My husband and I are planning our second baby. Our first baby was very premature and had to be kept in hospital for some time. We didn't have private health insurance at the time. The costs which arose as a result of having a premature baby really put pressure on us financially. We have taken out private health insurance since but as we are planning our second baby now, we are concerned I may go premature again – and of the costs which would arise if so. So we are considering upgrading our plan – or changing to another provider if necessary. What kind of cover do private insurers typically provide for premature births – and is there any plan you would recommend which offers good cover for premature births?

Premature Births are treated the very same as full term births by the health insurance providers. The most important thing to do is add your newborn to your policy straight away. It’s a common mistake people make, they think that because the health insurer knows you are pregnant your child will be added on automatically to the plan. However, without a name and a date of birth the provider cannot do so. The four health insurers – Aviva, Glo Health, Laya Healthcare and VHI – allow 13 weeks for your newborn to be added to the plan. If you do not add your baby on within this time frame they will unfortunately be subject to the new customer waiting periods which are: 26 weeks for any new conditions that may arise (illnesses that commence after you join) and 5 years for any pre-existing conditions (as of the 01/05/15 this is defined as any illness that existed up to 6 months before becoming insured on a plan). Accidents or injuries are not subject to any waiting period so will be covered from inception.

Regardless of whether you choose to go publicly, semi-privately or privately for maternity you can still add your baby to your health insurance plan and they can then be treated as a private patient. This means that you will not be subject to the fee of €75 per night. In relation to upgrading your cover, this really won’t make a difference as all plans offer the same treatment for premature births as full term births.

Some plans offer ‘parent accompanying child expenses’ which can be used for travel expenses, parking in the hospital and accommodation costs if you are visiting your child in hospital. This is an excellent benefit for people who have premature babies. The benefit varies from one provider to another, some plans offer up to €100 back per day up to 14 days. This can be used for children of any age not just premature babies; it is a great benefit that many people are not aware they have.

We recently discovered that my wife is infertile. So we have decided to do down the IVF route. Which private health insurer and private health insurance plan is the best one to be on when it comes to cover for IVF? We also are a bit concerned about the cost – I have heard that you may have to go through three rounds of treatment (and even then, there is no guarantee of success). Should we have to go through three rounds of treatment, I understand the costs could easily clock up to €15,000. Do private health insurers typically restrict the cover they provide for IVF to one round of treatment?

Unfortunately the cover offered for IVF under private health insurance is very limited and it is only available from some insurers under certain plans. 

Glo Health offers a 10% discount for Infertility treatment in the Beacon Hospital in Dublin which can be used on an annual basis. This benefit is included on the Maternity Personalised package which can be added to most Glo Health plans at no additional cost. As of 30/06/16, Glo Health will have the best cover available on the market for In Vitro Fertilisation (IVF), Intracytoplasmic Sperm Injection (ICSI) and Intrauterine insemination (IUI) treatment. They are introducing a ‘maternity booster’ to their ‘Best Plan Ultimate Cash II’. It will cover 50% up to €2,000 for these treatments and unlike any of the other providers; this can be used twice per lifetime in any treatment centre. You do not need to serve an additional 52 week waiting period to receive this benefit; as long as you served your initial 52 week waiting period for maternity benefits you will be covered. This plan also offers €300 for maternity consultant fees which in conjunction with the maternity personalised package brings the total amount members are eligible to claim to €600, which is a very generous amount given the relatively reasonable price tag on this plan. This plan is being reduced from €1,719 to €1,593.76 as of 30/06/16. 

Most VHI plans do not cover IVF. However, their PMI 0411 offers a one-time infertility benefit of €2,000 which is the best benefit available on the Irish market prior to the introduction of Glo’s offer above. This €2,000 is a one-off cover per member per lifetime towards the cost of IVF, ICSI and IUI.  The treatment must be carried out in one of the five VHI approved clinics which are The Clane Fertility Clinic, The Cork Fertility Clinic, Rotunda IVF, Merrion Fertility Clinic and The Galway Fertility Clinic. You must also be on the plan a year before you start any fertility treatment to be covered for the benefit. This plan is on the expensive side, coming in at €3,666. In saying that, the benefits on it are fantastic. This plan is the only plan on the market that will potentially fully cover the costs of private maternity care. It offers €5,000 for maternity consultant fees, €5,000 for laser eye surgery in approved centres as well as very generous reimbursement of consultant fees, GP fees and out other outpatient expenses. So while it is a pricey plan, if you have reason to use the benefits on this plan there is no doubt you will be receiving a large cheque from VHI rather than being out of pocket. 

