What can I claim on my health insurance?

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What can I claim on my health insurance?

Health insurance policies have evolved in recent years. Having private medical insurance 10 years ago simply meant that you were covered for treatment in a particular hospital and the cost of a procedure or scan would be covered by your insurer. But this has changed. Many health insurance plans now cover you for visits to everyday medical practitioners like GPs, dentists, physiotherapists, and specialist consultants. Even acupuncture and reiki are covered under some plans.

Day to Day Cover

To see if you’re covered for this, check the "Day to Day" or "Out-Patient" cover section on your table of benefits. If your out-patient excess is €1 or €0, you can claim back on these expenses immediately. But if your out-patient excess is over €100, it’s likely you’ll only be able to claim a small amount back.

Online Access

Another change has happened online. All Irish providers now offer access to GPs and other medical professionals online – this is free on some plans. All providers now let you claim expenses back online. This is much more efficient. Instead of gathering all your receipts and sending them to your health insurer at the end of the year, you can submit these as and when you have an expense – refunds are paid within five days.

Unique Benefits

Health insurers are also now creating unique benefits for their members. These include money back on gym membership, sports massage, health screens and travel vaccinations.

Alternative Practitioners

Many people don’t realise that that visits to an acupuncturist, chiropractor, physical therapist or even dietitian may actually be partly covered under their private medical insurance. Recent strides have been made by private health insurers in relation to the coverage of alternative therapy means that the cost of a visit to a homeopathist or acupuncturist might be covered in the same manner as a trip to your GP. Cover for alternative and complementary therapy however varies widely between insurers and plans. While all insurers now include good cover towards the cost of eligible alternative treatments, you need to be on the right plan. Most plans cover popular treatments such as acupuncture, osteopathy and chiropractic care. You'll also get cover on some plans for physical therapy, reflexology, and chiropody. If you are a frequent visitor to any alternative therapist you should speak to a health insurance expert to ensure you are on the right plan for your needs.

How do I claim?

Your health insurance lets you claim for a wide range of benefits, but how you submit your claim depends on what you’re claiming for.

1. Day to Day and Out-Patient Claims

These are claims for benefits such as GP, consultant visits, and other treatments where you’re not admitted to hospital.

They can be submitted in one of two ways – online using Scan and Claim or by posting your original receipts to your health insurance provider (within 13 weeks of the expiry date of your policy).

2. Hospital Claims

This will be for a procedure in hospital, either a day case or overnight/in-patient stay.

Before the procedure, you should confirm you’re covered with your insurer. To confirm cover you’ll need to provide your insurer with:

1. The name of the hospital

2. The full name of the consultant

3. The unique procedure code (contact your consultant's secretary for this).

During your stay, inform the hospital you have private medical insurance, and complete the claim form (you will need your policy or member number). If your plan has a hospital excess you pay this directly to the hospital.

After your stay – you don’t have to do anything! Your insurer will handle everything and will then send you confirmation of your claim settlement.

How do I know if I'm covered?

Check your covered before your treatment.

Before receiving hospital treatment, it’s very important you check your plan with your insurer to make sure you’re covered for that procedure.

To confirm cover you’ll need to provide your insurer with

  1. The name of the hospital
  2. The full name of the consultant
  3. The unique procedure code (contact your consultant's secretary for this).

Once you’ve served all applicable waiting periods, your insurer will be able to confirm cover and if any excess is payable under your plan. If the procedure is fully covered under your plan, your health insurer will settle the claim directly with the hospital on your behalf.

If you are referred for a scan, ask your health insurer where your closest 'approved centre' is. This is important – if you attend a non-approved centre, you may not be covered.

So always check your policy before undergoing treatment!

What is an excess and how does it affect me?

Most health insurance plans carry excess amounts of different types and sizes

1. In-patient excess

This is the first part of the claim you will need to pay yourself for an overnight stay in a private or hi-tech hospital. Your insurer will pay the rest. If you are being treated in a public hospital you don’t need to pay any excess.

2. Day case excess

Again, this is the first part of the claim you will need to pay yourself but it is only payable when you’re being treated in a private or hi-tech hospital, and not staying overnight (for example a wisdom tooth removal or colonoscopy).

3. Out-patient excess

This differs from the other excesses, and can be confusing. Instead of being the first part of the claim you pay before cover kicks in, it’s the threshold which you must exceed in claimable expenses before you are eligible to claim. Treatments that can carry outpatient excess include A&E, GP visits, consultations and scan cover. The lower your outpatient excess, the more likely it is that you’ll be able to claim back. If you have a number of these expenses you should look for a plan with lower outpatient excess. See table below highlighting the advantage of having a low out-patient excess.

Plan Information sourced from Health Insurance Authority (www.hia.ie), all plan information correct from 01/08/2018. Vhi Healthcare DAC trading as Vhi Healthcare is regulated by the Central Bank of Ireland. Irish Life Health dac is regulated by the Central Bank of Ireland. A private company limited by shares. Cornmarket cannot be held responsible for information contained on third party websites.