Health Insurance - Covered subject to €125 excess per claim?

Duke Leonal Felmet · 09-09-2011 10:56PM #1

What does 'Covered subject to €125 excess per claim' mean?

I see it on health insurance products, but I'm not sure what it means.

This is my first time looking into this, so any other tips would be great.

Thanks.

ted1 · 09-09-2011 10:58PM

You pay the first 125 they then cover the rest. So on a bill for 500 they will pay 375.

Andromeda_111 · 09-09-2011 10:58PM

For each claim the insured (you) will have to pay the first €125 themselves.

Duke Leonal Felmet · 09-09-2011 11:00PM

So obviously that is more useful for expensive procedures. Any other tricks I should be looking out for?

cookie1977 · 10-09-2011 05:21AM

Have a look here for advice:
www.hia.ie

broker2008 · 10-09-2011 05:09PM

Be careful of plans that say €50/€125 excess because in most instances - location dependent - it will be €125.

There are plans that have no excess, €50, €75, €125 and €250 - generally the higher the excess the lower the premium BUT beware of missing benefits excluded from cheaper plans. The hia is merely a guide - these missing benefits might not be obvious on the HIA !

cookie1977 · 10-09-2011 07:57PM

I have to say that the HIA website is first class for comparing plans. There is so so so many plans available to people it's actually insane and a minefield. i dread every December when I have to trawl through all of them again to find the best one for me.
Remember you can take any plan the insurer offers, including plans that sound specific to a particular company or sector (teachers/nurses). This is by law permitted but not fully evident to users landing on any of the insurers sites. Some of these plans can be better then the standard consumer plans but they may have a slightly higher excess. Sometimes excesses are worth taking for the services or prices offered. Dont discount a plan because of a high excess. Always look deeper.

Think of the annual price you want to pay and start comparing the plans that cost that to see what suits you best.

broker2008 · 10-09-2011 08:03PM

Why wait until December to renew your plan? There are better plans and better prices available at other times of the year that don't have the same exclusions that are available in December !

cookie1977 · 10-09-2011 08:04PM

I dont renew until February but I start the search in December.

broker2008 · 10-09-2011 08:06PM

In some instances you won't be aware of the best deals until the month before or the day of !

cookie1977 · 10-09-2011 08:10PM

Of course but I have to make some sort of plans in advance of renewal. Reading T&C's takes time and as long as I'm happy with the deal I get the day I take the deal then that's fine. I cant get upset over a better deal the day after as I didn't know about it.

broker2008 · 10-09-2011 08:17PM

Ask me or PM me in February and I'll try and assist.

cookie1977 · 10-09-2011 08:18PM

Thanks for your help but I think I'll be ok

Stinicker · 10-09-2011 11:41PM

My mum switched to Aviva on New Years Day, she took ill early in the year and her health insurance has paid out over €30k so far, however my dad and her pay around €1200 a year for the two of them and she has had to pay out the €125 excess multiple times and their health bill has easily gone over the €3k bill with her paying more in excess charges than the actual insurance itself.

They switched from VHI as my fathers company insurance moved enmasse over to Aviva and she hadn't claimed off VHI before this year for several years. She is now thinking of switching back so I wonder do VHI charge the excess also or would the same thing have happened also if she was with VHI? She was to see many different physicians, into different hosptials and had dozens of checks and tests done;

we are all of no doubt I'd be visiting her grave today had she not had private health coverage but you don't have a clear idea of what your health coverage is going to properly cost with this stupid excess system, people are paying through the nose already besides have to pay even more. Thankfully my mom made a good recovery and is back to work and all now but Aviva we feel has left her down badly with this addon charging.

Is there any insurer that doesn't have these excess charges ontop of it?

No.2 · 11-09-2011 12:16PM

Stinicker wrote: »

My mum switched to Aviva on New Years Day, she took ill early in the year and her health insurance has paid out over €30k so far, however my dad and her pay around €1200 a year for the two of them and she has had to pay out the €125 excess multiple times and their health bill has easily gone over the €3k bill with her paying more in excess charges than the actual insurance itself.

They switched from VHI as my fathers company insurance moved enmasse over to Aviva and she hadn't claimed off VHI before this year for several years. She is now thinking of switching back so I wonder do VHI charge the excess also or would the same thing have happened also if she was with VHI? She was to see many different physicians, into different hosptials and had dozens of checks and tests done;

we are all of no doubt I'd be visiting her grave today had she not had private health coverage but you don't have a clear idea of what your health coverage is going to properly cost with this stupid excess system, people are paying through the nose already besides have to pay even more. Thankfully my mom made a good recovery and is back to work and all now but Aviva we feel has left her down badly with this addon charging.

Is there any insurer that doesn't have these excess charges ontop of it?

The legislation mandating the minimum entitlements contained in health insurance contracts (the Health Insurance Act, 1994 (Minimum Benefit) Regulations, 1996, as amended) explicitly allow for excesses up to a certain amount in all plans (see regulation 7(a) on outpatient excesses for example), and all the insurers seem to take advantage of these in some way or another. Even the best plans will have some degree of an excess / maximum claimable amounts to at as a disincentive for high use of services / claiming.

broker2008 · 11-09-2011 04:26PM

The €125 excess is per claim in private and high tech hospitals but none in public hospital.

Depending on the plan you switched from VHI and when it was, the reduction to the company in premiums might have been as much as 50%.

If you switch to a plan with no excess with Aviva (or Quinn or VHI) they will charge you the same excess for 2 or 5 years depending on her age.

