Everyday Medical Costs
Your everyday medical expenses are also known as out-patient expenses. These include expenses that you pay yourself on a day-to-day basis, such as GP fees, visits to consultants or fees for physiotherapy. This is a list of your everyday expenses which are subject to an out-patient excess. Please note there are limited out-patient benefits on the Essential First, Essential Starter, Essential Connect and the Essential Health schemes. Benefits marked with an * are not covered under the above listed schemes. Benefits marked with ** are not covered under the Essential Choice scheme.
Direct payment centres e.g. MRI, CT, DEXA scans
Executive health check centres
Participating therapists
Well woman centres
Appliance list
If you have alot of everyday medical expenses we would recommend you view our HealthManager or CareManager range of schemes which offer 50% back on your expenses with no out-patient excess.
| Treatment | The amount you can claim |
|---|---|
| Speech & language therapy (on GP or consultant referral), chiropody, occupational therapy* | Up to €20 per visit for up to 12 visits per year combined. For Essential Gold members, we allow 1 speech and language assessment, if billed, up to a maximum of €77. Health Smart Members are allowed €20 per visit for 5 visits for chiropody & occupational therapy and €20 per visit for 8 visits for speech & language. |
| GP health check | €50 per year (Essential Complete, Health Smart & Essential Plus only) |
| Radiologist fees for consultants in the full cover scheme | Full refund |
| Pathologist fees | Up to €20 for each referral. Up to €60 per referral for Health Smart members. |
| Pathology | Full refund for charges by participating hospitals and Laya Healthcare approved diagnostic centres |
| Hospital casualty charge | Up to €20 per visit. Up to €60 per visit for Health Smart members up to a maximum of 4 visits. |
| Physiotherapy* | Up to €20 per consultation for a maximum of 25 visits per year |
| General Practitioner* | Up to €20 per consultation |
| Approved reflexology, including baby reflexology*/** | Up to €20 per consultation for a maximum of 8 visits |
| Approved complementary therapies*/**– acupuncture, homeopathy, chiropractic and osteopathy | €20 per consultation for a maximum of 12 visits per therapy |
| Physical Therapy*/** | €20 per consultation for a maximum of 8 visits per year |
| Dietician*/** | Up to €25 per visit for 5 visits per year |
| Certain medical and surgical appliances | Full or partial refund for appliances on the Laya Healthcare approved list (please ask us for details). |
| Consultant fees (excluding maternity) | Up to €51 per consultation. Up to €60 per consult for Health Smart members. |
| Consultant fees (for maternity) | Up to €400 for each delivery (not covered on Essential First or Essential Starter). Up to €300 for Essential Complete) |
| Home nursing following in-patient treatment for a person aged 18 years or over (on consultant referral) | Up to €40 per day for up to 40 days per year and up to 20 days for Essential First and Essential Starter. Up to €20 per day up to 20 days for Essential Select |
| Women’s cancer screening (at approved centres) | Up to €30 per year (not covered on Essential First and Essential Starter) |
| Blood tests for the purpose of prostate cancer screening (at approved centres) | Up to €20 per year (not covered on Essential First and Essential Starter) |
| Dental visit* | Up to €25 per year |
| Emergency dental treatment for, and which immediately follows (i.e. within five days), a dental injury caused by an accidental external impact | Up to €510 for restorative treatment provided by a dentist. Up to €475 on Essential Complete. Up to €460 on Essential Starter. Up to €400 on Essential First and Essential Select. Up to €300 on Health Smart. |
| Optical* (eye test/glasses/lenses) | The cost of visits to an optician up to €20 each year |
| Orthoptic visits* | Up to €20 per visit for up to 8 visits each year |
| Sports Health Screening | Up to €150 per screening every 2 years. This benefit is not available under the Essential/Essential Choice and Essential First/Essential Starter schemes |
| Executive health check at approved centres. (These centres may change from time to time so please call us for an up to date list before having your screening.) | Up to €100 per year (Essential Gold members only). Up to €50 per year for Essential Complete, Health Smart & Essential Plus members |
| Radiology | Full refund for charges by participating hospitals and diagnostic centres which Laya Healthcare have approved for direct payment. We will allow up to a maximum of €500 per membership year, for charges by participating hospitals and diagnostic centres which have not been approved for direct payment |
An excess applies to any out-patient claim on the Essential suite, for example the first €250 for an individual policy or the first €470 for a family policy on our Essential scheme must be covered by the member themselves. Any expenses in excess of these can be submitted for refund. Please refer to the table above for the amount allowed for each benefit.
| Laya Healthcare annual out-patient excess on each scheme | Essential First | Essential Starter | Essential Choice | Essential | Essential Select | Essential Plus Starter | Essential Connect | Essential Health | Essential Complete | Health Smart | Essential Plus | Essential Gold |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Yearly excess per member | €150 | €150 | €150 | €250 | €220 | €220 | €150 | €150 | €220 | €220 | €220 | €250 |
| Yearly excess per member with dependants | €300 | €300 | €300 | €470 | €440 | €440 | €250 | €250 | €440 | €440 | €440 | €380 |
