Health Insurance VHI Dental Policy - misleading wording?

[tnegun]

Unfortunately, I've found myself having to make several large claims against our dental policy and am shocked at the difference in advertised/perceived cover vs. what they will actually cover. Long story short as the result of an accident I've had to claim for several implants and implant-supported crowns for my partner.

Our VHI Corporate Dental Policy claims 70% cover for implants and implant-supported crowns in the Headline of the policy, the Key Benefits Section of the Policy and again in the Table of Benefits but the table then enforces a separate annual maximum of €250 for implants and €600 for crowns. These maximums apply regardless of the number of implants and implant-supported crowns required. The cost of an implant is €1000 and the implant-supported crown is €1500 bringing the true level of cover to 25% for a single implant and 40% cover for the implant-supported crown. In our case, the replacement of several teeth is required so the actual % level of cover is substantially less.

I'm considering making a complaint to the FSPO regarding this as VHI has already conceded that they have made multiple "human errors" in the admin and processing of related claims to date. I contented that they mislead us and frustrated our attempts to claim for treatments covered under the policy and they admit several human errors were made in the processing of our claims and offered a small sum in compensation. I suppose my question is, is their wording/descriptions appropriate and is it something worth submitting a complaint about? I would have thought phrases like a maximum of 70% cover, up to 70% cover would be more suitable or is it acceptable to frustrate this level of cover by placing such restrictions in the table of benefits?

For reference, ToB is here https://www.vhi.ie/pdf/myvhi/TOBVDC1 V10 Jan21.pdf and some screenshots highlighting the prominence of the 70% cover claims.

 

[Clamball]

The conditions are there in the fine print. I don’t think you would succeed in a complaint to FSPO, However if they mislead you over the phone you should complain to VHI especially if you would have taken a different course of action if you had the correct information.

I queried my LAYA policy when my child turned 18. I had gotten two renewal notices and one was 300 - 400 more expensive. So I phoned and confirmed the lower quote was the valid one, and they said yes. 4 months later it transpired we had paid (through work) a higher premium. When I phoned they were able to recheck the call logs, I had the dates, and agree I had been given incorrect information so they honoured it.

 

[so-crates]

I can't help you with the VHI but, just in case you aren't aware of it, you can also claim back tax on the expense of this work not covered by insurance. It won't be "70% cover" but at least it will be something.

Dental expenses

This pages outlines how you can claim relief for non-routine dental care

www.revenue.ie

 

[tnegun]

Thanks for the replies,

I'm not disputing that conditions exist I just think it's very misleading to state 70% cover when their own conditions make it nigh on impossible to get anything near that level of cover, why not just state the € figure they'll cover instead of hiding behind a % and a maximum? I suspect its because 70% looks much better than €250 and that sort of marketing has no place in health insurance but that's just my opinion.

It took VHI over 2 months and several calls just to explain confirm the implications of the Table of Benefits to me and no agent was certain when queried so part of my thinking is if their own staff had difficulty in determining what level of payout could be expected and if it was per tooth or for all claims. e.g. I read this as meaning €250 per implant but VHI say now it's a max of €250 for all implants and their agents struggled with it too.
Implant supported crowns – once per tooth per lifetime including a contribution
towards the dental implant fixture to an annual maximum of €250

Thanks for the tip on tax I was aware but will make sure I get all the correct forms completed!

 

[Páid]

You can claim for the initial consultation and any diagnostic procedures, not just the implants. The software these practices use doesn't seem to correctly list all eligible charges on the MED 2 form. Check it to be sure that everything you should be claiming for is included.