Health cover for seriously ill baby?

Q OUR first child was born a few weeks ago and we added her to our private health insurance policy on birth. We recently discovered that she has cystic fibrosis and she will therefore require extensive hospital treatment over her life. Given she was born with this condition, will our private health insurance — which is VHI Family Plan — cover the cost of her treatment and care? Should we upgrade our plan? James, Dublin.

AS you added your newborn baby to your policy from her date of birth, your child is on cover immediately and therefore no waiting periods or exclusions for pre-existing conditions apply.

Note that young children with serious underlying conditions will normally be treated via the public health system. For children under six weeks of age, no charges apply. However thereafter, a fee of €80 per night will be charged, subject to an annual maximum charge of €800 a year (ten nights) — and this is fully covered by the health insurance policy. If your child is eligible for a medical card (which may be the case), no inpatient or outpatient public hospital charges will apply.

Assuming that your child is insured on the VHI Family Plan Plus Level 1, she will be free from her date of birth until the next renewal date of the policy — but thereafter, a charge of €535 will apply. Whilst this is still good cover, it is a dated plan and given the risk of you incurring higher than average outpatient expenses — possibly on a private basis if there are any delays via the public system, I recommend you consider the VHI Company Plan Extra Level 1. This plan costs €423 and it gives far better overall cover — especially for eligible outpatient expenses — but at a lower cost.

Health cover for 60-year-olds

Q

MY parents are in their early Sixties and have asked me to get them signed up to private health insurance. They have never had health insurance before. My mother has never had any health issues. My father has a heart condition which he manages well — but which could cause more problems as he gets older. Their budget is €1,500 each. Can you recommend some plans for them? My father regularly attends the GP but my mother rarely does. Mary, Co Sligo.

THERE are a couple of issues to be considered here before deciding on the ideal plan. The first issue is age loadings: as both your mother and father are over 34 on joining private health insurance and as neither have ever held cover previously, a loading of about 52pc (based on a 60-year-old joining) will apply to the gross premium and this will remain on their policy for the next ten years.

The second issue to consider is waiting periods. All new members have to serve standard waiting periods which means that while accidents are covered immediately on joining, a six-month waiting period will apply to any new conditions that arise after joining — and all pre-existing conditions may not be covered (for inpatient treatment or day case procedures) for the first five years.

Given that the budget is approximately €1,500 per adult and taking into account the impact of the age loadings, we’re suggesting the following plans be considered: VHI One Plan 250 (which costs €926 per adult), Laya Signify Plan (which costs €961 per adult) and Irish Life Health Benefit Access 300 (which costs €907 per adult). Please note, the rates quoted are net of tax relief with no age loadings — once age loadings are accounted for, the cost of these plans will roughly range from €1,400 to just under €1,500, depending on the actual premium.

Covid-19 test covered by insurer?

Q

MY two-year-old son will be getting grommets this spring — in a private hospital. He will have to get a Covid test before he is admitted. I have heard these tests can cost around €250. Will my health insurance cover the test? Tom, Co Louth.

YOU should not be asked to pay up front for any Covid-19 tests in advance of the procedure for your son — due to an agreement which the health insurers reached with each of the private hospitals in mid-2020. Under this agreement, any Covid-19 test required in advance of a hospital admission should be included on the overall claim (for inpatient and day-case procedures only) — and this claim will be submitted by the hospital directly to the insurer for payment.

As with all medical treatment, procedures or scans, contact your insurer in advance with the procedure code, the name of the consultant and the hospital to confirm your exact cover to ensure that everything is fully covered including these Covid tests.

Consultant fees covered for child?

Q

I had to take my child to a hospital’s emergency department a few weeks ago over a suspected heart issue. My daughter has been referred to the cardiology unit of the hospital for further investigation. When I called to arrange an appointment with the cardiologist, I was asked if she was to be seen publicly or privately. I opted to get her seen privately. Will our plan — VHI

One Plan family — cover us for our visits to the cardiologist? Karen, Dublin.

WHILST the existing cover on the VHI One Plan Family scheme is well priced at €1,254 per adult and €249 per child, it is not a corporate plan and therefore does not include any guaranteed refunds on outpatient expenses such as GP fees or consultant’s fees. On this plan, VHI will allow €60 per consultant visit to be included in the claim but each member then has to exceed a personal excess of €250 before any benefit is payable — which simply means they have to incur exceptionally high expenses before getting any meaningful return.

We recommend that you first consider an alternative corporate plan from VHI called Company Plan Plus Level 1.3 which at €1,252, is a very similar price for adults as One Plan Family. At €315 per child, the corporate plan is slightly more expensive for children than One Plan Family.

However, Company Plan Plus Level 1.3 provides more comprehensive cover especially for outpatient expenses as each member can claim 50pc refund on a range of eligible costs such as GP, consultant fees, physiotherapy and many more with no excess to pay first (this benefit applies immediately for all members under 50).

If you want increased refunds for your daughter, consider the Company Plan Extra Level 1 scheme costing €423 as this plan gives 75pc back on GP and consultant fees for a slightly higher premium. There is no issue splitting the cover which means that everyone can remain on the one policy but on different plans.

If you’re interested in switching insurer, you could consider the Laya Inspire Plus scheme — which costs €1,286 per adult and €287 per child, or the 4D Health 2 from Irish Life Health at €1,361 per adult and €335 per child. Email your questions to lmcbride@independent.ie or write to ‘Your Questions, Sunday Independent Business, 27-32 Talbot Street, Dublin 1’. While we will endeavour to place your questions with the most appropriate expert for your query, this column is not intended to replace professional advice.