Frequently Asked Questions

Below is a list of the questions our team are frequently asked. If you don't find the answer you're looking for please contact one of our team members and we'll look after you.

 

How much cover do I need?

How much insurance is right for you depends on a number of things. First, your lifestyle. You need to make sure you get a scheme that has the right benefits for you. Second, your preferences. For instance, you might feel better off in a private room or you may be happy to have a semi-private room.Third, your budget. You need to find the scheme that has the right combination of benefits and value for you. Fortunately, that’s what we specialise in at laya healthcare.

What is a waiting period?

This applies when you first take out health insurance. The insurer is allowed some time to make sure no pre-existing conditions have gone undetected. In that time you’re 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.

 Here’s an overview of the waiting periods that might apply to you: 

Waiting Periods   
Accident or InjuryIllnesses that develop after you joinIllnesses that develop before you join
None 26 weeks 5 years

A 52 week waiting period applies to maternity/infertility benefits.

A 2 year waiting period applies if you want to avail of a higher level of cover/benefits for any disease, illness or injury which began or the symptoms of which began before you upgraded.

Useful Definitions:

Prior to 01st May 2015: The definition of a pre-existing condition is when the symptoms of the illness or injury began before the original date of joining.

After 01st May 2015: The definition of a pre-existing condition will be an ailment, illness or condition where the signs or symptoms existed at any time in the period of 6 months prior to the insurance commencing.

What is an 'excess'?

The excess on your insurance is the amount of money that you pay towards medical bills before you can claim back from your insurer. For instance, when it comes to healthcare insurance, you might pay the first €150 of your everyday medical expenses (doctor’s visits and so on) before you can claim back money from laya healthcare. 

What is a 'shortfall'?

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.

What scan centres do you cover?

Most laya healthcare members have full cover for scans at participating centres. You’ll be covered for MRIs, mammograms, CT scans, DEXA scans and more. You can find out more about scans and the scan centres we use here.

What is the difference between 'public' and 'private' 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 would be on a ward with more than five beds.

What is lifetime community rating?

Lifetime Community Rating (LCR) is a government initiative to encourage people to take out healthcare insurance earlier in life. It is due to come into effect on May 1st 2015. It will make healthcare cover for first-time buyers more expensive if they take out cover after they’ve turned 35. We will be updating information on this on our information hub www.healthinsurancewise.ie.

How can I pay?

You can pay your premium in one go, either by credit card or annual direct debit. You can also pay in monthly instalments by direct debit.

If you're paying by monthly instalments then there is a 3% charge but this covers the extra costs the banks charge us for processing monthly payments. If you pay your annual premium in one go, the bank doesn’t charge us, so we don’t have to pass it on to you.

One thing to note if you pay by monthly direct debit is that the first payment may be more or less than your regular payments. That’s because the date you policy starts might be different from the date the direct debit usually goes out on. Don’t worry, it all evens out.

Didn't find the answer you were looking for?

We’re here for you. Here’s how to get hold of us by phone:

LoCall: 1890 700 890

Landline: +353 21 20 22 000

What is the Young Adult Rate (YAR)?

Young Adult Rate

The Health Insurance (Amendment) Bill provides for ‘Young Adult Rates’ of premiums. This aims to address the sudden increase in premium rates that occurs for most young adults after their 21st birthday, where premiums can increase by 100% or more.  This will come into effect on 1st May 2015.

The new rates will be age-based rather than student-based and are designed to graduate the premium payable between the child rate and a full adult rate.

Insurers will retain the discretion whether or not to provide Young Adult Rates on some or all of their products. Where an insurer chooses to provide them, they must provide the full range of rates within the specified bands: 

Age

% of Full Adult Rate

18-20

up to 50%

21

51% to 60%

22

61% to 70%

23

71% to 80%

24

81% to 90%

25

91% to 100%

26

100%

 

This policy change also removes the requirement for young people to a dependant of an adult policy holder, or a full-time student dependent on parents.

If you're thinking of switching to laya healthcare from your current provider, you might have some questions. You'll find answers to the ones we're asked most below. 

Can I switch to laya healthcare from another provider?

Yes, absolutely. You’ll be welcomed by a team of people whose goal is to look after you always. 

