AccessHealth – Insurance Product Information Document

Company	AXA Insurance dac
Trading as	laya healthcare
Product	AccessHealth

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: Full cover

Hospital Cover - Private Hospitals

Private hospital excess: €275 excess per claim
Day-case/Out-patient surgical: Full cover, including Beacon Hospital
Semi-private: Full cover, including Beacon Hospital
Private: €250 shortfall per night, including Beacon Hospital. Full cover in Mater Private Cork & Bon Secours Limerick
Specified Orthopaedic & Ophthalmic Procedures: 40% shortfall

Hospital Cover - Hi-Tech Hospitals, Blackrock Clinic, Mater Private Dublin & Beacon Hospital

Hi-tech hospital excess: €275 excess per claim
Day-case/Out-patient surgical: Full cover in Beacon Hospital only. No cover in Blackrock Clinic & Mater Private Dublin
Semi-private: Full cover in Beacon Hospital only. No cover in Blackrock Clinic & Mater Private Dublin
Private: €250 shortfall per night in the Beacon Hospital. No cover in the Blackrock Clinic or Mater Private Dublin
Cover for specialist cardiac procedures in Hi-tech hospitals: Full cover up to a semi-private room in the Beacon Hospital (excess applies). No cover in Blackrock Clinic & Mater Private Dublin
Specified Orthopaedic & Ophthalmic Procedures: 40% shortfall in Beacon Hospital. No cover in the Blackrock Clinic & Mater Private Dublin

Hospital Cover - Other Benefits

Participating Consultants' fees: Full cover
Psychiatric treatment: Full cover up to 100 days per calendar year
Drug, Alcohol, Gambling & substance abuse: Full cover up to 91 days every 5 years
Convalescence care: Up to €40 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

What is insured?

Maternity Benefits

Maternity in-patient hospital delivery/homebirth costs: Full cover for 3 nights in a public hospital. No cover for homebirth costs
Maternity out-patient consultations (subject to annual out- patient excess): Up to €250 per pregnancy
Post natal home nursing if hospital stay is less than 3 nights: Up to €1,200 for 2 nights home nursing & up to €600 for 1 night home nursing
Midwife support service : Full cover for a phone consultation each trimester & one call within the first 3 months of your child's birth (021 202 2824)
Paediatric First Aid Course: Up to €20 per year Maternity Yoga/Pilates: Up to €25 per pregnancy 3D/4D Scans: Up to €25 per pregnancy

Child Healthcare Benefits

Home nursing for children (following in-patient treatment): Up to €50 per day for 28 days
Child counselling (subject to annual out-patient excess): Up to €30 per visit - 5 visits per year
Parent travel & accommodation benefit: Up to €50 per day for 14 days
Vaccinations (subject to annual out-patient excess): Up to €25 per year Treatment Overseas
Emergency hospital admission while overseas (+353 21 422 2204): Up to €100,000 per episode of illness or injury
Medical Evacuation: Up to €2 million towards the cost of medical evacuation. Up to €1,000 towards companion evacuation
Treatment not available in Ireland: Full cover in the EU or UK- subject to prior approval
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 Laya Healthcare Concierge
Healthcare Concierge clinical support service: Unlimited access to clinical support service with a dedicated healthcare professional (021 202 2893)

Healthcoach

Healthcoach face to face consultations: Full cover for 1 consultation every 2 years

Minor Injuries & Illnesses

QuickCare consultations & treatment: €75 excess per visit in approved minor injuries & illness centres

Digital Health

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

Fertility Benefit

First Steps fertility package: 50% of costs up to €1,000 per year. Please refer to rules for the list of eligible fertility tests and treatments
Fertility Counselling (0818 100 030): Full cover for 5 visits per year. Please refer to rules for criteria
Fertility Preservation: €1,000 per lifetime for egg freezing, €1,000 per lifetime for embryo freezing, €150 per lifetime for sperm freezing, at approved centres
Pre Implantation Genetic Testing: 50% of costs up to €2,000 per lifetime. Please refer to rules for eligible tests and criteria 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
Direct payment mammogram: Full cover in approved direct payment centres
Direct payment bone density/dexa scan: Full cover in approved direct payment centres

24/7 Mental Wellbeing Support Programme

24/7 Telephone Counselling (1800 911 909): Full cover
Face to face/Video/Phone Counselling: Full cover for 6 visits per presenting issue. Please refer to rules for criteria
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: €6,500
Consultant visits: Up to €40 per visit Hospital casualty charge: Up to €50 per visit
Radiologist fees (professional fees): Up to €25 per scan in hospitals & approved diagnostic centres
Pathologist fees (professional fees): Up to €25 per test in hospitals & approved diagnostic centres
Radiology diagnostic test (technical fees): Up to €50 per scan in hospitals & approved diagnostic centres
Pathology diagnostic test (technical fees): Up to €50 per test in hospitals & approved diagnostic centres
Approved Appliances: Refund for the amount shown for approved appliances on laya healthcare appliance list

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.

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.

AccessHealth – 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?