VHI renewal and claim

masterboy123

Hi,

We are a couple (under 35), and our VHI (PublicPlus Care Day-to-day) is due next month. It's costing us €1026 annually for both.

1. Is it true that we may get a better rate if we switch? We don't have any health issues and are happy with what VHI provides.

2. We have a healthy toddler. Is it advisable to add them to your private health insurance?

3. If we make a dental claim, will it effect premium for the following year?

Thanks 🙂🫁

coylemj

1. Is it true that we may get a better rate if we switch? We don't have any health issues and are happy with what VHI provides.

You may be happy with what VHI is providing now but do not assume that the same scheme will provide the same benefits next year, if you renew. It can happen that they water down the benefits so if you stay on the same plan, you might pay the same premium but could have reduced benefits. I always download the statement of benefits when renewing, so if I decide to stay on the same plan with the same provider, I can compare this year's statement of benefits with the one from 12 months ago. You need to literally do a line by line comparison so you can spot if they drop some benefits or (for specific procedures) reduce the % they will pay or the maximum they will pay.

Caveat Emptor.

2. We have a healthy toddler. Is it advisable to add them to your private health insurance?

Definitely. If your toddler is diagnosed with a serious but not life-threatening condition, you do not want to join the queue for public services. Add the child to your policy now, do not wait until renewal time.

3. If we make a dental claim, will it effect premium for the following year?

No.

masterboy123

https://www.boards.ie/discussion/comment/119437870#Comment_119437870

Thank you very much. Your advice is very helpful.

Re: adding child to our insurance, is it the same price as an additional adult?

L1011

https://www.boards.ie/discussion/comment/119438581#Comment_119438581

No, it is generally a small fraction of the cost. The price will be available on their website.

masterboy123

I got the following reply that basic private insurance may not be worth it in my case.

Any comments?

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The fee for a public hospital is €80 a night, max €800 in a rolling 12 month period. That's more than 6 days needed per year in a hospital to cross the break even line against the cost of your premium. Private rooms are a rarity in public hospitals and the few that do exist are used based on need eg. Infection control.

You do get a little bit back on day to day. €20 capped x 3 for the like of GP. Usefulness will depend on whether you use these. You do get scans covered, which can be handy. However consultant cover is only €60 and there is a €100 excess before any claim is covered, so that's basically another €100 to add to your premium if you want to use that benefit twice.

Having access to scans and a private consultation without actually having access to private hospital treatment is not all that useful. The benefit is you will get diagnosed earlier but then any treatment they offer you, you're going to have to pay out of pocket or go back to your GP to get a referral to a public hospital and join the same waiting list you would have been on anyways.

Urgent care is covered for 2 visits at €75 all inclusive. This can be very good to have. It is missing the follow up package of other plans for the likes of physio, classes etc

Really the main benefit I can see is the waiting time to upgrade to a private hospital plan and have cover for existing issues is 2 years instead of 5 years if you have no insurance.

For the toddler, it's similar to your own case. The government are currently looking to abolish hospital charges for under 16. Until then if the premium is small it could be handy having it cover any potential hospital stays. However the main benefit ( for getting faster access to common surgeries with long waiting lists) would be in private hospitals for which there is no cover. No cover for VHI paediatric clinic. Cover for urgent care x 2 visits which is handy for potential injuries.

Perhaps you may be better off taking that money and putting into a healthcare pot which you can spend as you need to. Then join a plan again before you turn 35 to avoid age loading.

Or perhaps you could consider upgrading to the lowest cost company plans now eg VHI PMI 5210 or Laya Inspire but this will entail increasing your budget to at least around €1200 per person. €200-350 for a child.

It really depends on how much you want to be covered for any unexpected chronic illness/injury that has a long waiting list in the public system.

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coylemj

OP, I'm not going to attempt to analyze the cover you get in your current plan. The main reason people buy medical insurance is to get access as a private patient to consultants and have at least some cover for treatment in a public hospital. If your plan only covers GP, dental and the €80 per night charge in public hospitals then it's pretty much a 'bare bones' policy and you seriously need to consider an upgrade, especially with a young child.

masterboy123

My story of private health insurance:

I took VHI when I was 32 and, in the same year had an emergency procedure done. I was admitted via A&E and kept in a semi-private room. There were daily investigations and morning consultant reviews.

I was very happy that I had VHI. Because I realised I could have been in another room sharing with six others and where the consultant doesn't see patients daily.

And I paid zero euros. Although the VHI summary indicated, that the total hospital bill was around €5000. That day I decided to continue with VHI.

I do acknowledge that a semi-private/private room may not be available at all times.

coylemj

https://www.boards.ie/discussion/comment/119442619#Comment_119442619

You were admitted via A&E so you got the same medical treatment as anyone else. They may have put you in a semi-private room when you told them you were in the VHI. And you must have been on a better plan back then if the VHI coughed up €5k.

But if it wasn’t an emergency and you were relying on medical insurance, the policy you are on now would have been completely useless since it appears to have no cover for any inpatient procedures. And the maximum annual benefit per person is €850.

masterboy123

https://www.boards.ie/discussion/comment/119442832#Comment_119442832

It was actually only a basic cover back then and now I have upgraded to a level up. I believe if you're admitted via A&E, VHI has to pay for the procedure irrespective of the amount.

Yes, once I mentioned I have VHI, they told me to sign a form and I could move to a semi-private room. I thought that was fair enough.

coylemj

https://www.boards.ie/discussion/comment/119443407#Comment_119443407

If you're admitted via A&E, you wil be treated as a public patient and you do not have to reveal that you have insurance cover. There is a thread currently running on that topic, you recently contributed to it. See my post in that thread: #6.