It’s a simple process. We recognise all of the time you have spent with your previous health insurer and you will have continuity of cover. First, choose what product you would like from us and then fill in a cancellation letter and send it to your insurer.Then we’ll be ready to look after you always.

What does ‘continuity of cover’ mean?

It means your cover continues seamlessly when you switch from one healthcare insurance provider to another. No waiting, no gaps, no hiccups. The only condition is that you’ve completed your waiting period with your previous provider and that you have not been without health insurance for more than 13 weeks. If you still have some time left to go, no problem. We won’t start you all over again. We’ll take into account the waiting period you already served.

What is a ‘pre-existing condition’?

Pre-existing conditions are medical conditions that you already had before you took out healthcare insurance. You may not have even been aware of them. In some cases, it can take a while for symptoms to show. That’s why insurers have a waiting period during which you’re covered for accident and injuries, but not for illness. 

What is the Young Adult Rate?

Young Adult Rate

The Health Insurance (Amendment) Bill provides for ‘Young Adult Rates’ of premiums. This aims to address the sudden increase in premium rates that occurs for most young adults after their 21st birthday, where premiums can increase by 100% or more.  This will come into effect on 1st May 2015.

The new rates will be age-based rather than student-based and are designed to graduate the premium payable between the child rate and a full adult rate.

Insurers will retain the discretion whether or not to provide Young Adult Rates on some or all of their products. Where an insurer chooses to provide them, they must provide the full range of rates within the specified bands: 

Age

% of Full Adult Rate

18-20

up to 50%

21

51% to 60%

22

61% to 70%

23

71% to 80%

24

81% to 90%

25

91% to 100%

26

100%

 

This policy change also removes the requirement for young people to a dependant of an adult policy holder, or a full-time student dependent on parents.

Call Us

If you’d like to chat in more detail about switching to us, here’s how to get hold of us by phone:

LoCall:1890 700 890

Landline:+353 21 20 22 000

If you have a question about your insurance, there's a good chance you'll find the answer below.

How do I check that I am covered for a specific treatment?

The easiest thing for you to do is to give us a ring on 1890 700 890 (lo-call) or 021 202 2000 (regular
landline). We can tell you over the phone.

 When you call, could you have these three things to hand please?

  1. The name of your consultant;
  2. The hospital you’ll be going to;
  3. The procedure code (your consultant will be
    able to give you this)
How do I check my hospital cover?

The name of your scheme is written on your membership card, once you know what scheme you’re on you can check your cover here.  If you’re still unsure please call us and we’ll be happy to help you. 

What do I need to do to renew my cover?

You will receive your renewal pack with all the relevant documentation at least four weeks before you're due to renew. If you are happy with the details of your renewal as outlined in the documentation you receive, your policy will automatically renew. However, as always, if you wish to discuss any aspect of your policy, especially your subscription, we would love to talk to you.

You can call us on 1890 904 067 or email info@layahealthcare.ie. We are confident that we can offer you a competitive scheme at a competitive price, ensuring you get the best value cover.

Can I renew online?

If  you’d like to pay for your renewal in full by credit/debit card please click here.

However, as always, if you wish to discuss any aspect of your policy, especially your subscription, we would love to talk to you. You can call us on 1890 904 067 or email info@layahealthcare.ie. We are confident that we can offer you a competitive scheme at a competitive price, ensuring you get the best value cover.

How can I review and compare my cover?

At laya healthcare we offer a wide range of schemes to suit you and your family's needs. Our online Compare and Save tool will allow you to review and compare your existing scheme with similar schemes providing clarity in the options available to you should you wish to upgrade or downgrade your cover.

When can I change my level of cover?

You can change your cover up to 14 days following your renewal date, otherwise your renewal will be on the basis of the cover details outlined in the renewal pack you receive.  

How do I make changes to the people covered on my policy?

The Member Login area of our website allows you to add or remove people from your policy.

How can I pay for my renewal?

You can pay for your renewal by credit card, laser card or direct debit annually, or if you want to spread your payments over the year you can set up a monthly direct debit with us. Please note, if you are paying for your renewal by instalments a 3% credit charge will apply.

