Must I have health insurance for a year to be covered for maternity?

Q. My husband and I are looking at taking out private health insurance this month. He is currently with VHI and insured under his parents' plan. I have a medical card that covers me until July and I will have to take out health insurance for myself then also. Must I have the policy in my name for twelve months before I could potentially avail of any maternity benefits? Ciara, Co Louth

A. Yes, you will need to be on the policy for a year to claim for maternity benefits. However, you don’t need to be the policyholder, you just need to be named on a plan. A premium will need to be paid for each person named on the plan. If you have been insured for 52 consecutive weeks at the time you give birth, you will be covered for the maternity benefits listed on your plan.  

As well as the 52-week waiting period for maternity cover, there is a 26-week waiting period for cover for new conditions and a five-year waiting period for any pre-existing conditions or illnesses. As your husband is currently on his parents’ plan, he will not have to reserve any waiting periods when he takes out a new plan. If he’s still serving any waiting periods, such as for pre-existing conditions, he will be able to finish serving these with his new provider – he won’t have to start from scratch. 

There are a plethora of options available to expectant mothers in Ireland and many services can only be accessed through private healthcare. When choosing your healthcare for maternity, it all comes down to personal preference. The priority is ensuring you feel comfortable and supported throughout your pregnancy, birth and antenatal treatment.

Whether you choose to go as a public or private patient for your maternity care, each insurer offers excellent maternity benefits to support you along the way. To find out the differences between being treated as a public, semi-private or private patient for maternity care in hospital, you could read the blog post on 'Pregnancy, Planning and Private Care' on hcc.ie.

One very important thing to note is the lifetime community rating loading, which was first introduced in May 2015. Under this system, if you take out health insurance for the first time after your 35th birthday, there is a 2pc loading for every year you are 35 or over – which is chargeable for ten years. For example, if you take out health insurance at 36, a 4pc loading will apply, but if you wait until you’re 40, you’ll be paying a 12pc loading for the first ten years of your policy. For this reason, it's very important to arrange cover as soon as possible – as doing so will allow you to keep costs to a minimum.

Cover for day-to-day medical expenses

Q. I haven't bothered getting health insurance with cover for day-to-day medical expenses in recent years as my children were all very young and therefore eligible for the under six's GP visit card. However, my youngest has since turned six and he has also recently been diagnosed with a heart condition which will likely see much more frequent visits to the GP. We (that is, my husband, myself and our three children) are currently on VHI One Plan Family, which doesn't cover us for GP visits. Can you recommend a good plan which is not that much more expensive than One Plan Family, which has a similar level of hospital cover as One Plan Family – but which also covers GP visits? Also, if I do upgrade to a plan which covers GP visits, is there a waiting period that must be served before that cover kicks in? Jean, Co Kildare

A. When you upgrade your cover, there is a two-year upgrade waiting period for any increase in benefits relating to an existing medical condition. This only applies to inpatient cover, but it’s a good idea to get your son on a plan with good inpatient cover as soon as possible, as this waiting period may apply. 

No waiting period will apply when adding day-to-day benefits. While some providers may apply a 26-week waiting period for this, these only apply to members who are aged 55 or over. 

If you would like to stay with VHI, I would recommend a plan called ’PMI 5310’. This plan offers excellent day-to-day cover and inpatient benefits. ‘PMI 5210’ is also a good option, but this plan has a 40pc shortfall for certain orthopaedic and ophthalmic procedures. Laya Healthcare’s ‘Inspire’ and Irish Life Health’s ‘4D Health 2’ are excellent options too if you are open to switching health insurance providers. 

There is no one-plan-fits-all when it comes to health insurance, so be sure to do a full comparison of the various plans (or get your broker to do this for you) to ensure you are getting cover for what’s important to you. Many people think adding cover for day-to-day medical expenses will massively increase their annual premium, but this is not always the case. Anyone with more than four visits to a GP, dentist and/or consultant a year should have day-to-day benefits included on their health insurance plan.

Mental health support for lockdown-weary son

Q. My 19-year-old son has been struggling with his mental health since lockdown. He is insured with Irish Life Health (ILH) on a plan called ‘Be Fit 1’. Are there any supports available from ILH for mental health issues? Tom, Co Cavan

 

A. Yes, ILH offers a number of free resources to help members care for and understand their own mental health. It has a Healthy Minds programme, which offers a 24/7 telephone support line with access to professional counsellors. The insurer also covers six face-to-face counselling sessions through this programme and give access to its LifeWorks app, where members can take an assessment to help understand their mental health. The app provides simple lifestyle changes that can positively impact mental health. As well as providing toolkits, assessments and content that can help your son assess his current situation, the platform also lets him speak to a counsellor via webchat if preferred.  

‘Be Fit 1’ offers access to all of the above as well as the ability to claim 50pc back on the cost of nine counselling or psychotherapy visits – up to a maximum of €800 per policy year. I would recommend switching him to a plan called ‘4D Health 2’ as this plan offers 50pc back on 12 counselling and psychotherapy visits – up to a maximum of €1,000 per policy year.

ILH also offers benefits under its Mind Extra package – including contributions towards stress reduction and self-compassion programmes. This can be added to ‘4D Health 2’ for free. 

Finally, ILH has a ‘Couch Counsellor’ series available on Facebook and YouTube which offers professional advice on ways to make the lockdown easier on people’s mental health. You can access these for free, regardless of your membership status.

Should you ever change your insurer in the future, both VHI and Laya also offer mental health supports to their members.

Barbara Sheahan is managing director of HealthCare Compare (hcc.ie)

 

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