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 might pay on private hospital claims.
  • An out-patient excess is the amount that is deducted from the amount payable to you.

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 an amount payable in relation to total out-patient claims per year.
  • There is often an annual excess i.e. an amount that is deducted from the amount payable to you.
  • 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 expense.

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

Outpatient 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

Outpatient 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

 

Outpatient Claim Time Limits

Vhi Healthcare

Outpatient claims must be submitted within 3 months of the end of the policy year. Vhi may, at their own discretion, allow claims that are submitted outside of the 3 month limit.

Vhi Healthcare has a web-based application called Snap and Send which you can access through your membership profile, allowing you to submit receipts at any time of the year.

Laya Healthcare

Laya Healthcare will only accept outpatient claims that are submitted within 12 months of the treatment date from 1 August 2017. In order to help customers with this transition, Laya will pay out-patient benefits for any receipts that you have not previously submitted, if you send them to them within the next 12 months.

Laya Healthcare has a member app which will allow you to submit your receipts at any time of the year.

Irish Life Health

Outpatient claims can be submitted throughout the policy year or at the end of the policy year.

Irish Life Health a has a web-based application which you can access through your membership profile, allowing you to submit receipts at any time of the year.