If you wish to pay for your renewal in full, you can pay by card online now click here.

What do I need to know about monthly direct debit collections?

Your monthly direct payment will come out during the first week of each month. To help you plan, here are
the payment dates for the next few months:

  • 4th September 2015
  • 9th October 2015
  • 6th November 2015
  • 4th December 2015

If your payment is unsuccessful one month, we’ll roll it over to the next month and collect both instalments in one go. If direct debit doesn’t go through two months in a row,give us a ring and we can chat about an alternative payment method.

Where can I access a claim form?

Right here. If you’re claiming for inpatient treatment, download this form. If you're claiming for outpatient treatment, this form is the form for you.

Can I claim for everyday medical expenses?

Yes. You can claim for medical expenses on all of our schemes. Do be aware that you may have an excess level on your policy. In other words, you’ll pay for medical expenses up to your excess level. Everything after that is covered by us bearing in mind that the most you will recieve back is between 50% to 75% subject to the rules of your scheme. 

The level of excess for medical expenses at laya healthcare changes depending on whethether you have an individual or family policy. You can find out which level applies to you in your scheme’s rules booklet. There’s a list of downloadable rules booklets here.

Can you tell me more about maternity cover?

As a parent-to-be, you can get a whole range of insurance options with laya healthcare. These include post-natal homecare, baby massage, counselling and breastfeeding consultancy. And you can add your baby to your policy as soon as they are born. In fact, we’ll add them for free until your renewal date. You just need to contact us in the first 13 weeks after the birth.

We’ll even help you with infertility treatment on some of our schemes. You can get €1,000 towards a specific treatment at an approved centre once you have served your one year waiting period for maternity benefits.

Am I covered abroad?

Yes, you are. The exact benefits will depend on your insurance scheme, but for six months out of every year, you can call upon your healthcare insurance with us while you’re travelling. If something happens to you, call us on +353 21 422 2204. You’ll find the number on your membership card, along with your membership number, so don’t forget to bring the card with you on your travels.

What is the Young Adult Rate?

Young Adult Rate

The Health Insurance (Amendment) Bill provides for ‘Young Adult Rates’ of premiums. This aims to address the sudden increase in premium rates that occurs for most young adults after their 21st birthday, where premiums can increase by 100% or more.  This will come into effect on 1st May 2015.

The new rates will be age-based rather than student-based and are designed to graduate the premium payable between the child rate and a full adult rate.

Insurers will retain the discretion whether or not to provide Young Adult Rates on some or all of their products. Where an insurer chooses to provide them, they must provide the full range of rates within the specified bands: 

Age

% of Full Adult Rate

18-20

up to 50%

21

51% to 60%

22

61% to 70%

23

71% to 80%

24

81% to 90%

25

91% to 100%

26

100%

 

This policy change also removes the requirement for young people to a dependant of an adult policy holder, or a full-time student dependent on parents.

What tax relief am I entitled to?

You’re eligible for tax relief on 20% of your premium, up to a maximum of €200 per adult and €100 per child. You don’t need to do anything to get it. We deduct this for you on behalf of the Revenue. If you’d like to know more about tax relief on healthcare insurance, there is plenty of information here.

Call us

Here are the telephone numbers you’ll find useful as a member:

 

LoCall:1890 700 890

Landline:+353 21 20 22 000

Overseas Assistance Line:+353 21 422 22 04

24 Nurseline:1850 923 500

What is Lifetime Community Rating (LCR)?

Lifetime Community Rating (LCR) has been signed into law by the Minister for Health to support sustainability and competitiveness in the health insurance market from 1st May 2015. The planned outcome from this measure by the Government is to encourage people to take out health insurance earlier in life and to control premium inflation across the health insurance market. The introduction of Lifetime Community Rating (LCR) will see customers over the age of 34 pay an extra 2% loading per year in addition to their health insurance premium.

Up to now a person could enter the health insurance market at any age and be charged the same premium regardless of age. With the implementation of Lifetime Community Rating (LCR) you need to enter the health insurance market before the age of 35 to avoid loadings. If you take out private health insurance earlier in life, and retain it, you will pay lower premiums compared to someone who joins when they are older (over 35).

