Timing of VHI claim - covered or not?

54and56

Hi all,

A family member has VHI cover for himself, his wife and two kids as part of his salary package. His son had a foot related problem earlier in the year which was referred by his GP to a surgeon who operated and all worked out well. VHI picked up the tab.

The parent is starting a new job with a new company Feb 1st who offer a similar level of cover but with Aviva so his VHI cover will cease on Jan 31st. The son who had the earlier operation has developed the same problem on his other foot. The likelihood is if he goes to his GP he will once again be referred to the surgeon for the same procedure but if he goes to the GP this week the the operation won't take place until after Jan 31st.

In the above situation which healthcare insurer picks up the tab? Will VHI pick up the tab because the claim started prior to the end of the cover period i.e. Jan 31st or will Aviva pick up the tab if the actual operation happens after Feb 1st?

LostArt

If the operation is before the 31st it's VHI and after the 31st it's Aviva.

54and56

LostArt wrote: »

If the operation is before the 31st it's VHI and after the 31st it's Aviva.

Crap!! I can see that being a complication with Aviva. Might make sense to wait until Feb for the GP referral and start the whole process under Aviva cover.

LostArt

It'll make no difference to Aviva whatsoever, they'll just need proof of previous insurance

Brian201888

Je_suis_Jean wrote: »

Crap!! I can see that being a complication with Aviva. Might make sense to wait until Feb for the GP referral and start the whole process under Aviva cover.

Zero complication, it's literally as simple as bills incurred during vhi time paid by them bills incurred during Aviva time paid by them.

54and56

Would a procedure which is "work in progress" not have to be declared to Aviva when joining them? I'm thinking that sometimes insurance companies won't provide cover for pre-existing conditions or for events which are not unforseen at the time cover is taken out. Why would Aviva (or anyone) agree to accept premiums of e.g. €2,000 when a claim for €7,000 is already known about and ready to land on their desk?

LostArt

because they have to. It's as simple as that.

coylemj

Je_suis_Jean wrote: »

Would a procedure which is "work in progress" not have to be declared to Aviva when joining them? I'm thinking that sometimes insurance companies won't provide cover for pre-existing conditions or for events which are not unforseen at the time cover is taken out. Why would Aviva (or anyone) agree to accept premiums of e.g. €2,000 when a claim for €7,000 is already known about and ready to land on their desk?

By law you don't lose cover for a pre-existing condition if you move seamlessly with no break in cover from one medical insurer to another.

If there is a break in cover then, depending on age, there will be a waiting period (longer if you're older) during which the new insurer doesn't have to cover you for pre-existing conditions.

3DataModem

That's why it's critical never to have a break in cover. The above posters are correct, new insurer will have to pick up the tab.

Oral Surgeon

Agree with the above.
If you apply the same logic, why would Vhi keep you covered for another 2k when they know the operation is coming.... That's the game....