Assure Protect – Insurance Product Information Document

On this page

• What is this type of insurance?
• What is insured?
• What is not insured?
• Are there any restrictions on cover?
• Where am I covered?
• What are my obligations?
• When and how do I pay?
• When does the cover start and end?
• How do I cancel the contract?

Insurance Product Information Document

Company: AXA Insurance dac       Product: Assure Protect

AXA Insurance dac, trading as laya healthcare, is regulated by the Central Bank of Ireland.

This document and the cover detailed within it, is a summary and for your guidance only. You must read this document in conjunction with all other policy documents, including your Benefit Table and your Scheme Rules.

What is this type of insurance?

This is a private health insurance contract. Private health insurance is insurance that helps cover all or part of medical costs incurred. Other benefits may also be provided as part of your policy.

What is insured?

Hospital Cover - Public Hospitals

• Day-case/Out-patient surgical: Full cover Semi-private: Full cover
• Private: A shortfall will apply per night for private accommodation

Hospital Cover - Other Benefits

• Participating Consultants' fees: Full cover
• Psychiatric treatment: Full cover up to 100 days per calendar year in all public hospitals. No cover for private psychiatric centres
• Drug, Alcohol, Gambling & substance abuse: Full cover up to 91 days every 5 years in public hospitals
• Convalescence care: Up to €28 per day for 14 days Cancer Care Benefits - Out-patient Treatment
• Breast prosthesis or hairpiece (following cancer treatment): Full cover for both
• Cancer accommodation benefit: Up to €100 per night. No limit
• Manual lymph drainage: Up to €500 per year Medical tattooing : Up to €150 per year
• Sleeping caps: Full refund for 1 sleeping cap per membership year

Maternity Benefits

• Maternity in-patient hospital delivery/homebirth costs: Up to €400 towards costs in public hospitals. No cover for homebirth costs

Child Healthcare Benefits

• Home nursing for children (following in-patient treatment): Up to €40 per day for 28 days

Treatment Overseas

• Emergency hospital admission while overseas (+353 21 422 2204): Up to €65,000 per episode of illness or injury
• Medical Tourism : Full cover for treatment in another country within the EU or UK , up to the amount payable in Ireland - subject to prior approval
• Consultant Connections: Full cover - subject to prior approval Healthcoach
• Healthcoach face to face consultations: Full cover for 1 consultation every 2 years

Minor Injuries & Illnesses

• QuickCare consultations & treatment: €100 excess per visit in approved minor injuries & illness centres

Digital Health

• GPlive (online GP consultation): Full cover - unlimited consultations

What is insured?

• Specialist GPlive Consultations: Discounted online access to GPs with specialist expertise. Check your Member Area for details
• 24 Hour GPline (021 202 2860): Full cover from Ireland & abroad
• 24 Hour Nurseline (021 202 2861): Full cover from Ireland & abroad

Health Screening

• HeartBeat cardiac screening: Full cover for 1 screen every 2 years for members over the age of 12
• Direct payment MRI, CT & PET scans: Full cover in approved direct payment centres (maximum 66% cover in private hospitals)
• Direct payment mammogram: Full cover in approved direct payment centres (maximum 66% cover in private hospitals)
• Women's cancer screening (subject to annual out-patient excess): Up to €20 per year
• Men's cancer screening (subject to annual out-patient excess): Up to €15 per year

24/7 Mental Wellbeing Support Programme

• 24/7 Telephone Counselling (1800 911 909): Full cover Cover for specific support services: Full cover for 1 session per presenting issue for legal, consumer & health advice, career guidance, life coach & mediation.

Everyday Medical Expenses

• Annual out-patient excess: €10 Out-patient limit: €2,500
• GP/Nurse visits: Up to €20 per visit - 3 visits per year Consultant visits: Up to €40 per visit
• Hospital casualty charge: Up to €20 per visit
• Radiologist fees (professional fees): 50% of costs in hospitals & approved diagnostic centres
• Pathologist fees (professional fees): 50% of costs in hospitals & approved diagnostic centres
• Radiology diagnostic test (technical fees): 50% of costs in hospitals & approved diagnostic centres
• Pathology diagnostic test (technical fees): 50% of costs in hospitals & approved diagnostic centres
• Optical: Up to €55 per year
• Dean Clinic out-patient mental health consultations: Up to €50 per visit - 12 visits per year
• Lois Bridges out-patient mental health consultations: Up to €50 per visit - 12 visits per year
• Approved Appliances: Refund for the amount shown for approved appliances on laya healthcare appliance list (not subject to the out-patient limit)

What is not insured?

