The following is from the Aviva FAQ.
The marketing speak makes it difficult to folllow in places.
http://www.avivahealth.ie/focus-plans/faq/
More about Aviva Focus Plans
To offer customers more choice and affordability Aviva have developed a range of plans known as Focus Plans.
The information below may be useful if you are considering buying a Focus Plan or if you already have a Focus Plan.
As a rule of thumb, you must be treated in a hospital that is within the select network of hospitals that applies to your Focus Plan.
Aviva has made every effort to ensure that all medically necessary procedures and treatments are available within each select network of hospitals, and so it is extremely unlikely that you would not be able to receive the procedure or treatment that you require in a hospital that is within your network of hospitals.
Remember, we’re here to help so please call us if you have any questions and always call us before making any decisions on where you’ll be treated. You can contact Aviva Customer Care on 1890 717 717.
Why do Focus Plans cover selected hospitals only?
We know that value and affordability is a primary concern for health insurance customers. The Focus Plans have been designed to provide more choice for private health insurance customers who are looking for more affordable options. The Focus Plans are more affordable because they cover a select network of hospitals rather than all hospitals.
Each select network of hospitals was developed in line with customer needs based on detailed market research we conducted. By providing cover under a select network of hospitals we can price the Focus Plans very competitively. We recommend you familiarise yourself with the select network of hospitals that applies to your Focus Plan. You can find these on our website www.avivahealth.ie.
Each select network of hospitals has been designed to provide a broad geographical spread of hospitals and to ensure that the best possible range of medical procedures and treatments are covered.
For customers that are more comfortable with access to a full range of public hospitals our full product suite remains available.
Call us
It is advisable to contact us on 1890 717 717 before having a procedure or treatment carried out. We will confirm the level of cover on your plan and whether you are covered for that procedure or treatment in the hospital or treatment centre that you have chosen. It would be helpful if you could please have your policy number, the procedure code, as well as the name and address of your consultant, and the place and dates of any proposed treatment to hand when you call.
Good advice
We strongly recommend that you review the select network of hospitals that applies to your Focus Plan before going to see your GP. If you need to be referred to a consultant, you should ensure that your GP refers you to a consultant who can admit you to a hospital that is within the network of hospitals that applies to your Focus Plan.
What happens if I go to a hospital that is not within my network of hospitals?
There are usually two ways people are admitted to hospital.
1. Emergency Admission through Accident and Emergency
Aviva understands that where an accident, injury or other acute event occurs, you may be taken by ambulance to an acute public hospital that is not within your network of hospitals or you may have to make your own way to the Accident and Emergency department of a hospital that is not within your network. If it is necessary for you to be admitted to that hospital through its Accident and Emergency department, we will provide you with the same level of cover as you would have received in a hospital that is within your network of hospitals whilst you are receiving emergency care.
If you require a follow-up elective procedure or treatment, you should move to a hospital that is within your network of hospitals to have that procedure or treatment performed. However, if you are medically unfit to move following your emergency care, we will cover the elective procedure and treatment in that hospital in accordance with the benefits set out in your table of cover. Remember, we’re here to help so please call us if you have any questions on 1890 717 717.
For example: You are brought to the Accident and Emergency department at the closest public hospital (a hospital not within your network of hospitals) by ambulance after dislocating your shoulder in a traffic accident or sporting accident. Aviva will cover your emergency care in that hospital. Following your emergency treatment, (your shoulder being put back in place) it is decided that you need to remain in hospital to receive follow on care in order to stop the injury re-occurring. This treatment will be classed as elective treatment. In this example, you must have the follow up elective treatment performed in a hospital that is within your network of hospitals in order to be covered. However, if your consultant deems that you are medically unfit to move to a hospital that is within your network of hospitals and that your elective treatment must be performed immediately, rest assured you will be covered by Aviva for your treatment up to the same level of cover as you would have received in a hospital that is within your network of hospitals.
2. Admission for a Medically Necessary Elective Treatment
If you require a medically necessary elective procedure or treatment, you must attend a hospital that is within the network of hospitals that applies to your Focus Plan. It is important to contact us to check that you are covered regardless of the plan you are on. If you are being admitted for a medically necessary elective procedure or treatment, you will usually have been seen by your GP who will have referred you to a consultant. Following an initial consultation, your consultant will determine if you need further diagnosis and/or whether you need to receive treatment or a procedure. In these instances your treatment or procedure should be performed in a hospital that is within the network of hospitals that applies to your Focus Plan. Many consultants operate in both public and private hospitals so you should check with your GP (before you are referred to a consultant) and with your consultant that your procedure or treatment will be carried out in a hospital that is within the network of hospitals that applies to your Focus Plan.
