Insurance phrases explained (in actual English)
This applies when you first take out health insurance. During your waiting period, you will be covered for accident and injury treatments, but not illness. Once the waiting period has passed, you’ll be able to claim all your scheme’s benefits.
Everyday Medical Expenses - also referred to as out-patient expenses
These are fees and charges for hospitals and consultants for non-surgical treatment (other than radiotherapy and chemotherapy out-patient treatment). Only benefits shown as having cover on your Benefit Table are eligible for benefit.
Annual Out-Patient Excess
The everyday medical expenses excess is the amount that must be reached per membership year before you can claim money back from laya healthcare. The amount you can claim back is the benefit amounts listed on your benefit table less amount shown as the out-patient excess. For example, if you have an everyday medical expense excess of €50 and the allowed amount shown on your benefit table for consultant visits is €40, you have not reached your excess yet. If you have 2 consultant visits worth up to €40 on your plan then €40 + €40 = €80 , less €50 excess, you would receive a refund of €30. Where two amounts are shown, the first amount applies where there is only one member on the policy and the second amount applies to where there are dependents on the policy. If there is a mix of schemes on the policy with different excesses, please contact us to confirm the applicable excess.
Public vs private hospital accommodation
A private room is exactly that. It’s just you.
A semi-private room is a room with no more than five beds.
Public accommodation means you’d be on a ward with more than five beds.
A co-payment isn’t the same as an excess. Instead, it’s an arrangement by which the costs of certain treatments are split between you and laya healthcare.
Typically, we agree with you in your insurance scheme what cost of certain treatments you’ll pay. And we do, of course, set a limit.
You then make your share of the payment directly to the provider of the treatment.
Inpatient cover pays for treatment, procedures and accommodation in a hospital once you are admitted to a hospital. This may vary from being admitted for a few hours, a day, a night, or more.
Sometimes there is a gap between the charge for hospital treatment and how much your insurer covers. That gap is known as a ‘shortfall’. As you’ll be making up this difference, it’s worth comparing schemes to make sure you’re comfortable with the level of shortfall you’d be expected to pay.
Day-case treatment covers you when you have to be admitted into a hospital and occupy a bed during the day, but you don’t stay overnight.
This is cover that pays for hospital visits when you go home on the same day as the treatment or procedure.
These are specialist hospitals that provide complex cardiac (heart), oncology (cancer) and orthopaedic treatment. They also provide other demanding care.
There are three Hi-Tech Hospitals in Ireland, all of which are in Dublin: Beacon Hospital, Blackrock Clinic and Mater Private Dublin.
A rules booklet is a guide to your healthcare insurance scheme. It sets out your cover and benefits, along with all the applicable terms and conditions.
You’ll find a list of downloadable rules booklets here