Health Insurance Excess
What is excess and why do we have it?
Excesses allow you to manage the cost of your health insurance. You can choose whether you’d like to have an excess on your policy or not. If you choose to have one, you’ll usually pay a lower premium.
An excess amount means you pay a portion of each claim or of your overall claims, with the balance covered by the insurer.
An Inpatient excess is the initial amount of a private or hi-tech hospital claim you pay, with the remaining balance covered by the insurer. An Inpatient excess does not apply to public hospitals.
The excess can apply for both day-case and overnight procedures.
There is a common misconception that an excess applies to each night you stay in the hospital but that’s not case. You pay the excess once per hospital admission, but this may differ as per your chosen level of cover. You can check your cover easily in your Member Area.
Example - policy with a €150 Inpatient excess
If your Inpatient excess is €150 and you go to the hospital for 7 nights, you pay €150 and we cover the rest.
The Outpatient excess is the amount that you must exceed per membership year before you can receive any refunds on your everyday medical expenses. Things like GP visits, Physio visits and much more.
The amount you will be refunded is not what you pay for each expense. The amount you can claim back is the allowed amount per benefit less the Outpatient excess on your plan. You can check your cover easily in your Member Area.
The allowed amount which you claim back can be shown in monetary and/or percentage values.
Where two Outpatient excesses are shown on the benefit table, the Individual excess applies where there is only one person on the policy and the Family excess applies to where there is more than one person on the policy.
Example - policy with a €50 Outpatient excess
- John has an Outpatient excess on his policy of €50 and he visits a Consultant
- John's allowed amount that he can claim back for Consultant visits is €80
- The amount that John can claim back is the allowed amount (€80) minus the Outpatient excess (€50)
- John will receive a refund of €30
- For future receipts/claims, John will receive the full allowed amount (€80), as the excess has been executed.
Example - policy that shows Individual and Family excess
Sarah and Michael have a policy together. Because there is more than one person on the policy, the family Outpatient excess will apply when Sarah and Michael submit their receipts.
- The family excess is €250. Sarah visits a GP
- The allowed amount to claim back for GP visits is €40
- The amount Sarah can claim back is the allowed amount (€40) minus the Outpatient excess (€250)
- Sarah will not receive a refund in this case as the allowed amount does not exceed the Outpatient excess.