Some Confusing Health Insurance Terms Explained


Excess

This is the first part of any claim that you have to pay yourself. For outpatient or day to day claims this is the amount we deduct from your claim before we send you the payment.

Here is an example of how an excess is applied to a claim:

Consultant

GP

Cover shown on Table of Cover

€60 x 4 visits

€25 x 6 visits

Number of times you visited your health care provider in your policy year and how much you paid per visit

3 x €150

7 x €60

Total amount that you can claim

3 x €60 = €180 (3 being the number of times you visited a consultant and €60 being the maximum amount that can be claimed per visit)

6 x €25 = €150 (6 being the maximum number of times you can claim for a visit to a GP and €25 being the maximum amount that can be claimed per visit)

Total amount that you can claim under both benefits

€330 (i.e. €180 + €150)

Less out-patient excess

€200

Money  we pay you back

€130


Co-payment

A co-payment is a large excess and is an amount that must be paid by you for some Orthopaedic (musculoskeletal system - bones and joints etc.) or Cardiac (heart) procedures carried out in a private or high-tech hospital.


Pre-existing condition

A pre-existing condition is an ailment, illness or condition, the signs or symptoms of which existed at any time in the six months before you took out health insurance for the first time, or before you took out health insurance following a break in cover of 13 weeks or more.


Waiting Periods

A waiting period is the length of time you need to have health insurance before you can make a claim.

There are three different types of waiting periods:

  • Initial waiting period - this applies when you take out health insurance for the first time or when you take out health insurance after your health insurance has lapsed for 13 weeks or more.
  • Pre-existing condition waiting period - Where you make a claim that relates to a pre-existing condition, a pre-existing condition waiting period will apply. Pre-existing condition is descibed above.
  • Upgrade waiting period - this applies when you upgrade your cover, i.e. purchase a plan with more comprehensive cover than your previous plan.

Depending on when you took out your health isnurance with Irish Life Health, different waiting periods apply.

Click here to find out more about waiting periods


In-patient

A patient who receives treatment that requires an overnight (or longer) stay in a hospital or medical facility.


Day Case Treatment

Treatment received by you where you are admitted to a hospital or medical facility for treatment but you not need an overnight stay.


Out-patient

A patient who receives treatment or a medical service without being an in-patient or day case.


Day-to-day benefits

Benefits which cover medical expenses such as GP, Dentist or Physiotherapist visits. 


Private room

A private room will contain a single bed.


Semi-private room

A semi-private room will contain up to 5 beds.


High-tech Hospital

The Blackrock Clinic, the Mater Private and the Beacon Hospital are the only three high-tech hospitals in Ireland.

These are private hospitals with specialised equipment and they treat complex conditions including cardiac, oncology (cancer) and orthopaedic conditions. 


Schedule of Benefits

The Schedule of Benefits sets out the treatments and procedures we cover and which of these need to be pre-authorised by us before we will cover them. It also sets out the treatments and procedures that will only be covered if they are performed by a certain type of health care provider or if they are performed in a certain place (i.e. in a hospital).