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

Apologies for following up again but unfortunately I have still been unable to pull the trigger on a health insurance plan.
I was all set to go with a semi-private Laya corporate plan like Inspire or Simple Connect.

But unfortunately my HR department here at a Local Authority County Council have informed me that if I want to set up deduction at source then the only group salary deduction schemes here at the local authority are with VHI or Irish Life exclusively so Laya is not an option. I must confess I would prefer a deduction at source from my salary, as I am not used to having to pay for health insurance having been spoiled by the NHS up North. Therefore I think having to now shell out for health insurance might be a little bit easier to stomach if it is already paid for before my wages reach my bank account.

Can you recommend the best semi-private corporate plans from VHI and Irish Life to try to help me decide on a suitable plan between the two? It would also be interesting to know what the difference is between the two in terms of additional perks and hospitals/clinics covered in both the Midlands and County Derry if I was visiting the North.
 
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PoundMan said:
Local Authority County Council have informed me that if I want to set up deduction at source then the only group salary deduction schemes here at the local authority are with VHI or Irish Life exclusively so Laya is not an option.
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Well that's pretty useless of them isn't it. I don't believe its any different to set up deductions with Laya than it is with VHI. Suspect someone just can't be bothered to do it.

PoundMan said:
Therefore I think having to now shell out for health insurance might be a little bit easier to stomach if it is already paid for before my wages reach my bank account.
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I wouldn't let this be a deciding factor. It's just a bill you have to pay; your mobile or broadband costs aren't deducted from your salary. This is no different.
 
Why don't you set up a direct debit.

I'm HSE and they are getting rid of a lot of these deductions from pay.
 
Hi folks, having put this on the long-finger I am finally having to pull the trigger on it this year given that I'll be turning 35 years old in August and want to avoid the LCR loading fees. I had thought about leaving it as close to my 35th birthday as possible but wasn't sure how long the process takes so thought I would be best to get it sorted out early in the year. I also heard that prices are expected to increase from March. I wish there was more guidance on deciding an affordable budget for health insurance, I couldn't find any rule of thumb that applies (there was American articles suggesting 10% of gross annual salary) but the consensus for Ireland seems to be that a minimum of €100 per month for good quality cover. I had a near-drowning scare at Lahinch beach in Co.Clare back in the summer, and although I was relatively fine the doctor suggested I go to A+E for a check-up as a precaution. I ended up losing a full day of my summer holiday in Limerick A+E for something that could've been sorted out quickly had I bothered about private health insurance. Needless to say, I knew I would have to sort out my health insurance this year for a host of reasons.

I have narrowed my search down to a number of semi-private corporate plans between VHI and Laya:

VHI
  • PMI 36 13
  • Company Plan Plus 1.3
  • PMI 52 10
  • PMI 60 10
  • PMI 53 10
Laya
  • Inspire
  • Inspire Plus
  • Simply Connect

I am starting to lean slightly more towards VHI as I'd ideally prefer monthly payments as opposed to a lump sum. Laya charges an extra 3% fee for direct debit monthly instalments whilst VHI don't charge any extra for choosing to pay monthly. I have heard that Laya offers a 10% discount for Credit Union members but I didn't think that was true as I understood that health insurance prices are fixed for everyone with minimal scope for discounts. Perhaps that isn't necessarily the case? I am a FORSA trade union member and my employer (Local Authority) has a group scheme through VHI but I don't believe it offers any cheaper prices on a specific plan, I think it is purely a deduction scheme which enables staff to pay their premium through their payslip. The ability to setup a deduction through payroll as a small advantage to VHI but this is not crucial for me.

Beyond price, I am wondering what else I should consider when comparing between the two providers. I currently live in Westmeath so which provider would cover most hospitals\clinics in the Midlands to save my travelling to Dublin all the time? I am originally from Northern Ireland, so it would be great if there was a provider who also covered hospitals/clinics in the North if I required some form of medical treatment whilst visiting family. I am also wondering if there is much difference in the smartphone apps from both providers or are they both fairly similar?