Laya healthcare offers cover of up to €1,000 per lifetime towards IVF, IUI or ICSI. This benefit is available on a number of their plans when carried out in one of the seven Laya approved centres. These are: The Cork Fertility Centre, The Galway Fertility Clinic, Clane Assisted Conception Unit, The Sims IVF clinic, Merrion Clinic, Rotunda IVF and the Morehampton Clinic.

While Aviva Health doesn’t offer any specific cover for infertility treatment, they have some very competitive plans with excellent outpatient benefits which assist with the additional costs such as consultant and GP fees while undergoing fertility treatment.

My husband and I recently got married and we are planning to have children in a couple of years. We'd like to get on a good plan for maternity benefit first though. What's the best plan for maternity benefit offered by each of the different providers?

 The first thing to note is that all health insurers providers apply a 52 week waiting period to maternity benefits so be sure to plan ahead. The next is deciding which care option you would like to choose – public, semi-private or private. If you choose to go publicly, it will make no difference whether you have health insurance or not as you will be fully funded by the state.

Should you choose to go semi-private or privately, some health insurance plans offer stronger benefits than others. There are 355 inpatient health insurance plans on the market, so it really depends on your budget. Below is a corporate option from each provider all in the price range of €1,162 - €1,248.

Aviva – ‘Health Plan 16.1’

Glo Health – ‘Best Smart’ (must add the maternity ‘personalised package’ for free to avail of full maternity benefits)

Laya Healthcare – Simply Connect Plus

VHI - PMI 3613

There is a new maternity booster being added to Glo Health’s ‘Best Plan Ultimate Cash II’ as of 30/06/16. It is also being reduced in price from this date to €1,593.76 and provides excellent cover.

VHI’s plan PMI 04 11 offers €5,000 for pre and post natal maternity care (consultant fees) should you choose to go privately. This is the only plan on the market that will potentially cover the cost of private maternity. It is an excellent plan albeit it expensive, costing €3,666 per annum. 

I have had bad varicose veins since the birth of my children. I would like to get them treated. I do have private health insurance but I would be happy to switch insurer/plan if I can get better cover for varicose veins elsewhere. Which insurer/insurers offer the best cover for varicose vein treatment – and which of their plans is the best to be on for this type of treatment?

As there are over 10 different procedures for the treatment of varicose veins, it would be impossible to advise on which provider offers the best cover without the procedure code to determine the specific treatment you are in need of. There are three pieces of information needed when confirming cover or comparing providers for specific procedures. These are the procedure code (which your consultant will give you), the name of the consultant you are attending and the hospital you are attending.  The provider will then confirm the level of cover you have and whether you will have an excess applied for this treatment.  

Should you find that one provider offers better cover, unfortunately this does not necessarily mean that you will get immediate cover as the ‘upgrade waiting period’ will apply. All four providers apply a waiting period of 2 years when you upgrade your cover and you have an existing medical condition at the time of the upgrade. This waiting period only applies to additional benefits that are related to the existing medical condition. 

My husband and I are in our late 20's. We don't have private health insurance yet but we're planning to start a family. Our finances are a bit tight so I'm not sure if we can really afford private health insurance. Will I get any different care if I go public, semi-private or private to have my baby – and what kind of costs would I typically incur in each instance?

The most important point to highlight firstly is that all four health insurance providers impose a 52 week waiting period for maternity benefits when you are taking out health insurance for the first time. This means that you have to be on the plan 52 weeks at the time you are giving birth, not before you conceive. All plans have to include some level of Maternity Benefits, regardless of age or gender, due to the minimum benefit legislation. So it would be important to act fast if you are hoping to be covered for maternity benefits. 

The three options available – public, semi-private and private, all offer great maternity care, it is really down to your preference.

If you choose to go publicly, it is fully funded by the state. This includes GP appointments, pre-natal appointments and ultrasounds. You will be in a public ward in a public hospital and you cannot opt for a private room at the time of birth if you are a public patient all along. So even if you have private health insurance cover but choose to be treated publicly, you are not then entitled to a private room in a public hospital after you have given birth. So really it does not make a difference whether you have private health insurance or not should you choose to be a public patient. However, failure to familiarise yourself with all aspects of the cover could lead you to miss out on some additional valuable benefits such as post-natal home help and breastfeeding consultancy.

