Insurance Cover

Private Health Insurance cover can be difficult to understand.  The simplest piece of advice we have is to ring us on Admissions Information: 01 – 885 8856 or 01 – 885 8124 with your policy and admission details and we will talk you through what insurance cover and excess you can expect.

NEWS !! SPECIAL PACKAGES
The Mater Private Hospital has waived or reduced the shortfall on over 50 procedures, many of which are cancer related for a wide range of insurance plans, resulting in 100% cover for many patients.  Other areas include cardiac, paediatric, joint replacement and disc procedures.

Am I Covered?

**The information in this section is a guide – it changes regularly and so this is not binding information

• The level of cover varies by procedure.  There at 1000’s of procedures, so it is impossible to give a definitive list.
• In short, there is limited cover (35-50%) on basic and primary plans (e.g. VHI Plan A)
• There is some to good cover (50-100%) on mid level plans (e.g VHI Plan B’s, Family Plan Plus, Company Plan Extra)
• There is excellent cover (90-100%) on top level plans

 

First we need to explain some ‘lingo’:

There are 2 types of admission to the Mater Private – inpatient (overnight/multiple-night stay) and day case (in and out on the same day):

• Inpatient admissions are classed as either ‘per diem’ i.e. there is a daily rate for up to a maximum of 10 nights per stay for mid level plans only.  However there is an exception for cancer related admission where by the maximum is 10 nights per calendar year (again for mid level plans only).
• ‘Fixed Price Procedure/FPP’ i.e. there is a set price for the procedure irrespective of length of stay.  The insurers decide what is a per diem or an FPP.

 

Some costs are covered by ‘direct settlement’ i.e. the insurer pays us directly on your behalf

Other costs are covered by ‘indirect settlement’ i.e. you pay and then reclaim the cost from the insurer.

If there is an ‘excess’ on your chosen policy, this is payable by you as per policy rules – this is usually a minimum amount which you cannot claim back.

A rough guide of the level of cover you can expect by admission type for a mid level plan

• 100% cover on listed cardiac procedures
• 100% cover for day case procedures
• 55% cover on Per Diem inpatient admissions (semiprivate) – 45% excess is payable by patient – on average the nightly excess is €260 with maximum of 10 nights per diem payable
• 90% cover on FPP inpatient admissions (semiprivate)   – 10% excess is payable by patient)

 

Once your Consultant recommends a plan for you, if the Consultant doesn’t have the cover information to hand, then ask for the procedure code or treatment details and ring us on 01 – 885 8785 to get clarity.  Once you have clarity on your level of cover, if your cover is not enough you can discuss alternative options with your Consultant.