How to keep health cover during US stay

QOUR 28-year-old daughter is about to be posted abroad to the United States for two years by her employer. We have always had her insured on our VHI policy and want to make sure that she retains quality cover whilst away — but that she doesn’t have to re-serve her waiting periods all over again on her return to Ireland. What is the best course of action? Maureen, Co Kilkenny FIRST, you should consider full international cover for your daughter. These policies offer comprehensive medical cover for extended stays abroad, whether one is travelling or relocating abroad temporarily. They can be expensive but the premium reflects the risk associated with medical costs outside of Ireland — especially for those travelling to the United States. This cover is available from the likes of Allianz Worldwide Care, Bupa International, Cigna and Aviva International, but I recommend that you first engage with VHI International.

As well as offering competitive terms and conditions, VHI International will allow you to transfer seamlessly from your domestic VHI policy to the international plan with no break in cover. More importantly, on your daughter’s return to Ireland, you will be able to transfer her back to domestic cover from VHI with no break in cover. At present, health insurers are under no obligation to recognise international cover whilst abroad for the purpose of waiving waiting periods on returning to Ireland — and this gives the VHI International product a distinct advantage.

I also recommend that your daughter’s employer engage with VHI International as it may be possible to set up a group scheme with discounts and enhanced benefits for her and other employees travelling abroad.

Fears over changing insurer

QWE are an elderly couple in our 70s with private health cover. We need to reduce our costs but are reluctant to change our private health insurance policy for fear of losing benefits. If we do change, are we fully protected by the healthcare legislation and what are the consequences for us if our health insurer decides to cease operations in Ireland? Jimmy, Monkstown, Co Dublin THE first point to note is the protection offered by the health insurance legislation.

Open enrolment means that all insurers must accept everyone irrespective of age, gender or medical history. Lifetime cover means that your insurer must renew your cover at each renewal regardless of how many claims have been paid — or whether further treatment is pending. Community rating means you will pay the same premium as a healthy 26-year-old for the same cover.

This means that you get full credit for the time spent with your previous insurer(s) and once you switch from your renewal date, there will be no break in cover.

If you are switching to an equivalent plan with another insurer, such as where both plans cover the same hospitals, there will be continuity of cover irrespective of your medical or claims history. For example, let’s assume your renewal date is September 1 and you’re due to have a hip replacement on September 2. Should you change to an equivalent (lower cost) plan with another insurer from your renewal date, your claim will be paid. The only questions that matter to the new insurer are: what plan are you currently on (this determines your existing standard of cover); and how long have you been insured on this plan (this determines if you have already served all your waiting periods).

In the unlikely event that an insurer ceases operations in Ireland, the legislation allows you to transfer seamlessly to any of the remaining insurers with no break in your cover.

With health insurance, you should always shop around prior to each renewal, and if you find a better deal, don’t be afraid to switch.

Best way to reinvest saving

QWE are a couple in our late 50s and have always had a good standard of health insurance, which has covered us for up to semi-private care in private hospitals. Our eldest child has now switched onto their own policy, which saves us about €1,500 a year. We are thinking of reinvesting this saving in better overall health cover for us. What benefit enhancements might be worth considering if we do this? Marie, Inchicore, Dublin 8 SPENDING more money on health insurance doesn’t always equate to better cover. A needsbased analysis is important to try and match the cover to your specific requirements.

Based on the cover details provided, there are a number of scenarios where it may make sense for you to increase your cover. For example, if you would like access to private accommodation in private hospitals (if available), a cover upgrade makes sense. If you have an excess (the first part of a claim you must pay yourself ) on the existing plan, but your preference going forward is for no excess, this is another valid reason for increasing your cover. If the current plan has restricted cover for certain orthopaedic or ophthalmic procedures, then an upgrade in cover may be worthwhile to remove these restrictions.

If you would like full cover for the high-tech facilities which are available in the Blackrock Clinic and Mater Private, then an upgrade may be necessary. However, €1,500 may not be sufficient. If fact, you may need to double this figure to achieve this standard of cover for both of you.

Finally, many members consider upgrading their health insurance if their existing cover for outpatient or day-to-day expenses is inadequate. Customers need to be careful here to ensure that any extra cost incurred by the change of plan will be more than offset by the expected increase in refunds over the insurance period. Also, before spending more on core health insurance, you should also consider other complementary benefits such as dental cover or cash plans.

Public hospital warning

QWE are a young couple with good private health insurance which we are finding quite expensive. Given that we are in good health, we are thinking of reducing our plan to cover public hospitals only as we can always increase it again in the future. This means we still won’t have to pay any age loadings. Is this wise? Tina, Cork City YOU need to be very careful here. You are correct in that age loadings will not apply if you reduce to public hospital cover only. However, to have a decent standard of health insurance cover, you need cover for all private and public hospitals.

It is becoming increasingly difficult to access services privately in public hospitals and if you are referred to a specialist in a private hospital, you will have no cover — or potentially significant shortfalls — to pay. In terms of access to treatment quickly, you may find simple diagnostics such as MRIs and endoscopies may be available within days in a private hospitals compared to longer wait times in a public hospital. For certain treatment (especially relating to orthopaedics), it can be difficult to access this privately via the public system but these are widely available in all private hospitals such as the Beacon and Hermitage. Bear the upgrade rule in mind. If you reduce cover and upgrade in the future, you will have to wait two years before the additional cover commences for any pre-existing conditions. So if you have no option but to reduce your cover, I would advise you to upgrade again at the earliest possible opportunity.