Semi-Private treatment is only available in Dublin hospitals. You would attend a consultant’s team in a private clinic in a public hospital. You may have some of your appointments with your GP which is known as combined care. You may have a semi-private room but this is subject to availability. Most plans on the market cover the cost of the room (which is €813 per night) and the delivery. You would pay the consultant directly for your pre and post-natal appointments. You may be able to redeem some money back on certain plans; this amount varies on each plan.

If you choose to go privately in a public hospital, you will choose your own consultant and pay them directly. Your appointments would all be with this consultant. You may avail of a private room in a public hospital but again this is subject to availability. Most plans will cover the cost of the room which is €1,000 per night and the delivery.

Below is a guide to the different options and the average costs that you pay, the state pays and private health insurance pays.

I am in my early 40s and recently learned I am pregnant with my first child. Due to my mature age, my doctor has advised I get first-trimester screening – as this can help detect Down Syndrome. It costs about €250. Are the costs of tests such as this covered by private health insurance?

Only two of the four providers contribute towards first-trimester screening. VHI offer up to €200 on 17 health insurance plans. Glo Health offers a Maternity Personalised package which can be added to most plans for free. There is a €30 contribution towards an early pregnancy scan included in this package which can be used with ‘Baby Scan’ which is available in Dublin, Cork and Galway or MD ultrasound which is available in Limerick. Glo Health are also adding a benefit of €200 towards foetal screening to their “Best Ultimate Cash II’ plan as of 30/06/16.

I am on a plan through my employer but it only covers semi-private accommodation in a public hospital. I am hoping to go privately for maternity so I need cover for a private room. Do employers allow you to change plans to suit your needs or will I have to start paying for my own plan?

This would be down to the discretion of your employer. Most companies have no problem allowing employees to choose a different plan and they will cover the cost up to the amount of the plan they selected initially. If the plan you choose is more expensive than the agreed plan, they will usually deduct this from your salary. My advice would be to discuss it with the scheme administrator and they can put you in touch with your broker to review your options and select a plan to best suit your needs.

I am currently a medical card holder and I have private health insurance. My husband and I feel it is a waste of money for me to be covered by health insurance as I have a medical condition that entitles me to a medical card. We are thinking of taking me off the health insurance plan. My only concern is that we are hoping to start a family over the next few years. Will I be entitled to the same level of care from the medical card?

This is the conundrum faced by many medical card holders – do I need health insurance as I get free medical care anyway? The answer to me is very simple; if you can afford it do not give up your health insurance. There is no overlap between private health cover and having a medical card. Yes you will not be subject to the €75 per night fee in a public hospital; however, you will still be placed on a waiting list in the public system. You mentioned you have an existing medical condition which is a major reason to not give up your health cover. If you leave and you want to re-join again in the future, your existing medical condition will not be covered for 5 years.

In relation to maternity care, everybody in Ireland is entitled to what is called ‘The Maternity and Infant Care Scheme’. This is covered regardless of whether you hold a medical card or not.

The ‘Maternity and Infant Care Scheme’ provides an agreed programme of care to all expectant mothers who are ordinarily resident in Ireland. It combines antenatal care provided by a GP of your choice and a hospital obstetrician. Patients usually attend their GP before the 12 th week of pregnancy. The GP provides a further 6 examinations during the pregnancy. The first visit to the hospital antenatal clinic should take place by the 20 th week. If the mother suffers from a significant illness such as diabetes or hypertension, up to 5 additional visits to the GP may be provided.

The public health nurse visits the mother and baby at home during the first 6 weeks, free of charge. The GP who attends the mother also provides care for the newborn; they will provide two developmental examinations free of charge at 2 weeks and 6 weeks following the birth.

The mother is entitled to free in-patient, out-patient and accident and emergency/ casualty services in public hospitals in respect of the pregnancy and the birth and is not liable for any of the hospital charges. Treatment for other illnesses which you may have at this time, but which are not related to the pregnancy are not covered by the scheme.

The medical card does not cover the costs if you choose to be treated as a private patient. So regardless of whether you choose to be treated publicly, semi-privately or privately you will be treated the same with or without the medical card. 

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