Sunday Independent (Ireland) - Business & Appointments - - FRONT PAGE -

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.

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