Excess and Outpatient Claims

Excesses

  •  An excess is the first part of any insurance claim that you have to pay yourself.
  • An inpatient excess is the amount you pay of some hospital claims.
  • An out-patient excess is the amount deducted from your total out-patient claims per year.

Outpatient Claims

You will have to pay for the treatment first, keep a receipt and claim at the end of your policy year. Features of this cover often include the following:

  • There is often a maximum level of benefit that is paid in relation to out-patient cover.
  • There is often an annual excess i.e. an amount you must pay before you can claim anything.
  • Usually, you can only claim for a portion of the cost of the visit to your practitioner. This is called the ‘allowable expenses'. For example, a GP's visit may cost €50 but you may only be allowed to claim €20. The €20 is the allowable expenses.

Some policies will have all three of these features. It could be the case that even though the total of your outpatient expenses is more than the out-patient excess, you might still not be in a position to claim because your total allowable expenses have not yet reached the level of the out-patient excess.

Example A

Out-patient Expense Actual   cost of visit Benefit Provided per visit Number of visits Expenses incurred Allowable Expenses
GP visit €50 €20 6 €300 €120
Physiotherapy €70 €40 2 €140 €80
Dental €90 €20 1 €90 €20
Subtotal       €530 €220
Less, out-patient excess         -€300
Amount you may claim back         €0

Example B

Out-patient Expense Actual   cost of visit Benefit provided per visit Number of visits Expenses incurred Allowable Expenses
GP visit €50 €20 10 €500 €200
Physiotherapy €70 €40 6 €420 €240
Dental €90 €20 1 €90 €20
Subtotal       €1,010 €460
Less, out-patient excess         -€300
Amount you may claim back         €160