When did the introduction of Lifetime Community Rating (LCR) take place?

Loadings apply on health insurance policies written from 1st May 2015 for anyone aged 35 or over.  Some reductions and exceptions are allowed.  

So what’s changing?

Currently

In Ireland, everybody is charged the same price for a particular health insurance scheme, irrespective of a person’s age, gender or state of their health. This is called community rating.

Under the proposed new system of lifetime community rating, community rating will be changed to reflect the age at which a person takes out private health insurance. You may be charged an additional loading if you join the health insurance market at age 35 or over.

Why is the government bringing this in?

The primary reason for introducing Lifetime Community Rating (LCR) is to encourage younger people to purchase health insurance. Encouraging more people to join the market at younger ages helps spread the costs of claims by older and less healthy people across the market, helping to support affordable premium levels for all.  

Can you explain the loadings to me/how will they be calculated?

The level of loading will depend on the age at which you take out private health insurance. The only way to avoid paying this loadings is to take out private health insurance before reaching the age of 35. 

For example if you are 45 and have never held private health insurance you will pay a 22% loading on your premium for life (11 years from the age of 35 to 45 x 2%).  

Will I have to pay a loading for the rest of my life if I continue to maintain my private health insurance cover?

Yes. The loading that applies, depending on your age, if you purchase private health insurance will apply in subsequent years. 

Is there any way the loading would not apply to me?

Yes. Everyone who has health insurance on or before 30th April 2015 will be assumed to have a continuous period of cover and therefore no loadings will apply once you maintain your cover.

Is time spent as a dependant on a health insurance policy credited towards potential LCR loadings?

Time spent as a dependant paying the adult rate on a health insurance policy is credited towards potential LCR loadings from age 18 onwards; however, time spent as a dependant on a policy paying the child rate / student rate does not count towards your credited period.

Why is Lifetime Community Rating (LCR) being introduced from age 35 rather than a younger or older age?

The government considers 35 to be the most appropriate age to allow young people sufficient time to complete education and to achieve secure employment for a number of years.

If I cancel my policy with my provider do I still have to pay the loadings?

In order to totally avoid the loadings you must not have a break in cover in excess of 13 weeks. If you have a break in cover in excess of 13 weeks loadings may apply to your premium. The level of loading will be reduced by the number of previous years health insurance cover you have.

Is there any way that I will be subject to a reduced loading?

You can reduce your loadings where you have a qualifying credited period. A credited period can apply where individuals previously had health insurance.

In addition, provision is made for a credited period (in total not exceeding 3 years) for individuals who previously had health insurance cover, but who stopped their cover since 1st January 2008 because of unemployment.

Will my age affect my health insurance premium?

Yes.

If you are under 35 years of age you will pay no loading.  If you are 35 and over, you may be subject to a loading depending on your circumstances and any credited periods you have built up.

Please be aware that if you are over 35 and have a break in cover in excess of 13 weeks, you will incur a 2% loading per year on top of your premium. The 2% loading will increase every year of your life you spend without health insurance.

What is the maximum loading that will apply?

The maximum loading that can apply is 70% of the total premium. A loading of 70% will only arise on very rare occasions, where a person aged 69 or older is purchasing private health insurance for the first time. 

Why should persons in older age brackets taking out private health insurance for the first time be penalised with a 70% loading?

The loadings increase with age reflecting the higher claims experience in older age groups. If the loadings did not apply to older persons, the rate of loading for young persons would be far higher, and be disproportionate and end up being a financial disincentive.

Can you give me some examples of how this will work?

Example 1

I am 45 years old and I take out health insurance for the first time, will loadings apply?

 

Chronological Age

45

Less any qualifying credit – Prior PHI cover

0

Qualifying period of unemployment

0

Age at entry (for loading purposes)

45

Applicable loading (11 x 2% per year)

22%

 

 

Example 2

I am 45 years old and I take out health insurance, having had health insurance cover for 7 years (up to 2008) - will loadings apply to me?