At the moment my health is relatively fine, these are the only potential considerations:

  • I am prescribed sumatriptan typically once or twice per year at most to treat migraine headaches, but they are not a regular occurrence. I did purchase light-filtering migraine glasses in 2022 from an American firm named Avulux which were quite expensive so it would have been nice to have had some of those fees covered particularly if I ever needed to replace these glasses, but again I purchased these of my own decision rather than on a doctor’s recommendation. They seem to have helped but it could just be placebo effect.
  • I had some minor issues with haemorrhoids in 2021 and since then, the doctor recommended I go for a colonoscopy every second year purely as a pre-cautionary measure due to family history as I have an uncle who had survived bowel cancer in his late 60's.
  • I enjoy walking and hiking, and in 2022 I had to purchase €85 orthotics to help treat plantar fasciitis. I am not sure if I will need to keep purchasing these going forward or not, I haven't transferred them to my current walking shoes as of yet and the issue has not reappeared so I cannot say for certain if the plantar fasciitis pain will return again or not.

Taking everything I have said into consideration, it would be great to get some feedback and thoughts on which plan I should look to go with.
 
Just a few thoughts covering some of your queries.

Policies: I can't help with VHI, but am very familiar with Inspire and Simply Connect - both excellent policies but at your age I wonder if you really need that much cover? Certainly unless you are likely to need a joint replacement or cataract surgery in the next few years Inspire is more than adequate.

Those two policies will refund half of optician's costs including spectacles/lenses prescribed by them. You need the optician's receipt for this. Ditto the orthotics prescribed by a registered health professional - GP, consultant, physio, chiropodist etc.

Colonoscopies are covered but you must be referred by a GP. Even if the consultant recommends a repeat in x years time my experience is you will need another referral.

In an emergency, you might still spend the day in A&E, health insurance or not, though you can claim back some of the attendance fee. Or if your condition is suitable you can attend one of the VHI or Laya clinics, or A&E in one of the private hospitals during opening hours.

I'm sure someone else will help you with VHI.
 
Dermot Goode did an interview recently, he'd be considered on of Irelands experts on private health insurance. Here's the clip, it was very good I thought. He has a website and you can pay a fee to ask him specific questions if you want. I researched here and kept an eye for interviews on podcasts like newstalk etc.

Health Insurance Q & A

Phillip is joined by Charlie Weston, Personal Finance Editor with the Irish Independent and Dermot Goode, from TotalHealthCover.ie to answer listeners Health Insurance questions and queries.
www.rte.ie


The plans I scribbled down was

Inspire plus
VHI level 1.3
Irish Life 4D health 1.

I have the VHI plan I'm based in Galway. Very happy with it. I pay by direct debit.

In relation to the trip to the ED Limerick having a private plan wouldn't have made a difference to how long you waited or treated. There is no other ED in that area, one of the reasons it's constantly in the news.

On a grade v salary you should be able to afford a decent plan.

Using the States as a comparison is useless, their healtcare is very very different.
 
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First thing to note is there's a waiting period of 5 yrs for pre-existing illnesses/conditions. Non-pre-existing illnesses/conditions will be covered after 6 months. No waiting period for emergency treatment. Other thing is what type of accommodation cover do you want & how much you can afford. Do you want semi-private in a private, private in a private etc, high tech hospitals, private hospitals or private in public etc.

I would avoid yellow pack PHI plans that cover public hospitals only - waste of money. Also important to check the plan in regards to orthopaedic and opthamology cover. Some plans can include hefty co-payments whereas others will provide full cover. If you decide at a later point to upgrade the plan, there's a waiting period of 2 yrs. Other consideration is do you want day-to-day benefits like GP etc. Another relevant point are there private hospitals near to you - would you likely use the PHI - if there isn't. There are future plans for the Bon's in Limerick. Personally, I wouldn't use PHI for public hospital care or advise anybody to sign the waiver. You're entitled to those services as a public patient & there's talks of abolishing the inpatient/day levy in April in any case.

There's also no guarantee of a private/semi-private bed & even if they do put you in a private/semi private bed - the regulations allow them to move you into a public bed & to charge the PHI company €800 per night. You'll also be treated by the exact same team whether you go public/private and the exact same nurses. PHI companies are refunding the €800 annual public hospital levy. PHI will also not get you seen quicker in ED. With VHI you can attend VHI Swiftcare & there's also similar urgent care centers for Laya & one in Affidea. There's also private ED's in the Mater & Beacon. There's max fees associated with all these services however. If you present & you're high acuity (stroke, cardiac etc), you will be transferred out to the public hospital.
 
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Hi PoundMan,

You would want to get a move on to avoid as you say the 1st March price increase and the LCR loading and to-date you appear to have spent too much time deliberating about it

I'm only familiar with VHI because I prefer them. Most of the premiums in those plans seem to be in and around what you would need to spend to get worthwhile cover IMHO.

Sorry I can't comment on what hospitals you can avail of in your area or Northern Ireland as only familiar with Dublin hospitals.

