While most people will shop around for car or house insurance, we are far less likely to do so for our health insurance. Changing a plan or provider means getting to grips with what we’re actually covered for and what we’re not. Many of us live in blissful ignorance until the time comes where we need to hand over a policy number and we cross our fingers hoping that we are covered. But you are more important than your car.
Health insurance is not an easy topic to take on, but it is worth setting aside time annually to review your options. Not only will you become more familiar with the terminology, making it easier each time, but as your needs and financial situation changes over the years, your cover should adapt too.
Thankfully, free, impartial help is at hand. The Health Insurance Authority (HIA) is a government body that is a statutory regulator of the private health insurance market. Through its online Health Insurance Comparison tool, email service and phone line, you can cut through the noise to compare the benefits and prices of all private health insurance plans available on the Irish market, including corporate plans.
We caught up with a consumer affairs specialist from the HIA to get the answers to some commonly asked questions.
Peoples’ circumstances, particularly with Covid-19, have changed. Some will be looking at cancelling their health insurance, and insurers have allowed for certain circumstance changes for people who have lost their jobs or are on reduced hours. If you are up for renewal, finding it hard to make payments or finding it very expensive, now is the time to take a look at your health insurance and contact your insurer.
Close to 50 per cent of policy holders are up for renewal during the next three months. Think of the long-term and the year ahead. People often reduce the level of cover for their children or young adults as they might not need the same level of cover as adults. That’s something a lot of people don’t realise - many think policies are family plans and that everyone has to have the same cover, but that’s not the case. Everyone is priced individually; look at everybody’s needs; you can be on different plans but on the same policy. Kids and parents might be better served with different insurance providers, so you’ll have different policy numbers but the renewal date will be the same.
For any other inpatient cover, if you are upgrading and you have a pre-existing condition, you will have a two year waiting period for the higher level of cover. So if you’re going from a 90 per cent cardiac cover to full cover, the difference will be subject to a two year upgrade rule. If you’re upgrading and you don’t have a pre-existing condition that would relate to the higher level of cover, you’ll get the higher level of cover right away.
Maternity cover is a minimum benefit on all plans. However, many plans may not have full maternity cover which will be important if you want to go semi-private or private with a pregnancy. Anytime anyone is changing their level of cover, you need to be vigilant of the waiting periods that will apply while changing, and that would apply in the future if you were to change back. Maternity has its own waiting periods; it is 52 weeks for any higher level of cover.
Many people don’t realise fertility treatment may be covered on your policy. Fertility treatment is a relatively new benefit, and policies may give you a benefit towards certain tests or procedures. Fertility cover has its own waiting period which can be up to 104 weeks. If you are considering starting a family in the near future it may be something to consider when renewing your policy.
Your excess is a fixed amount that you have to pay if you make a claim. Consumers should look to see if their plan has an excess. Changing an excess, or choosing a plan that has an excess if your plan does not, can help reduce the cost of your premium. Having an excess of €200 means you’ll pay the first €200 – any charge above that amount your insurer will pay.
It’s easy to be caught out on the cooling-off period. If you are changing or thinking of changing, you have 14 days from the date of the renewal. So if your renewal is the 1st, you have until the 14th, not the 15th.
No, insurers have to provide cover. However, a waiting period of two years will apply for pre-existing conditions.
What matters is the level of cover you’re on. If you’re someone who has high blood pressure or if you have a particular cardiac condition, focus on the cardiac part of your policy and make sure you have good cover in the high-tech hospitals. They have the ability and technology to deal with more complex conditions.
Be wary of saving €100 on your policy if it means you lose access to the high-tech hospitals, and watch out for changes to co-payments. If you go from full orthopedic cover to a co-payment, then if you have osteoarthritis or rheumatoid arthritis, you might now have to pay something towards orthopedic procedures that you didn’t previously. It might not be worth the initial saving.
With Lifetime Community Rating (LCR), people have been prompted to take out health insurance before they are 35 because at 35 a loading will apply. If you’re 34 and below and you take out health insurance for the first time, you just pay your premium. There’s no additional amount.
From 35 and onwards you pay an additional 2 per cent loading on the plan you pick, and the loading increases by 2 per cent every year. So at 35 it is 2 per cent, 36 is 4 per cent, 37 is 6 per cent and so on. The maximum is 70 per cent which applies for 10 years and will then cease to apply.
Health insurance has evolved over the last number of years to include a focus on preventative care. A lot of the plans are introducing incentives, you might get money back if you join a gym or get a Fitbit, or you may be entitled to a benefit towards preventative screening such as cardiac or cancer screenings. It’s all about trying to encourage people to adopt a healthier lifestyle. Many young adults may feel they are not getting value for money out of their health insurance, however newer plans may give additional incentives like physio visits, sports massages and even travel insurance.