 

Chronological Age

45

Less any qualifying credit – Prior PHI cover

7

Qualifying period of unemployment

0

Age at entry (for loading purposes)

38

Applicable loading (4 x 2% per year)

8%

 

 

Example 3

I am 50 years old and had health insurance previously for 10 years but lost my job in 2010 and have three years qualifying periods of unemployment - if I take out health insurance , will I have to pay loadings and if so how much?

 

Chronological Age

50

Less any qualifying credit – Prior PHI cover

10

Qualifying period of unemployment

3

Age at entry (for loading purposes)

37

Applicable loading (3 x 2% per year)

6%

 

Can a health insurer make an exemption for me from the LCR loading?

 

No, applying the loadings will be mandatory and cannot be waived by an insurer. 

If I join a PMI provider, what happens if I switch from one insurer to another?

Switching from one insurer to another or from one policy to another does not affect the applicable loading. Loadings, if any, will continue to apply and insurers are required to supply each other with proof of an individual’s prior cover. 

Where can I get information about private health insurance policies?

Laya healthcare can provide you with all the information you need in regards to Lifetime Community Rating (LCR), we will also be able to provide a suitable level of cover for your own circumstances based on the excellent schemes we offer.

Independent information can be sought from the Health Insurance Authority www.HIA.ie

I currently have a Cash Plan/HSF policy how does LCR affect me?

All cash plans in the market do not fall under the definition of an inpatient private health insurance plan. Therefore Lifetime Community Rating (LCR) will affect you if you take out a health insurance policy. 

If you are purchasing a private health insurance policy for the first time at age 35 years or older you will pay a 2% loading on top of your premium for every year you are aged over 34, regardless of having a cash plan in the past.

My insurance is paid by my employer; will the loading affect my BIK?

If your employer covers the total cost of your health insurance premium including the loading then yes.  Below is an example of how this will work.

Example:

Employee aged 40 entering the health insurance market for the first time with no credits. 

Example gross health insurance premium: €1,200

Total LCR loading: 6 years x 2% = 12% (€144)

 

Health Insurance Premium only

Gross Cost

BIK Charge

BIK Charge

Lower Tax Bracket

Higher Tax Bracket

Adult as per example

€1,200.00

€372.00

€624.00

 

Health Insurance Premium & Loading

Gross Cost

BIK Charge

BIK Charge

Lower Tax Bracket

Higher Tax Bracket

Adult as per example

€1,344.00

€416.64

€698.88

 

Wondering about some technical terms?

Credited Period

In some instances a person will have credits applied to their loadings. These can be the sum (in years and months) of any period of previously held Health Insurance and/or a recognised period of unemployment( link to next paragraph)  So your loading will be dependent on your age as well as any credited period you may have.  The more credited periods you have, the less the loading that is applied.

Please note:

  1. Such credit only applies to those aged 18 and over who are/were paying a full adult premium rate.
  2. Such credit is not applicable if the person aged 18 and over is/was in receipt of a student rate/YAR-applied product.

Recognised Period of Unemployment

Where a person had insurance on or after 1st January 2008 and subsequently cancelled their Health Insurance as a result of unemployment (either their own, or a person they were dependent on) and either they or the person they were dependent on were in receipt of social welfare, they can receive a credited period from 6 months to 3 years. The periods of unemployment do not need to be consecutive and can continue to be earned after 30th April 2015.    You will need to tell us what your periods of unemployment were when you are buying health insurance from us so we can discount any loadings by the appropriate amount.

Age at Entry

You may hear this term a lot when Life Time Community Rating (LCR) is discussed.This is the age of the insured person in years and months when they take out a Health Insurance contract, minus any applicable credited period (see above for more information on this). The age of entry is the determining factor in deciding what loading a person receives on their health insurance premium. The age of entry is always rounded down to the nearest whole month. So if your age of entry is 37 years and 7 months, this will be rounded down to 37 years.  If a person is 40 and has a credited period of 3 years due to having health insurance for 3 years previously, then their age of entry is 40-3 = 37.  So they pay 6% loading ( 3 years x 2%) 

Overseas Waiver

If you live overseas on or after the 1st May 2015 and return to Ireland, you will be given a 9 month grace period in order to buy health insurance on entering Ireland, where no loadings will apply.  Once this grace period has expired, if you are over the age of 34, then loadings will be applied as normal.