you tell me what cardiac, orthopaedic and ophthalmic procedures co-payments typically arise on? My husband and I are both in our fifties and our children are in their teens. We are currently all insured under VHI’S Health Plus Extra plan. To save money, I’m considering moving the family onto VHI’S cheaper One Plan Family plan — but I’m concerned about co-payments as there is a history of heart illness on my side of the family, and my husband has ongoing hip pain. Margaret, Cavan town THERE are a number of plans on the market which have cardiac, orthopaedic and ophthalmic restrictions in private and high-tech hospitals. These differ with each provider and level of cover. Laya Healthcare offers the best orthopaedic cover — having no shortfalls for replacements on the majority of its plans. Irish Life Health has a list of 10 restricted orthopaedic procedures which carry a co-payment of €2,000. It also has a list of plans which carry a cardiac co-payment in private hospitals — most of these plans are outdated though, so if you are on a plan of this type, it is time to review your cover. These lists are all available to view on the Irish Life Health website.
VHI has a number of procedures which are only 80pc covered in private hospitals. These procedures include orthopaedic and ophthalmic procedures but unfortunately this list is not available to the general public.
You mention that you have your full family insured on ‘Health Plus Extra’. Firstly, you do not have to have your children on the same plan as yourself. There would be no need for a child to be on this level of cover and there are plenty of alternatives which offer more affordable and appropriate cover for children. The high price tag on your existing ‘Health Plus Extra’ plan with VHI is due to the fact that it fully covers cardiac procedures and orthopaedic replacements in private hospitals without any co-payment. Placing your children on a Level 2 plan without this cover will reduce your premium considerably over the year. (Level 2 plans cover a semi-private room in a private hospital).
By moving to ‘One Plan Family’, you would be decreasing your cover for cardiac procedures in high-tech hospitals to 90pc while restricted orthopaedic and ophthalmic procedures will only have 80pc cover. Given your family history of cardiac conditions and your husband’s existing hip problem, I would not recommend moving to this plan. In addition, this plan does not cover Level 2 fixed-priced cardiac procedures, so while the €1,200 saving may seem attractive, this could end up costing you in excess of €40,000 if you required one of these cardiac procedures in the future. (In this case, Level 2 is one of the two levels which VHI splits listed cardiac procedures into. These lists are common cardiac procedures which take place in the high-tech hospitals.)
Another important point to note is that if you were to downgrade your plan and wish to increase it again in the future, you would have to serve a two-year waiting period for the increased benefits if you have an existing condition at the time of the upgrade.
If you find yourself on a policy with a shortfall or co-payment, it is always worthwhile to check in with the hospital. Many of the private and high-tech hospitals often waive these shortfalls — though this won’t always be the case.