There is much confusion in the market as to what constitutes quality health cover or what are the essentials that need to be covered. Too many consumers hold entry-level or high-excess plans, yet they believe that they have adequate health cover in place which all too often is not the case. These plans are low-cost simply because the member is carrying all the risk. Take a plan with a private hospital excess of €500 per claim. Before you are admitted, you will be contacted by the private hospital to either arrange payment in advance or bring payment with you on the day of admission. If a follow-up hospital stay is required, then another €500 will be payable. Our experience is that members on these plans often go out of their way to avoid private hospitals because of the excess which defeats the whole purpose of having cover in the first place. Some will increase their cover at the next renewal date only to find that the Upgrade Rule applies which allows all insurers to restrict their cover to the previous plan for a further two years for any pre-existing conditions. This means that they will continue to be charged the €500 excess even though they are now paying for a higher plan.

Quite simply, having quality cover in place means having a plan that will work for you in the event of ill-health requiring hospital treatment. It’s the equivalent of holding comprehensive car insurance cover! This means you should have more control of your medical treatment in terms of which hospitals you attend; what accommodation you occupy; which consultants look after you; and also when suits you best to have the treatment carried out. It also gives you better access in that you can attend any public or private hospital that you are referred to. A quality plan may also include guaranteed refunds with no excess to pay on out-patient expenses such as GP, Consultants fees, Physiotherapy and many more which can quickly mount up. Finally, a quality plan may include full cover for some of the major cardiac procedures that might only be available in the high-tech facilities in Dublin. Based on current rates, one can expect to pay approximately €1,200 – €1,350 per adult for this type of health insurance cover. It’s important to note that most plans at this level include small excesses and some level of co-payments to keep the premiums affordable. For those who want less risk, there are plenty of higher cost options available to consider.

Unfortunately, we know that there are thousands of consumers who would like to hold this standard of cover, but these costs are unaffordable. For all consumers under cost pressure, we suggest a step-back approach where you remove some of the least essential elements of cover first. For example, remove the day-to-day cover for out-patient expenses or reduce / remove the high-tech cover. If at all possible, try and retain the coverage for public and private hospitals. Take on an excess if necessary but try and avoid the high-excess plans of €500 or higher. All insurers now offer plans with excesses of €250 – €300 per overnight stay with lower excesses for day-case procedures. Some plans now cap the number of excesses payable in any one year to minimise the overall risk for the member. If you need to select a plan with limited hospital coverage (network plans), make sure that all the key hospitals in your jurisdiction are covered.

The message on health insurance is the same for all other insurances. Help your customers to understand their exact cover requirements and therefore avoid under-insurance. Make sure they understand the implications of high excesses and downgrading cover. Help them to consider the benefits and not just the cost when reviewing other alternatives. Everyone hopes they never have to use their cover but if the worst case scenario becomes a reality, it will be money well spent.

All prices quoted are net of tax relief at source and are correct as of 1/1/17 as per (Health Insurance Authority). However, prices and benefits are subject to change and consumers should confirm all details directly with the insurer in question. PHI Consulting (Ireland) Ltd trading as Total Health Cover is regulated by the Central Bank of Ireland.