The Minimum Benefit Regulations set out the minimum payments that all health insurers must make for procedures and treatments that are listed in those regulations. These procedures and treatments listed in the Minimum Benefit Regulations are known as Prescribed Health Services. In the unlikely event that you require a Prescribed Health Service that cannot be performed in a hospital within your network of hospitals, we will provide you with the same level of cover for that Prescribed Health Service as you would have received if it had been performed in a hospital that is within your network. Such procedures or treatments must be pre-approved by us before they will be covered and so it is extremely important that you contact us before you have any procedure or treatment carried out in hospital that is not within the network of hospitals that applies to your Focus Plan. You can contact us by calling 1890 717 717
What happens if I am currently undergoing a course of treatment in a specific hospital and I switch to a Focus Plan which does not cover that hospital?
We always recommend that you consider what cover you need before switching plans to ensure that any new plan provides the level of cover that you require so that you receive continuity of care. If you are receiving treatment in a specific hospital or treatment centre and you wish to switch to a Focus Plan you should ensure that the hospital in which you are receiving treatment is covered under the Focus Plan before you switch. As a rule of thumb, you will not be covered for procedures and treatments in a hospital that is not within the network of hospitals covered by your Focus Plan. We also recommend that you ensure that you have no additional waiting periods as a result of an upgrade in cover.
If my consultant recommends that I attend a hospital that is not within the network of hospitals covered under my Focus Plan, will any of my medical bill be covered?
As a rule of thumb, you will not be covered for procedures or treatments that are performed in a hospital that is not within the network of hospitals covered by your Focus Plan. We will only cover procedures and treatments performed in hospitals which are not within your network of hospitals if that procedure or treatment is a Prescribed Health Service and are not available in a hospital that is within your network of hospitals. Aviva has made every effort to ensure that all Prescribed Health Services are available in each select network of hospitals, and so it is extremely unlikely that you would not be able to receive any medically necessary procedure or treatment in a hospital that is within your network of hospitals. If you believe the procedure or treatment that you require is not available within your network of hospitals, please call us before taking any action. Even if this is the case, we will need to pre-approve any procedures or treatments before they will be covered in a hospital that is not within your network of hospitals.
Are hospitals outside Ireland covered under the Focus Plans or are they considered to be outside the selected networks of hospitals?
We consider procedures and treatments that are received outside Ireland to be Overseas Benefits. Please see your Membership Handbook for full details of how we cover Overseas Benefits. Your entitlement to receive Overseas Benefits is not related to your selected network of hospitals in any way.
The marketing speak makes it difficult to folllow in places.
http://www.avivahealth.ie/focus-plans/faq/
More about Aviva Focus Plans
To offer customers more choice and affordability Aviva have developed a range of plans known as Focus Plans.
The information below may be useful if you are considering buying a Focus Plan or if you already have a Focus Plan.
As a rule of thumb, you must be treated in a hospital that is within the select network of hospitals that applies to your Focus Plan.
Aviva has made every effort to ensure that all medically necessary procedures and treatments are available within each select network of hospitals, and so it is extremely unlikely that you would not be able to receive the procedure or treatment that you require in a hospital that is within your network of hospitals.
Remember, we’re here to help so please call us if you have any questions and always call us before making any decisions on where you’ll be treated. You can contact Aviva Customer Care on 1890 717 717.
Why do Focus Plans cover selected hospitals only?
We know that value and affordability is a primary concern for health insurance customers. The Focus Plans have been designed to provide more choice for private health insurance customers who are looking for more affordable options. The Focus Plans are more affordable because they cover a select network of hospitals rather than all hospitals.
Each select network of hospitals was developed in line with customer needs based on detailed market research we conducted. By providing cover under a select network of hospitals we can price the Focus Plans very competitively. We recommend you familiarise yourself with the select network of hospitals that applies to your Focus Plan. You can find these on our website www.avivahealth.ie.
Each select network of hospitals has been designed to provide a broad geographical spread of hospitals and to ensure that the best possible range of medical procedures and treatments are covered.
For customers that are more comfortable with access to a full range of public hospitals our full product suite remains available.
Call us
It is advisable to contact us on 1890 717 717 before having a procedure or treatment carried out. We will confirm the level of cover on your plan and whether you are covered for that procedure or treatment in the hospital or treatment centre that you have chosen. It would be helpful if you could please have your policy number, the procedure code, as well as the name and address of your consultant, and the place and dates of any proposed treatment to hand when you call.
Good advice
We strongly recommend that you review the select network of hospitals that applies to your Focus Plan before going to see your GP. If you need to be referred to a consultant, you should ensure that your GP refers you to a consultant who can admit you to a hospital that is within the network of hospitals that applies to your Focus Plan.
What happens if I go to a hospital that is not within my network of hospitals?
There are usually two ways people are admitted to hospital.
