Health Insurance Health Insurance advice for someone accustomed to NHS free healthcare

Hi @PoundMan

Most of the companies have had a few price increases over the past year so if you want something cheaper you may well lose out on cover. You need to look carefully at the HIA comparisons and on Google get the Table of Benefits beside each other and toggle between the two to compare carefully. You are talking about a difference of approx. €87.21 between the Level 1.3 and 5210.

I had a look at on HIA at Company Plan Plus Level 1.3 and PMI5210 (I personally would rule out 5310 because of the lack of the Urgent Care cover as explained above).

The one thing screaming out on 5210 is it mentions only 60% cover for Ophthalmic and Ortho which is a big difference. While some of the hospitals can sometimes cover the 20% difference I very much doubt they would match 40%.

Like some of the other polices (PMI0710) I see they only cover 90% on 5210 for certain Fixed Price Procedures.

Both policies are restricted to €1,000 on day-to-day.

VHI recommended PMI3513 to me recently for a relative as a good all round policy but the premium would be even more expensive at €1,512.01 :(

Hope I haven't confused you further :)
 
Sue Ellen said:
Hi fizzy,

I actually clarified this with VHI recently for a relative and it can be quite confusing, even the VHI rep agreed with me on that. The way it was explained to me was, that you are covered for the visit to one of the 360 clinics and you pay the €75 fee. You then have to pay for additional stuff like x-ray etc. Dermot Goode actually forewarned people about this in one of his podcasts too. If you check the Table of Benefits for PMI5310 you will notice Section 12 does not contain 'Urgent Care' which most of the other plans do. It does contain full cover for the 360 Health Clinics but not Urgent Care which could mount up.

PMI5310 Section 12 Vhi Core Services, subject to an excess of €75 per visit

 Paediatric Clinic Full cover
 360 Health Clinics Full cover
Click to expand...
Many thanks for this extra info Sue Ellen. It's very confusing alright! We were all set to move to PMI 5310 until we heard this. A relative has found Carrickmines handy for scan referrals from physios etc, and it's a good and more affordable option to have vs private A&Es etc.

The VHI guy told me 5310 is a newer plan that was created for corporates who were specifically looking to exclude that Carrickmines urgent care cover, perhaps due to location etc.
 
Thanks for this feedback folks. I'm based in Westmeath so I'm wondering how big of a factor the Urgent Care cover would be for me. My partner is with Laya and I know she has had to go to their clinic in Cherrywood a couple of times, which was relatively easy to get to from Westmeath as it avoided the city centre area.
 
Sue Ellen said:
The one thing screaming out on 5210 is it mentions only 60% cover for Ophthalmic and Ortho which is a big difference. While some of the hospitals can sometimes cover the 20% difference I very much doubt they would match 40%.
Click to expand...

@Sue Ellen do you think this is an important factor for someone who is only 35 years of age? Dermot Goode was on the Claire Byrne show today and for VHI he recommended the usual suspects in 5210, 5310 and 0710. He also mentioned Company Plan Plus Level 1.3 a number of times so perhaps it is still good value and worth sticking with despite the 16% price hike?
 
Hi Sue Ellen,

Our health Insurance is up the end of Feb, myself and my wife are with Laya Simply Connect and we have a young Adult (19) and a Child (15) who are on Simply Connect plus, last year the policy net was 3780 but this is up to 4430, as our policy is up 230 each, the young adult 125 and child 50.

We require ortho care and dont really want the 20% contribution, likewise I loke to have the full cardiac care, and we have had a low excess on our day to day, as we all play sport so like to have this for physio etc and my son (19) in recent years has had to see a consultant so like to have a reasonable plan,

can you suggest suitable policies to compare our existing ones to to see if there are savings to me made,

Thanks in advance
 
PoundMan said:
@Sue Ellen do you think this is an important factor for someone who is only 35 years of age? Dermot Goode was on the Claire Byrne show today and for VHI he recommended the usual suspects in 5210, 5310 and 0710. He also mentioned Company Plan Plus Level 1.3 a number of times so perhaps it is still good value and worth sticking with despite the 16% price hike?
Click to expand...
Dermot said you need to spend at least €1400 pa for decent cover and company plan 1.3 is just over that.
 
PoundMan said:
do you think this is an important factor for someone who is only 35 years of age? Dermot Goode was on the Claire Byrne show today and for VHI he recommended the usual suspects in 5210, 5310 and 0710. He also mentioned Company Plan Plus Level 1.3 a number of times so perhaps it is still good value and worth sticking with despite the 16% price hike?
Click to expand...

IMHO it is possibly not important @ 35 on the ortho side of the cover, provided you don't do any damage, possibly through sport, but I don't have any medical qualification so can't be 100% sure if I'm correct in that line of thought.

