Ciara O'Kelly Health insurance Article

Health Insurance considerations for those considering switching their cover;

The key consideration when either joining or switching your health insurance is to make sure that the accommodation cover meets your requirements. Always ask the insurer or advisor to explain the following to you;

• how the new plan compares to your previous cover
• which benefits are you losing and which benefits are you gaining
• are there any upgrades in your cover and if yes, are there any upgrades rules that you need to be aware of
• similarly, if you are downgrading your cover, you need to understand how long you might have to wait before this can be reinstated
• if you are a new member, you need to understand the waiting periods that apply
• f you are an existing member and are switching to another insurer, you need to understand that any unserved portion of your waiting periods will be carried forward to the new insurer as well.

Below are some additional points worth considering;

• Make sure that your policy carries a comprehensive level of hospital accomm. cover. Ideally, it should include the following;
  • private accommodation in a public hospital
  • semi-private in all private hospitals (no more than 5 in a ward)
  Ideally, your plan will also cover you for day-care procedures and certain complex cardiac procedures in the three high-tech facilities, i.e. Blackrock Clinic, Mater Private and the Beacon Hospital.
• Now more than ever, it’s essential that you confirm with your insurer what terms / conditions might have changed on your policy since your last renewal. If you renew on the same plan even paying a higher premium, your cover may have changed compared to the previous insurance period. For example;
  • some insurers now lock you into annual contracts which means that you cannot amend or cancel your cover mid-term. If you try to do this, you may be subject to financial penalties;
  • two insurers have now introduced ‘Restricted Illnesses’ on many of their mid-range plans. This means that you may no longer be fully covered for certain orthopaedic or ophthalmic procedures that are carried out in private hospitals;
• If you are thinking of upgrading your hospital cover, please be aware of the following;
  • taking out cover for a private room in private hospitals will cost you more in terms of premium, but you are not guaranteed to get your accommodation preference. This depends purely on availability at the time of admission. Therefore, it this is not a priority for you, don’t spend extra money needlessly;
  • all three insurers apply upgrade rules in these scenarios which means that you will not be able to use the higher level of cover for any pre-existing conditions for between 2-5 years depending on your age. One insurer will also apply a waiting period for any upgrade even for any new conditions that present after the upgrade. The key message here is to establish exactly what the upgrade will cost and how long you will have to wait before the additional cover will commence.
• Now is probably a good time to consider adding ‘Day-to-Day’ cover to your plan. This is designed to give you refunds on your routine medical expenses such as GP visits, certain routine dental costs, consultant fees etc. Typically, the insurer will refund you approximately 50% of the cost subject to certain limits. Once again, you should establish the following before adding this to your policy;
  • how much extra will this cost. You may decide that your average expenditure will not give you a sufficient refund to justify the additional premium;
  • how long will you have to wait before the additional cover kicks in. All three insurers treat cover for these expenses differently, so check this out before committing to anything.
• Always monitor your payments to your insurer to prevent any break in your cover. You want to avoid a situation where your cover may have lapsed for more than 13 weeks. In this situation, your insurer would be entitled to treat you as a new member irrespective of the previous length of time insured. In this scenario, you may have to re-serve all of your waiting periods.
• Finally, always shop around at renewal to see what the best deals are. Once you’ve served all of your waiting periods with one insurer, all others must take you on with no new waiting periods assuming you’re not upgrading your cover.