The very public cost of private care

With rising costs and the Government's new health insurance levy, the price of private health insurance will force many members to go public

WHILE EVERY resident of the Republic is entitled to a range of free public health services, almost half of the population top up their entitlements with private health insurance.

However, following the Government's imposition of a new health insurance levy on health insurance providers of €160 a year per adult member and rising healthcare costs in general, it has become considerably more expensive to go private.

Despite the fact that private health insurance offers no guarantee of a private bed, from January, members of both VHI and Quinn Healthcare will see a substantial increase in the cost of their policies.

VHI is to increase its prices by an average of 23 per cent, which means that the cost of its Plan B scheme will increase for an adult by €163.34, up to €828, while the cost for a family on the same plan will rise by €442.84 to €2,256 for two adults plus two children.

Over at Quinn, the cost of its similar Essential Plus plan is set to rise by 19 per cent, or €114, to €715, while for a family, the cost will also jump by 19 per cent, or €316, to €1,978.

As such, members of VHI or Quinn might think it is now time to switch over to Hibernian Health's apparently cheaper plans, but are they really cheaper and how easy is it to actually switch policies?

Hibernian, formerly known as Vivas, has said that it has no plans to increase its prices and is actually offering 10 per cent off all its hospital plans for consumers who commence cover on December 21st or 30th. However, it is possible that its prices will increase in the new year, and the insurer may be looking to pull in new customers by offering a special deal this month, and then hiking up prices thereafter.

Nevertheless, at the moment Hibernian's prices certainly look cheaper and offer an opportunity for consumers to lock in at lower prices for at least a year.

For example, its "I" plan (Level 2), which offers a semi-private room in a private hospital, costs just €589 per year, while for a family of four, on the similar "We" plan, the cost is €1,608.

Unfortunately however, like figuring out which phone provider offers the cheaper overall service, it can be very difficult to compare health insurance policies on a like-for-like basis, and consumers need to do their research before switching.

For example, while both Plan B and Essential Plus offer a private room in public hospitals and a semi-private room in private hospitals, under the Essential Plus scheme, members may have to pay an excess of up to €200 for private hospital charges.

The need to carefully examine each policy before you decide which is best for you - and the cheapest - is clearly evidenced when you look at the contribution towards maternity consultancy fees on offer, as the existence of an "excess", which is an amount you must pay before you can claim anything, can significantly reduce the benefits.

In the aforementioned schemes, both Quinn and Hibernian offer up to €400 towards maternity consultancy fees, greater than the €250 offered by the VHI on its First Plan Plus option, which is similar to Plan B.

However, the contributions from both Quinn's Essential Plus and Hibernian's "I" plan are subject to an outpatient excess, which means that members can't claim back against the first €220 in allowable expenses they incur at Quinn, and €150 at Hibernian. So, if a member of Essential Plus only incurs maternity fees in a year, then the most they can claim back is €180 (€400-€220), while at VHI, members can benefit from almost the full amount on offer, as the excess is just €1.

The cost of accessing private hospitals such as the Blackrock Clinic, Beacon Clinic and Mater Private, or "hi-tech" hospitals as Hibernian refers to them, has also increased significantly. Already expensive, schemes such as Quinn's Healthmanager Gold and VHI's Plan E are now even more so, rising by 11.5 per cent and 29.7 per cent respectively, to €2,050 and €2,640 per adult per year. Hibernian's "I" plan (Level 5) costs €1,934 at present.

Outpatient costs should also be carefully analysed. For example, Quinn's comprehensive Healthmanager scheme includes 50 per cent back on costs such as GP, dentist and physiotherapist fees, while other providers offer outpatient benefits as add-on schemes, which can be purchased as a top-up to existing policies, or on their own. These include VHI's Healthsteps Silver, which will increase by €10 and cost €135 a year on a standalone basis from January, and gives €25 back per GP visit, and Hibernian's "Day-to-day plan A" which costs €143 and gives €30 back on GP visits - but only three times a year.

If you are considering switching, how can you find a plan that best suits your needs?

A useful place to start is the "switching comparisons" available on the insurance providers' websites.

The Health Insurance Authority also recommends that you ask yourself the following questions before making a decision on a policy:

• What kindof hospital cover do I want?

• Which benefits would be of most value to me?

• How much could I benefit?

• How much risk am I willing to accept?

• Which product offers the best value for my circumstances?

When examining policies, it is extremely important to not only consider what your needs are today, but what they are likely to be in the future, as waiting periods apply in many cases.

In principle, members of other health insurance firms can switch to a new provider and receive immediate protection.

However, it is not as easy as it looks if you are upgrading your policy, have a gap in cover of more than 13 weeks, or if you have not already served all of your waiting period with the old insurer. Then you may be forced to wait a period of time before you can avail of all of the benefits associated with the new scheme, although you are covered for accidents during this time.