Of the 5 VHI plans that you mention a quick look on the HIA website tells me that the only one I would not recommend is PMI 5210 as it appears to only offer 60% on ortho and opthalmic in semi-private and private in private hospitals. It also appears to generally have higher excesses than the other plans mentioned. The overall yearly payment on day-to-day cover is only €1,000 as compared to €3,200 on PMI 5310, PMI 3613, PMI 6010. Company Plan Plus Level 1.3 appears to have only €1,000 also.

As this is a very busy time of year with renewals you may have left it too late already if you did want to make an appointment to use www.totalhealthcover.ie (Dermot Goode's company) along with the price increase coming down the road but you could give it a try. A friend availed of their services but had quite a long wait for an appointment as they were so busy and that was mid-year.
 
Lots involved in this.

If you want full cover for special procedures and 50% back for day to day, look at PMI 3513, the cheapest VHI plan to offer so.

If you want the same but 75% back on day to day look at PMI 4610.

Other VHI plans around this price or cheaper offer 90% cover for some special procedures.

If you want 100% for orthopedic then look at Laya simply connect.

Laya's Inspire appears to be similar to PMI 3513, cover wise but as I've posted before I've haven't gotten clarity on cover for special procedures with Laya as they don't specifically separate them.

Vhi list cover for some hospitals in Northern Ireland. You'll find it in the directory list. https://www.vhi.ie/downloads/MRI_External_Directory_with_Plans.pdf
Other than these you must contact them and ask. Laya have a map on each page of their plans which shows all centres/hospitals.

As mentioned above PHI won't help much in a public hospital. Urgent care clinics can offer an alternative to A&E or some private hospitals offer private A&E during normal business hours but they won't take severe cases.

Glasses cover is in the day to day cover. Orthotics are usually covered under surgical appliances. Usually something like 50% cover with Laya up to 1k or a few k cover with VHI with around a €300 excess per year.

Be aware everytime you get a procedure done there has to be a clinical indication to justify having that procedure. These are part of the procedure codes. Some procedures have limits on how many times you can have a procedure done under the same indication. In other words usually you can't have a colonoscopy covered purely as a proactive procedure. Or there are limits eg once per 2 year period for the same clinical indicator. Before you get any procedure done, always always contact the insurer and ask them. They'll want to know the code, the consultant and the hospital. They'll let you know if there are any issues around this. Don't rely on your consultant telling you it's fine. With insurance you get the procedure first and the claim is dealt with after, sometimes months or years after. If there are any issues they can decline it even though it all looked fine with the hospital/consultant.

VHI 360 centres are now in Limerick and Carrickmines. If you plan to use these I think VHI offers better value for urgent care clinics. It's €75 on most plans all inclusive per visit. If needed and refered you get 4 visits to VHI core services included in that too. That could be physiotherapy for example. The likes of Laya Inspire for example offer €150 off your total bill. The cost of seeing the doctor in a Laya clinic is around €140. Then you pay per x-ray, boot etc. An x-ray is €100 an image.

Bear in mind all the waiting periods mentioned above. Whether something is deemed connected to a pre existing condition or not is the opinion of the insurers medical staff and the medical details of your case (from your consultant or GP) and not related to when you found out about the issue.
 
Thanks for those comments folks, just to point out I had actually already previously got a consultation with Dermot Goode's company back in 2021. At the time the advisor from TotalHealthCover.ie recommended that I either went for a mid-level plan or a corporate plan. I've also listened to Dermot Goode interviews over the last couple of years to try to correlate which plans he tends to recommend most often to see if it can help me come to a consensus. He also has some useful free services on his website:
https://www.totalhealthcover.ie/special_offers
https://www.totalhealthcover.ie/pol...50_-_1475_per_adult&who_is_covered=individual

Also apologies but I should have pointed out, I didn't expect that private health insurance would help with A+E waiting times but I remember at the time of the incident in Co.Clare, my girlfriend (who was with Laya) said if I had taken out private health insurance I could've got a medical check-up done much faster at an alternative clinic in the likes of Limerick or Galway.

I read recently in a consumer magazine that the average health insurance premium at Q4 of 2022 was around €1410 so I wouldn't want to spend any more than that really.
 
becky said:
And please tell us which one you go for. I want to hear the end of the story.
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So I called up both Laya & VHI today to try to get advice.
Laya asked me a few questions and recommended I go with their Inspire plan.
It sounded like a very good value plan but I was put off by their 3% admin fee for opting to pay monthly and they said they no longer offer 10% to credit union members.