This is not a complete list of what is insured, for full details of your cover please refer to your Benefit Table and General Rules policy booklet. General exclusions are listed in the ‘What is not covered under the scheme’ section of your General Rules policy booklet.

Normal waiting periods apply as set out in your General Rules policy booklet, i.e. once your waiting periods have passed you can claim the benefits included on your scheme.

Are there any restrictions on cover?

(a) When possible, you should tell us about any treatment you are going to have so we can tell you if you can claim for benefits.

(b) We will not pay benefits while you are breaking any of the terms of your membership.

(c) You should send your claims to us as soon as possible. We will only pay benefits if we receive all the following:

• A written claim within 12 months from the end of your policy year for any non-surgical out-patient treatment and six months of the date of any other treatment
• You must make the claim in the way that we reasonably ask you
• any proof we reasonably need to help us to decide if you are entitled to benefits. This can include: any medical reports and other information to do with the treatment
• the results of an independent medical examination which we may ask you to undergo
• original accounts and invoices for the benefits you are claiming
• written confirmation from you as to whether or not you think you can recover the cost of the benefits from another person or insurance company
• details of any Health Insurance Contract under which you were covered prior to becoming a member of the scheme
• original flight/travel tickets which will act as proof of your stay outside of Ireland up to but not exceeding 180 days in each calendar year.

(d) We shall only pay benefits for out-patient treatment after your renewal date.

(e) In order to process a claim we require a fully completed claim form.

(f) All out-patient receipts are assessed in date order received and treatment date.

( g) We may end your membership of the scheme by writing to you if you do not pay any or part of your subscriptions on the date they are due. If your membership ends because you do not pay your subscriptions, we may allow you to continue your membership, as long as you pay the subscriptions you owe within 10 business days of the date on the cancellation letter.

(h) Cover is only available to those resident in the republic of Ireland. Your membership of the scheme will end immediately if you stop living in Ireland for a period of time exceeding 6 consecutive months in your membership year. In the event that you cease living in Ireland for a consecutive period of 6 months or more ina membership year, you must contact us to cancel your scheme. If you do not cancel your scheme, and have been out of the country for a consecutive period of six months in your membership year or more, no claims will be eligible for payment.

Where am I covered?

You are covered in laya healthcare participating hospitals, on the island of Ireland, in accordance with the level of cover on your chosen scheme, notwithstanding any Overseas cover which may be included on your scheme.

What are my obligations?

You are required to provide laya healthcare with any information or material facts necessary to facilitate your policy. You are required to act honestly and within the terms of your contract.

You are required to make agreed subscription payments within the required timeframe.

You are obliged to respond fully and truthfully to any questions that have been posed by Laya healthcare.

When and how do I pay?

You must pay your subscriptions in a way which is reasonably acceptable to us. You can pay either by credit or debit card or annually, quarterly or monthly by direct debit. A creditor charge will apply if paying by instalments.

When does the cover start and end?

Your contract with laya healthcare is for a period of one year unless we agree to a different period when commencing your policy. Your cover starts from your membership start date or renewal date and ends at midnight on the day before the next renewal date. Your membership of the scheme will automatically renew on your renewal date, each year.

How do I cancel the contract?

You can cancel your policy by writing to Laya healthcare, Eastgate Road, Eastgate Business Park, Little Island, Co. Cork T45 E181 or go to the contact us page on our website within 14 days of receiving your welcome or renewal Membership Certificate. The 14 day period starts from the effective date or the renewal date of your policy shown on your Membership Certificate.

You can cancel your policy by sending us a message at layahealthcare.ie or by writing to Laya healthcare, Eastgate Road, Eastgate Business Park, Little Island, Co. Cork T45 E181, within 14 days of receiving your welcome or renewal Membership Certificate. The 14 day period starts from the effective date or the renewal date of your policy shown on your Membership Certificate.