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.
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.
There are two types of excess: Inpatient excess and Outpatient excess.
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.
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.
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.
A scheme is another word for ‘policy’.
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.
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.
We will only pay fees and charges for treatment, services and facilities that are reasonable and customary and in any event only up to the limits shown in the Benefit Table. By reasonable and customary we mean that what you are charged for and how much you are charged is not more than what the majority of our other members of the schemes are charged in Ireland for similar treatment services or facilities. Should you wish to find out the reasonable and customary amount for a service, please contact us and we will be happy to advise you.
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