The ophthalmic cover I presume depends on your health with your eyes and if you have problems in that regard or if you suffer an injury.

The 3 recommendations that Dermot Goode makes are probably where people have a particular budget and may well be enough for someone your age.

As mentioned above my preference is:

I had a look at on HIA at Company Plan Plus Level 1.3 and PMI5210 (I personally would rule out 5310 because of the lack of the Urgent Care cover as explained above).

The one thing screaming out on 5210 is it mentions only 60% cover for Ophthalmic and Ortho which is a big difference. While some of the hospitals can sometimes cover the 20% difference I very much doubt they would match 40%.

Like some of the other polices (PMI0710) I see they only cover 90% on 5210 for certain Fixed Price Procedures.

Both policies are restricted to €1,000 on day-to-day.

VHI recommended PMI3513 to me recently for a relative as a good all round policy but the premium would be even more expensive at €1,512.01

Don't forget that you got €314 back on last year's premium and whatever tax relief that you can claim so that did help with the overall cost. None of us know from day to day what's going to happen so I personally prefer to have the cover that I feel comfortable and relax about.

On the Company Plan 1.3 because the premium is lower than PMI3513 the excess goes up to €150 as compared to €100 and its the following that I don't like on the hospital cover on that plan:

Covered with an excess of €150 per claim; 90% cover for Special Non- Cardiac procedures in Hermitage Clinic and Galway Clinic with an excess of €150 per claim.

These are Fixed Price Procedures and I understand from VHI that the list of procedures is quite long. Having availed of this cover myself in the past it makes me conscious of the possibility of having to pay the 10% difference. I think it also applies to the Beacon but not 100% certain on that.

All of the above is just my opinion and it would be best if you discuss this with VHI yourself :)

PoundMan said:
Is there somewhere on the VHI website that someone can download the 'Table of Benefits' for each scheme? I looked but can't see it:
https://www.vhi.ie/all-health-insurance-plans
Click to expand...

The VHI staff told me that what they use themselves is to go to the bottom of the main page and click on Downloads where you will get access to all the Table of Benefits. Just like when you use Google to look at the different Table of Benefits you will need to toggle between two separate pages because you cannot get them side by side like the HIA site.


HTH :)
 
cloughy said:
Our health Insurance is up the end of Feb, myself and my wife are with Laya Simply Connect and we have a young Adult (19) and a Child (15) who are on Simply Connect plus, last year the policy net was 3780 but this is up to 4430, as our policy is up 230 each, the young adult 125 and child 50.

We require ortho care and dont really want the 20% contribution, likewise I loke to have the full cardiac care, and we have had a low excess on our day to day, as we all play sport so like to have this for physio etc and my son (19) in recent years has had to see a consultant so like to have a reasonable plan,

can you suggest suitable policies to compare our existing ones to to see if there are savings to me made,
Click to expand...

Hi cloughy,

I'm sorry I'm not able to make a recommendation for Laya policies as I have always been insured with VHI so no experience.

If you have a look at the previous AAM threads on Simply Connect you may be able to get some advice.

You could also possibly play around with the Laya Comparison Tool and it might help.

Very few policies these days have the full 100% on ortho and ophth and good cardio cover so you appear to be doing quite well IMHO. A friend of mine insured with VHI is paying over €3,000 to ensure she has that type of cover :(

HTH :)

P.S. It would be best if you start a new thread on this subject if you have further queries as you may get a better response from others who are insured with Laya :)
 
Not taking this too seriously, but just out of interest, I went on ChatGPT and uploaded a PDF containing the 'Table of Benefits' for four VHI plans under €1,400 and asked it to rank them in terms of similarity to my current plan. This was the response:

I have reviewed the 'Table of Benefits' document for the five VHI health insurance plans. Here's a summary and ranking of the other four plans compared to the 'Company Plan Plus Level 1.3', along with a recommendation for the best value plan for a 35-year-old male.

Summary of Plans:​

  1. Company Plan Plus Level 1.3: A comprehensive plan with a wide range of coverages including hospital charges, consultants' fees, mental health, maternity, baby benefits, cancer care, and more.
  2. PMI 08 11: Similar to the Company Plan Plus Level 1.3 but with some variations in the extent of coverages and excesses.
  3. PMI 10 11: Offers similar benefits but with slight differences in coverage levels and excess amounts in certain areas.
  4. PMI 53 10: Comparable in many aspects but with noticeable differences in specific coverage areas and excesses.
  5. PMI 52 10: Offers a similar range of services, however, it has notable differences in coverage levels for various services.

