health insurance coverage

fisher8181

My wife has been quoted a very high renewal from laya healthcare.

She wants to have maternity cover.

She is afraid that if she leaves laya and becomes pregnant that she would not be covered for the first 6 months.

Is that true.
I find it hard to believe that it is.

keithclancy

You need to check the terms of the policy you are signing up for.

okiss

Once your wife has health insurance for over 2 years she should be covered for maternity as she would have gone through her waiting period.
I would look at the level of maternity cover on her present policy and then look for another policy with similar cover for a cheaper price on www.hia.ie.
Some policies have better maternity allowance than others.

If she moves from Laya healthcare she will need to write to them to cancel her policy and let them know she has moved to x.
When she rings the other company she will need to tell them she was covered with Laya on the policy name since the date she started the Laya policy. I would then confirm with them that she would be covered on the maternity section of her new policy.

I would advise you that maternity cover on any health insurance will NOT COVER THE FULL COST for private maternity. You could have to pay €1000 plus of this cost yourself and claim 20% of this back with the med 2 form.
You need to keep all the receipts to make a claim.

I would tell her that if she goes as a public patient for maternity she will not be charged. I would advise her to turn up 30 to 40 mins before her appointment time so she will be seen quicker. She will get the same treatment and if they notice anything ie high blood pressure ect they will keep a close eye on her.

patsman07

I'm in a similar but more complicated situation.Myself and the wife have health insurance policies from Aviva. When I was buying the policy two years ago I requested that she be put on a good maternity plan because we were planning to start a family. She recently became pregnant and I have just found out that I need heart surgery, went to check the policies and it turns out that I have better maternity benefits than her but Im only covered for 35% of the heart surgery, whereas her policy has 90% cover for the heart op but worse maternity cover.

If I ring them is there any chance they would switch the policies for us? Or is it the case that if they get wind of my upcoming operation they won't let me switch?

28064212

patsman07 wrote: »

I'm in a similar but more complicated situation.Myself and the wife have health insurance policies from Aviva. When I was buying the policy two years ago I requested that she be put on a good maternity plan because we were planning to start a family. She recently became pregnant and I have just found out that I need heart surgery, went to check the policies and it turns out that I have better maternity benefits than her but Im only covered for 35% of the heart surgery, whereas her policy has 90% cover for the heart op but worse maternity cover.

If I ring them is there any chance they would switch the policies for us? Or is it the case that if they get wind of my upcoming operation they won't let me switch?

You'd be in very real danger of having 0% of your heart surgery covered if you switched. Any increase in the level of cover does not include pre-existing conditions, and if you're at the point where you already know you need surgery, it wouldn't be very difficult for the insurer to show it's pre-existing, and refuse any claim

Bakemate

Some slightly misleading advice above. In relation to maternity benefits, your waiting period as a new customer to the market would be 1 year. If you switch plans or insurers you do not serve this waiting period again, but any higher maternity benefits on the new plan would also carry a 1 year waiting period. They will cover you up to the limits of your old plan during this waiting period.

In regards to the poster with the wrong heart cover, the insurer won't switch your plans around without penalty unless you can show they messed up in assigning you the wrong plans in the first pace. All your calls are recorded, so you can ask them to listen to the call recording where you asked for high cardiac cover. If they made a mistake they would be obliged to fix it without applying waiting periods. Ordinarily, if you switch plans to one with higher benefits you would have to serve a waiting period for higher benefits. Aviva, Laya and GloHealth only apply this waiting period when you use the higher benefit for a pre-existing conditions, which would include your heart condition, whichy is why you would need Aviva to admit a mistake so you don't have to serve these waiting periods. If you do have to serve a waiting period, they will cover you up to the limit of the old plan while you're waiting for the higher benefit. There would be no scenario where you would have 0% cover, unless the new plan had 0% cover.
Additionally, if you're saying you have 35% cover, I'm guessing this is for high tech cardiac cover in the Blackrock Clinic, Mater Private and Beacon. These are not the only hospitals that carry out these procedures. You can get anything done in a public hospital for example.

You can read all about switching waiting periods on the HIA's website.

patsman07

Thanks Bakeman,

Since posting I found realised what you just mentioned; that I can get my op done in a public hospital as a private patient.

Whole area of health insurance and public/private cover is confusing.
Basically, as far as I can gather there are 3 health systems for patients: private patients in private hospitals, private patients in public hospitals and public patients in public hospitals.