Business plans or Quinn plans with excesses are not necessarily suitable for everyone as I have previously posted.

Some journalists have in the past suggested company plans as better alternatives to VHI Plan B yet without realising that there can be a downside and then found out that there is big price increase down the line.

http://www.irishtimes.com/newspaper/ireland/2011/0616/1224299001758.html

Advice is more important than one thinks rather than looking at bottom line price. This is the case in health insurance, motor and household insurance plans especially if bought off a bank or internet websites. Spend some time and read the t&c's and be aware of what happens if...:pac:

Excesses will become more and more a part of the Irish health insurance market as the insurers to keep premiums lower.

bigsaver99 · 22-09-2011 10:30PM

cookie1977 wrote: »

I dont renew until February but I start the search in December.

Unless you are with vhi the best advice I can give you is to call and advise you wish to change your renewal date in December to be for December the following year and you will avoid the new year price increases, There will still be an increase on last years price but it wont be as high if you do this. Aviva normally increase in March Vhi in february and Quinn in January but a lot of people would do this in december

NuMarvel · 23-09-2011 01:41PM

bigsaver99 wrote: »

Unless you are with vhi the best advice I can give you is to call and advise you wish to change your renewal date in December to be for December the following year and you will avoid the new year price increases, There will still be an increase on last years price but it wont be as high if you do this. Aviva normally increase in March Vhi in february and Quinn in January but a lot of people would do this in december

Unfortunately, I don't think that holds true anymore. Insurers are increasing the costs of different products at different times in the year. For example, I switched to one of Quinn's company plans last December and that's had two price increases since then; one in March and one this month. VHI and Aviva are doing the same.

This might be just a once off, and health insurers may move back to just one price icnrease per year. But with the sheer amount of plans on the market, I don't think insurers will wait until their "traditional" price increase time to raise the price of a plan if they think they need to do it.

loopymum · 04-10-2011 10:40PM

broker2008 wrote: »

The €125 excess is per claim in private and high tech hospitals but none in public hospital.

Depending on the plan you switched from VHI and when it was, the reduction to the company in premiums might have been as much as 50%.

If you switch to a plan with no excess with Aviva (or Quinn or VHI) they will charge you the same excess for 2 or 5 years depending on her age.

Business plans or Quinn plans with excesses are not necessarily suitable for everyone as I have previously posted.

Some journalists have in the past suggested company plans as better alternatives to VHI Plan B yet without realising that there can be a downside and then found out that there is big price increase down the line.

http://www.irishtimes.com/newspaper/ireland/2011/0616/1224299001758.html

Advice is more important than one thinks rather than looking at bottom line price. This is the case in health insurance, motor and household insurance plans especially if bought off a bank or internet websites. Spend some time and read the t&c's and be aware of what happens if...:pac:

Excesses will become more and more a part of the Irish health insurance market as the insurers to keep premiums lower.

That is an interesting article as I have just switched to PMI 06 11 from the Corporate Plan which increased by €126 to €852 since last year, I got the PMI plan at the €711 rate

broker2008 · 05-10-2011 05:05PM

What was and what is your renewal date now?

loopymum · 05-10-2011 05:40PM

broker2008 wrote: »

What was and what is your renewal date now?

Was that for me?

My renewal is 1 October and I have the 3 kids on the free one plus plan, I have till 14 Oct to make changes.

A question for you, the pmi 06 11 policy states for a semi private room in a private hospital that there is €75 excess, is that per night or per stay?

broker2008 · 05-10-2011 10:36PM

Per claim

mambo · 17-01-2012 06:59PM

Andromeda_111 wrote: »

For each claim the insured (you) will have to pay the first €125 themselves.

I'm on Quinn Essential Plus Starter, with an excess of €125 "per claim" for St Vincent's Private. I naively thought "per claim" effectively meant "per year" (assuming you put in a "claim" at the end of the year) but it effectively means "per visit".

So if you are in the hospital for a week, you pay the first €125, Quinn covers the rest. But if you are discharged, but have to come back the next day for more treatment, that's a NEW claim, and another €125 excess applies!

I'm getting a series of four treatments, once a week, so I will have to pay the first €125 of each one

I believe the VHI "excess" works the same way.

So be warned!

bigsaver99 · 18-01-2012 12:36AM

Hi Mambo,

It will depend on what type of treatment you are having. For instance if it is for chemotherapy the x/s is only once per year or for something like haemochromatosis where blood has to be taken regularly. Unfortunately if it is pain relief injections or something like that you will have to pay for each daycase or out patient surgical admission, J

mambo · 18-01-2012 11:47AM

bigsaver99 wrote: »

Hi Mambo,

It will depend on what type of treatment you are having. For instance if it is for chemotherapy the x/s is only once per year or for something like haemochromatosis where blood has to be taken regularly. Unfortunately if it is pain relief injections or something like that you will have to pay for each daycase or out patient surgical admission, J

Thanks for the info. Are the differences such as the above spelt out anywhere by Quinn and the other insurance providers? How are you supposed to know whether you will have to pay an excess each time?

NuMarvel · 18-01-2012 12:09PM

Your policy documentation usually sets out how your cover works, so it should be mentioned there. Quinn's information says the excess applies per claim, and further on, in the section about cancer treatment it says the excess applies "per condition, per membership year". Quinn's policy book also has a summary of the claims process at the front, and suggests contacting Quinn before any treatment to confirm cover.

bigsaver99 · 18-01-2012 06:15PM

NuMarvel is spot on, and always make sure you call before you have any hospital treatment.

Health Insurance - Covered subject to €125 excess per claim?

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