Health Insurance Can insurers withdraw orthopaedic benefits from renewal?

My partner is hoping to have his first knee replacement done next October, but his health insurance is due for renewal in September. My partner's current plan covers the full cost of the operation bar 75 euros excess. It is Laya Flex Explore 125.

However, my partner was given to understand last week from phone call re the operation codes and what he was covered for, that the orthopaedic element could be removed from this plan at his renewal date, or there could be a significant shortfall on orthopaedic benefits following his plan renewal in Sept. Is this possible? I thought once orthopaedic benefits were covered they stayed covered on the same plan.

My partner has his son's wedding in Spain in early September, so hence the date for surgery for October. He is now concerned though that he should bring the procedure back to before the renewal date. Any advice on this would be really appreciated.

They can change anything in a policy but not before renewal. So a person getting that plan today isn't going to get the orthopaedic cover.

He can ask for the policies that will have the exact orthopaedic cover when he renews but it might be a bit far out. What I mean is the people who decide this might change the cover for policy xy with effect from next month. They will honor whoever has it but at renewal the cover is no longer available.

Thanks, Becky, for that explanation. I think my partner better have the first knee surgery in early summer before his policy renewal in Sept. Just wondering though if they do remove orthopaedic cover from his plan, are they obliged to offer him another plan with orthopaedic cover, which will likely be more expensive, and for which there is no waiting period? My partner will get one knee surgery now done in early summer, but he will need to get the other knee done in November/December after his current policy renewal.

Mothergoose said:

Just wondering though if they do remove orthopaedic cover from his plan, are they obliged to offer him another plan with orthopaedic cover, which will likely be more expensive, and for which there is no waiting period?

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My understanding is they are not obliged to offer you anything,
It is your choice to choose from the plans, the one that best suits your needs that they provide to you at renewal
Which is why it's a bit of a head wrecker for most of us at renewal

Regarding cover it would be my opinion if you have full cover now and choose a new plan with full cover then there is no waiting
If you choose a plan with less cover well then you get less cover but if you decide to up that cover at a later date then waiting periods might apply to the cover level but you'd have to check that with Laya

And yes no mater what plan you're on today or choose tomorrow expect to pay more each and every year at renewal

Mothergoose said:

My partner will get one knee surgery now done in early summer, but he will need to get the other knee done in November/December after his current policy renewal.

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From looking at friends and relatives recovery times I would see that timeline as being very optimistic. One friend had his hip done and knee a few years later. He said there was a very big difference as so much of one's weight goes onto knee. Of course everyone's recovery differs but he should give himself time to see how things go.

Mothergoose said:

are they obliged to offer him another plan with orthopaedic cover, which will likely be more expensive, and for which there is no waiting period?

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As Cervelo has said once there is no higher cover the Upgrade Rule should not click in but definitely check with Laya.

How they can mention now that ortho cover may disappear from renewal in a few months, is crystal ball stuff at this stage, unless they are determined to get rid of it from all policies, which would not be surprising in light of the number of claims, that appear to be going through. VHI appear to charge an awful lot more than Laya for that type of cover.

You could always switch to another policy which conforms to the Upgrade Rule, with that cover for a couple of years, pay the extra, and then move back to something cheaper when all is done and dusted.

Mothergoose said:

my partner was given to understand last week from phone call re the operation codes and what he was covered for, that the orthopaedic element could be removed from this plan at his renewal date, or there could be a significant shortfall on orthopaedic benefits following his plan renewal in Sept.

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Flex 125 Explore - which your partner is on, is currently €2675 pa so hardly a budget plan. Assuming that Laya aren't doing away altogether with 100% ortho cover on every plan, I'd have thought it should be easy enough to find a suitably priced alternative if necessary. There are several less expensive plans that have the full ortho - Simply Connect, Simply Connect Plus and Simplicity come to mind.

Thanks Mct1 -I looked up Simply Connect and Simply Connect Plus and they are a lot cheaper than what my partner is paying currently. Thanks Cervelo for info re upgrade rule and there being no change if my partner needs to choose another plan with full orthopaedic cover. This Health Insurance stuff seems so complicated, at least to me anyway.