So I called VHI looking to get something as close as possible to the Laya Inspire plan. They asked a lot more questions than Laya so perhaps their algorithm is a little more complex. Based on my responses, they recommended I go with PMI 5210 or Company Plan Plus Level 1.3 so after lengthy discussions we decided that Company Plan Plus Level 1.3 was the better value in going from 60% orthopedic/opthalmic cover to 80% for an extra €5.30 per month. I know I am only 34 years of age so perhaps the 60% cover with PMI 5210 would have been more than sufficient but I just felt that Company Plan Plus Level 1.3 was that little bit more comparable to the Laya Inspire offering.

Hopefully it wasn't overkill and I am just really hoping that I've made a good choice. I listened to all the radio interview done by Dermot Goode over the last two years and he name-dropped Company Plan Plus Level 1.3, PMI 3613, Inspire & Inspire Plus the most. If I've made a bad choice at least I still have the 14-day cooling off period to make a change. I had asked about PMI 5310 but they said it didn't appear as a suitable plan in their search results based on my responses to their initial questions.

The only slight disappointment with VHI is that they didn't offer any discounts as they said my group scheme through work was for salary deduction only. The lady on the phone also mistakenly told me it would be more tax-beneficial as the health insurance deduction would reduce my taxable income but then she corrected herself when I told her that I thought the tax-relief was already built into the plan fee.
 
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Hi Poundman,

I think you made the right decision at end of the day. A relative of mine in and around your age was placed on the VHI Company Plan Plus Level 1.3 by his firm after they had also received paid for advice. You can relax now that you did the right thing
 
I think you picked a good plan. As another poster said, always check with VHI if you're covered for a procedure in the hospital.

I needed a dexa a few year ago. VHI didn't cover the Galway Clinic but covered it it the Bons. They do cover procedures in both hospitals but for some reason that particular procedure was only covered in one.
Thanks for the update.
 
You made the right choice. The shortfall for orthopaedic/ophthalmic procedures is sometimes covered by the hospitals themselves to get your business, so if you have 80% cover you are more likely to be offered that.
 
Hi folks,

Coming up to my first ever health insurance renewal which falls due on February 15th. I had set a reminder on my phone to start shopping around one month out from renewal. My current scheme is the 'Company Plan Plus Level 1.3' from VHI.

Last year I made five claims (two GP visits, one consultant visit and two A+E levy) for a total of €628 so with 50% on day-to-day medical expenses I managed to get back €314 from VHI. The main issue is that my premium for the Company Plan Plus Level 1.3 has gone from €1,245.38 in 2023 to €1,447.20 in 2024. This is a price increase of around 16% so I'm thinking it would probably be wise to consider changing plan this year in order to bring it closer to my ideal budget of around €100 per month for private health insurance.

I think I will probably stick with VHI, I had thought about the 'Inspire' plan from Laya but again I'm put off as I'm assuming they are still charging a 3% admin fee for anyone who prefers to pay their premiums on a monthly basis? I had thought about paying the premium in full using my AIB Platinum Credit Card in order to avail of 0.5% cashback but I probably cannot afford to pay such a lump sum in one hit, and I'd imagine the Health Insurance companies may not allow payments via credit card.

I'm a public sector worker and do have the option of having my Health Insurance fees deducted at source through my pay slips, but I'm not sure if there are any real benefits to doing this. If I ever changed jobs I am not sure how easy it would be to quickly get things setup with a new employer. Perhaps someone can convince me of the merits in doing this?

In terms of plans, I'm thinking my only options might be PMI 5310 or PMI 5210 as these seem comparable to Company Plan Plus Level 1.3 whilst being slightly cheaper. I listened to a recent radio call-in with Dermot Goode, and someone actually asked him for a recommendation in terms of an alternative for the Company Plan Plus Level 1.3 and he actually said that he thought it was a plan worth keeping. I was surprised because surely a 16% hike in price is not good value. He did seem to have name-dropped PMI 5310 and PMI 5210 in a number of recent interviews so I am thinking they are probably the best options for an affordable corporate plan.

Keen to hear some thoughts on this.
 
Just re PMI 5310, VHI told me that’s one of the few plans that doesn’t include cover for their urgent care centre in carrickmines in Dublin if that’s relevant for you.
 
fizzy said:
Just re PMI 5310, VHI told me that’s one of the few plans that doesn’t include cover for their urgent care centre in carrickmines in Dublin if that’s relevant for you.
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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
 
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