By law, there is a maximum limit on this new waiting period, depending on your age when you are first named on the higher contract - of up to two years if you are under 65 and up to five years if you are over 65.

If, for example, a consumer under the age of 55 wishes to switch from Quinn Healthcare's relatively basic Essential Plus plan to Hibernian Health's top- of-the-range Level 5 "I" plan, then they must wait 26 weeks before they are fully insured under the new plan. The waiting period goes up to 52 weeks for those aged 55-65, and up to 104 weeks for those aged over 65.

"Exclusion periods", whereby consumers cannot claim for certain pre-existing conditions, also apply, so again, consumers need to read the fine-print to ensure that they are not giving up essential cover.

By law, for those aged under 55 this can be up to five years, those aged 59, seven years; 60 and over, 10 years.

"It is possible that its [Hibernian's] prices will increase in the new year, and the insurer may be looking to pull in new customers by offering a special deal this month, and then hiking up prices thereafter

How to spend your cash wisely

Jane is a 22-year-old graduate who has just started her first job. Her biggest concern is reducing the amount she spends on visits to the doctor to deal with a chronic complaint, but she would also like to get hospital coverage, if it was cheap enough.

Current plan:VHI HealthSteps Silver.

Cost:€125.

Pros:It's one of the cheapest products on the market, and it refunds €25 per GP visit, up to a maximum of 25 visits, as well as offering money back on other outpatient charges including €60 on consultant visits and €25 per dental visit.

Cons:It offers no coverage for hospital stays and will increase by €10 in January.

Switching options:Quinn Life Essential Starter.

Cost: (From January)€330.

Pros:Jane will be covered for a semi-private room in a public hospital.

Cons:The excess on outpatient claims is €150, and Jane won't be able to claim anything back against GP fees.

Alternative package:Hibernian day-to-day plan A.

Cost:€143.

Pros:It refunds €30 on each GP visit and €30 on each visit to the dentist.

Cons:Only three visits to the GP and dentist are covered each year, and it doesn't cover consultant fees.

Linda and Ronan have a three-year-old daughter and are currently members of Quinn's Essential Plus plan, but would like to look at other options. As expanding their family is priority, good maternity benefits are key.

Current plan:Quinn's Essential Plus

Cost:€1,662

Pros:It offers a private room in public hospitals and a semi-private room in private hospitals and refunds up to €400 of maternity consultancy fees.

Cons:It will increase to €1,978 from January and there is a family excess of €440 for outpatient costs, including maternity consultancy fees.

Switching options:"We" plan (Level 2) from Hibernian

Cost:€1,417 for two adults and one child

Pros:This scheme offers private coverage in a public hospital, and a semi-private room in private ones. The scheme also offers €400 towards maternity consultancy fees, as well as benefits such as a €200 discount on hiring a doula and a contribution of up to €55 on a 4D ultrasound.

Cons:The €400 is subject to the policy's outpatient excess of €250 and maternity or pregnancy benefits are not covered for 52 weeks from the date of becoming a Hibernian member.

Alternative package:VHI's Family Plan Plus (Level 1).

Cost:(From January) €1,870.66 for two adults and one child.

Pros:This scheme offers private coverage in a public hospital, and a semi-private room in private hospitals. The scheme also offers €400 towards maternity consultancy fees, with an excess of just €1, and other benefits such as €100 towards baby massage classes.

Cons:A 52-week waiting period applies to maternity/ pregnancy benefits.

Gemma and Paul are a middle-aged couple in their late 40s who are currently on VHI's Plan B, but are now looking to upgrade their cover as Gemma has a history of cancer in her family. Having read that cancer patients have better survival rates in private hospitals, Gemma would like to get full coverage as part of her new plan.

Current plan:VHI Plan B.

Current cost:€1,329.32.

Pros:It provides coverage in a semi-private room in over 40 private hospitals.

Cons:It is a fairly basic package and coverage excludes the Beacon Hospital, the Blackrock Clinic and the Mater Private Hospital. The price will rise to €1,656.33 from January.

Switching options:Quinn HealthManager Gold.

Cost:(From January) €4,100.

Pros:This scheme will give Gemma and Paul full coverage in private hospitals, including the Blackrock Clinic, the Beacon Hospital and Mater Private, as well as extensive cancer support services. An extensive range of outpatient expenses can be claimed against, without any excess.

Cons:There will be a two-year waiting period for the supplementary benefits as the couple is looking to upgrade their cover.

Alternative package:Hibernian "We" plan (Level 5).

Cost:€3,868.

Pros:The plan gives full cover in a private room in a private hospital, including the Blackrock Clinic, the Beacon Hospital and Mater Private, as well as extensive cancer-support services. It also gives overseas cover for access to new surgical procedures abroad.

Cons:There is a waiting period for this scheme, of 26 weeks, and an excess of €250 on outpatient expenses.