Laya Outpatient Claims once a year only?

I have been covered by company schemes for many years with VHI, Aviva and Laya and never came across any restrictions on outpatient claims. Now I am with Laya outside a company scheme (Flex Explore), and after sending in a claim for outpatient expenses, for which I am covered, I was told I would have to wait 12 months for payment as outpatient expenses are only paid after the next renewal date. As my renewal date was October I have to wait nearly 12 months to be re-imbursed. So, have I been fortunate to claim in the past close to renewal date, is this a new practice with Laya, is it common to all insurers and what is the reason? No other claim types have this restriction, as far as I can see looking at the Laya Ts and Cs. Would be interested in other experiences of outpatient claims and whether this is a common practice or a Laya thing?

Best of my recollection it was the same when I was with Aviva. I am also with Laya and when I rang them I was told them the same. But our plan was part of my wifes employers plan, so as a result that condition was waived.

peteb said:

Best of my recollection it was the same when I was with Aviva. I am also with Laya and when I rang them I was told them the same. But our plan was part of my wifes employers plan, so as a result that condition was waived.

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Thanks, I suspect that this is a result of me no longer being in a company scheme. Why is it only outpatients claims that are treated this way? Are they worried folks will claim then cancel the policy? I am awaiting Laya's response to my request for more information.

Because inpatient claims are billed directly by most hospitals. The day to day cover obviously can't be dealt with in that way.

You can claim anytime with VHI. Irish Life Health(Aviva) have online claiming so you can claim anytime with them too.

Thanks peteb and Stevekl. Looks like Laya fall behind the others on outpatient claims, here is the response from them to my query:

"The rule regarding claiming your out-patient expenses in on page 3 of the attached Rules Booklet. This was a business decision made by the management.
From 01/12/2016 this rule is being changed. You can submit your receipts mid year if your use our Claims App but if you submit them in paper form the receipts can only be submitted at your renewal time"

Reading between the lines it looks like a cost issue for Laya, but now they allow claims 'mid-year' if you use their app so maybe they have had some poor feedback on the post-renewal only rule and are relaxing a little.

you're assuming that they will mean that they will process your payment mid-year. That technically isnt what they have said. They may mean that you can use the app as it will store the receipts for your claim under your account directly. Posting in your receipts mid year and them having to wait until the end of the year would be a pain form them as they would have to allocate them etc.

All the insurers are moving to claiming online to save money and also to replicate their competitors benefits.