Ranking According to Similarity to Company Plan Plus Level 1.3:​

  1. PMI 08 11: Most similar in terms of coverage and benefits.
  2. PMI 10 11: Very close to PMI 08 11 but with minor differences.
  3. PMI 53 10: Similar but with more noticeable differences compared to Company Plan Plus Level 1.3.
  4. PMI 52 10: While similar, it has the most differences in coverages compared to Company Plan Plus Level 1.3.

Recommendation for 35-Year-Old Male:​

Given the cost and similarity to the Company Plan Plus Level 1.3, I recommend the PMI 08 11 plan. Priced at €1,309.13, it is not only more affordable than the current plan but also maintains a high level of similarity in coverage. This plan balances cost savings with the retention of key benefits, making it an attractive alternative for someone seeking comprehensive health coverage similar to their current plan.

Please note, while making this recommendation, I have considered the broad spectrum of coverage similarities. It's important for the individual to consider specific health needs or preferences they may have, which might make one plan more suitable over another.
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PoundMan said:
Not taking this too seriously, but just out of interest, I went on ChatGPT and uploaded a PDF containing the 'Table of Benefits' for four VHI plans under €1,400 and asked it to rank them in terms of similarity to my current plan. This was the response:
Click to expand...


Lots of restrictions on cover for certain hospitals with that 0811 plan which is probably why VHI/Dermot Goode don't recommend such as Hermitage, Galway Clinic, and Bons Cork, Galway and Tralee.

60% on the ortho/ophth again :(
 
I think I will ring VHI in the coming days and simply ask if they have an equivalent plan that is more affordable, but if not I may end up just sticking with Company Plan Plus Level 1.3 for another year, despite the 16% hike in premium.

I was trying to think about ways in which one could determine a fair price or affordable budget in terms of private health insurance. Would it be logical to look at the average salary in Ireland and average health insurance premium in Ireland, and then work out a percentage based on those figures? For example, if the average gross salary was €40,000 and the average premium was €1,500 then would it be reasonable to say that a fair price for health insurance would be ((1500/40000)x100) approximately 3.5% of ones gross salary? I suppose the only problem with that methodology though is that HIA have yet to publish a report for the average premiums in 2023 and I'm not sure if the CSO have published figures for average salaries in 2023 yet either.
 
You're probably thinking too deeply about it but perhaps that's just me :)

Obviously I'm a lot older than you so at a different stage in my health. I just want to make sure that I'm covered for a good hospital plan and day-to-day. As you mentioned above about Dermot Goode's comparison of approx. €1,400 for a good policy. I listened to the podcast that you provided (thanks for that) and was amazed at the number of times the Laya Simply Connect Plus was mentioned in it. So many people looking for the 100% on the Ortho and Ophthalmic.
 
I got this response from Dermot Goode's company who were happy to engage with me on the basis that I had paid for their consultation services previously:

"Although the Company Plan + L1.3 has increased in price, it still remains a decent level of cover. None of these plans will fully cover orthopaedic and ophthalmic procedures (hip, knee, shoulder replacements, cataract removal etc). The Company Plan +L1.3 will cover 80% of these procedures, while PMI 5210 will only cover 60%.

Unfortunately, most plans have been hit with price hikes this year and some are due to increase again over the coming months.

If you wanted to keep the 80% ortho cover and didn’t want to increase excess or switch provider, this plan is still a very good option."
Click to expand...

So I'm leaning towards sticking with my current plan as it seems there isn't really a more affordable equivalent from VHI on the market at the moment.
 
Hi Poundman,

If you refer back to my post 60 you should see the explanation that VHI gave me recently. fizzy's post 62 above also confirms the situation.

My explanation in that post 60 was:

I actually clarified this with VHI recently for a relative and it can be quite confusing, even the VHI rep agreed with me on that. The way it was explained to me was, that you are covered for the visit to one of the 360 clinics and you pay the €75 fee. You then have to pay for additional stuff like x-ray etc. Dermot Goode actually forewarned people about this in one of his podcasts too. If you check the Table of Benefits for PMI5310 you will notice Section 12 does not contain 'Urgent Care' which most of the other plans do. It does contain full cover for the 360 Health Clinics but not Urgent Care which could mount up.

PMI5310 Section 12 Vhi Core Services, subject to an excess of €75 per visit

 Paediatric Clinic Full cover
 360 Health Clinics Full cover

Whereas Company Plan Plus Level 1.3 shows

Vhi Core Services, subject to an excess of €75 per visit

 Urgent Care Full cover
 Paediatric Clinic Full cover
 360 Health Clinics Full cover
 Health screening - HealthCheck, in each 24 month period

Check it out yourself on the 2 Table of Benefits because they have not changed recently.

You could ask totalhealthcover to clarify also.
 
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