Aviva Health Insurance Excess

n0brain3r

Hi all,

I've a Level 2 day to day hospital plan for myself, OH and 3 kids.

The OH was quite ill last year and we had numerous A&E, GP, consultant, procedure and scan fees. Some where covered at the time and some where to be claimed at the renewal date.

I submitted my receipts and they sent back the settlement but they calculated the total excess based on their payout for a claim. e.g. I paid €100 for a trip to A&E and they reimbursed €60 but the excess for the year is €250 so they figured I had €190 left and not €150. They applied the same excess calculation for all the receipts no covered under the day to day element of the plan.

Is this how excess would normally be calculated? I thought it was based on what I pay and not the reimbursement amount?

thanks,
nb

n0brain3r

Going by the explanation here http://www.hia.ie/consumer-information/claims-and-excesses/. It may be that they set allowable expenses so of the €100 for A&E they only allow €60 to be used towards the excess?

NuMarvel

That would be correct. Insurers calculate your total out-patient benefit based on the amounts they cover, not what's paid, and then deduct the excess from that.

So if you went to the A&E 5 times, your total benefit would be €300 (5 visits by €60 allowed per visit), less an excess of €250, giving you a payment of €50.

n0brain3r

Thanks NuMarvel I couldn't find it on their site or in the member handbook it just makes reference to excess but not how it's calculated

okiss

When you get your claim back from Aviva take a copy of it all long with the medical expense invoices and fill out a med one form which you can get on the Revenue website.
You may be entitled to 20% of the cost of your expenses back.

n0brain3r

okiss wrote: »

When you get your claim back from Aviva take a copy of it all long with the medical expense invoices and fill out a med one form which you can get on the Revenue website.
You may be entitled to 20% of the cost of your expenses back.

I'm going to submit them ASAP once I get everything cleared up with Aviva.

Quick question the excess on my plan changed this year it's €200 for out patient cover per policy but last year it was €250 per family or €150 per person. For my claim they applied the €250 excess for out patient claims despite them all relating to my wife I've queried it but what do you think as all the out patient claims relate to the OH so the €150 rate should apply?

okiss

If you have 2 adults and 3 children on a policy all health insurance companies will apply the family allowance.

Also Level 2 Hospital with Day to Day with Aviva
cost per adult is €1627.80 and per child is €423.80
You are currently paying €4256.00 a year cover =
2 adults = 3255.60 and 3 children = 1271.40

Have you looked up the Hia.ie website to see if you could get better cover which allows more day to day expenses to be claimed back?
Also I would not be paying for high cover for a child. They will not be seen in the
Mater Private or Blackrock Clinic so don't be looking at plans that include these for children. Also it is possible with all insurance companies to have parents and children on different policies and this may save you some money.

n0brain3r

Thanks okiss I guess that makes sense re the excess it's a pity the guys answering the phone for Aviva aren't more knowledgeable! I've considered changing plans for the kids but my eldest has a serious heart condition and its was such a battle to get her the gp visit card I just left the insurance. Everything for her seems to be covered though private consultant visits, ECG, echo etc I'd always assumed it was the policy?