) until I read the fine print ...
Anyway ......another lesson learned ...

thanks for the clarification...
 
There are different excesses on some plans for different categories of expense - e.g. the €1 annual excess on GP and other day to day medical expenses versus other/higher excesses on other categories of expense/claims. You need to read the policy terms & conditions carefully to figure these out and make sure that a specific policy covers your needs. The consumer information on www.hia.ie might be helpful in this context.
 
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