1. Emergency Admission through Accident and Emergency
Aviva understands that where an accident, injury or other acute event occurs, you may be taken by ambulance to an acute public hospital that is not within your network of hospitals or you may have to make your own way to the Accident and Emergency department of a hospital that is not within your network. If it is necessary for you to be admitted to that hospital through its Accident and Emergency department, we will provide you with the same level of cover as you would have received in a hospital that is within your network of hospitals whilst you are receiving emergency care.
If you require a follow-up elective procedure or treatment, you should move to a hospital that is within your network of hospitals to have that procedure or treatment performed. However, if you are medically unfit to move following your emergency care, we will cover the elective procedure and treatment in that hospital in accordance with the benefits set out in your table of cover. Remember, we’re here to help so please call us if you have any questions on 1890 717 717.
For example: You are brought to the Accident and Emergency department at the closest public hospital (a hospital not within your network of hospitals) by ambulance after dislocating your shoulder in a traffic accident or sporting accident. Aviva will cover your emergency care in that hospital. Following your emergency treatment, (your shoulder being put back in place) it is decided that you need to remain in hospital to receive follow on care in order to stop the injury re-occurring. This treatment will be classed as elective treatment. In this example, you must have the follow up elective treatment performed in a hospital that is within your network of hospitals in order to be covered. However, if your consultant deems that you are medically unfit to move to a hospital that is within your network of hospitals and that your elective treatment must be performed immediately, rest assured you will be covered by Aviva for your treatment up to the same level of cover as you would have received in a hospital that is within your network of hospitals.
2. Admission for a Medically Necessary Elective Treatment
If you require a medically necessary elective procedure or treatment, you must attend a hospital that is within the network of hospitals that applies to your Focus Plan. It is important to contact us to check that you are covered regardless of the plan you are on. If you are being admitted for a medically necessary elective procedure or treatment, you will usually have been seen by your GP who will have referred you to a consultant. Following an initial consultation, your consultant will determine if you need further diagnosis and/or whether you need to receive treatment or a procedure. In these instances your treatment or procedure should be performed in a hospital that is within the network of hospitals that applies to your Focus Plan. Many consultants operate in both public and private hospitals so you should check with your GP (before you are referred to a consultant) and with your consultant that your procedure or treatment will be carried out in a hospital that is within the network of hospitals that applies to your Focus Plan.
The Minimum Benefit Regulations set out the minimum payments that all health insurers must make for procedures and treatments that are listed in those regulations. These procedures and treatments listed in the Minimum Benefit Regulations are known as Prescribed Health Services. In the unlikely event that you require a Prescribed Health Service that cannot be performed in a hospital within your network of hospitals, we will provide you with the same level of cover for that Prescribed Health Service as you would have received if it had been performed in a hospital that is within your network. Such procedures or treatments must be pre-approved by us before they will be covered and so it is extremely important that you contact us before you have any procedure or treatment carried out in hospital that is not within the network of hospitals that applies to your Focus Plan. You can contact us by calling 1890 717 717
What happens if I am currently undergoing a course of treatment in a specific hospital and I switch to a Focus Plan which does not cover that hospital?
We always recommend that you consider what cover you need before switching plans to ensure that any new plan provides the level of cover that you require so that you receive continuity of care. If you are receiving treatment in a specific hospital or treatment centre and you wish to switch to a Focus Plan you should ensure that the hospital in which you are receiving treatment is covered under the Focus Plan before you switch. As a rule of thumb, you will not be covered for procedures and treatments in a hospital that is not within the network of hospitals covered by your Focus Plan. We also recommend that you ensure that you have no additional waiting periods as a result of an upgrade in cover.
If my consultant recommends that I attend a hospital that is not within the network of hospitals covered under my Focus Plan, will any of my medical bill be covered?
As a rule of thumb, you will not be covered for procedures or treatments that are performed in a hospital that is not within the network of hospitals covered by your Focus Plan. We will only cover procedures and treatments performed in hospitals which are not within your network of hospitals if that procedure or treatment is a Prescribed Health Service and are not available in a hospital that is within your network of hospitals. Aviva has made every effort to ensure that all Prescribed Health Services are available in each select network of hospitals, and so it is extremely unlikely that you would not be able to receive any medically necessary procedure or treatment in a hospital that is within your network of hospitals. If you believe the procedure or treatment that you require is not available within your network of hospitals, please call us before taking any action. Even if this is the case, we will need to pre-approve any procedures or treatments before they will be covered in a hospital that is not within your network of hospitals.
Are hospitals outside Ireland covered under the Focus Plans or are they considered to be outside the selected networks of hospitals?
We consider procedures and treatments that are received outside Ireland to be Overseas Benefits. Please see your Membership Handbook for full details of how we cover Overseas Benefits. Your entitlement to receive Overseas Benefits is not related to your selected network of hospitals in any way.