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Allowable amount/expenses

Usually you can only claim for a portion of the cost of the visit to your practitioner. For example, a GP’s visit may cost €55 but you may only be allowed to claim €20. The €20 is the allowable amount/expense.

Benefit

What you may claim for under your policy.

Cash Plan

A cash plan provides monetary amounts for a range of medical events but does not include cover for medical and hospital costs incurred in hospital as a private patient.

Certain cardiac procedures/certain special procedures

These are lists of cardiac and non-cardiac related procedures, for which the insurer has negotiated a set price with the hospital. The Authority does not hold these lists. You must ask your insurer for details.

Certain orthopaedic and ophthalmic procedures

Hip, knee and shoulder replacement surgery and cataract surgery. Please ask your insurer for details.

Community rating

The system in Ireland whereby a person’s age does not determine the level of premium paid. There are a number of exceptions in respect of children, full time dependent students under the age of 23, members of group schemes and pensioners of Restricted Membership Undertakings.

Company plan

A plan which is marketed primarily towards companies. These plans are available to all; one does not have to be a member of a company to purchase one.

Co-payment

A co-payment is a payment paid by a member each time a specified medical service which is liable to a co-payment is used. It is a percentage or value payment up to an agreed certain limit as specified in the terms and conditions of a members contract. It must be paid directly by the member to the medical service provider and is not reimbursable under the member's plan of insurance and cannot be counted in the cost of any excess or outpatient claim.

Credit Charge

Laya Healthcare currently charge consumers an additional 3% credit charge for paying the premium on a monthly basis. The consumer can avoid paying this charge by paying annually.

Day-patient

Treatment received during a hospital stay in a day care bed which does not include an overnight stay.

Day-to-day benefits

Benefits which cover medical expenses which involve seeing a doctor/specialist in their own rooms or practice e.g. physiotherapy, GP visits or osteopathy.

Dependant

Your husband, wife, co-habiting same or opposite sex partner and any child who is named on your membership certificate as one of your dependants and is not the main policy holder.

EAP

Employee Assistance Programme, often involving telephone or face to face counselling services.

Excess
  • 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.
Exclusions

These are conditions or treatments for which you are not covered under your health insurance plan.

Group scheme discount

A discount of not more than 10% of the premium that may be available to a person that is a member of a group of persons.

Hi-tech hospital

The Blackrock Clinic, the Mater Private and the Beacon Clinic are considered hi-tech hospitals.

In-patient

Treatment received during an overnight stay in hospital.

IP Address

The identifying details for your computer (or your internet company’s computer) expressed in internet protocol code; for example 192.175.54.23. Every computer connected to the web has a unique IP address. An IP address serves two principal functions: host or network interface identification and location addressing.

Lifetime Community Rating

Lifetime community rating is a system whereby the premium that individuals pay for health insurance rises with the age they enter the private health insurance market but does not vary in relation to their current age. Under this system, a 50-year-old who has held insurance since he or she was 30 would pay the same as a 30-year-old, but a 50 year old who purchases insurance for the first time would pay more than a 30-year-old.

Lifetime Cover

It guarantees you the right to renew your policy irrespective of your risk status, age, sex or claims history.

Open enrolment

It guarantees you the right to buy health insurance irrespective of age or claims history.

Out-patient

Treatment which does not involve in-patient treatment or day care procedures, and includes consultations with complementary and alternative medicine practitioners.

Open Membership Insurer

Open Membership Insurers must provide insurance to everybody who requests it from them.

Policy limit

This is the maximum amount you can claim on your policy for out-patient benefits.

Pre-existing condition

A "pre-existing condition” means an ailment, illness or condition, where, on the basis of medical advice, the signs or symptoms of that ailment, illness or condition existed at any time in the period of 6 months ending on the day on which the person became insured under the contract.

Premium

This is the amount you pay per year for your health insurance policy.

Private room

A private room will contain a single bed.

Procedures other than Cardiac and Special

These are any un-listed procedures where the insurer has not negotiated a set price with the hospital. The Authority does not hold these lists. You must ask your insurer for details.

Restricted Membership Undertaking

Restricted Membership Undertakings provide insurance to people who are members of a particular group, normally a vocational group or employees of a particular organisation and their dependants e.g. The Garda Medical Aid.

Schedule of benefits

This schedule details the amount an insurer will pay under the policy.

Semi-private room

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

Shortfall

A shortfall is the amount you must pay yourself and is generally applied on a nightly basis.

Tax relief

Tax Relief is an amount that can be claimed against your health insurance premium to reduce the cost of the premium. In the case of health insurance, this is carried out at source by the insurer, so the premium quoted will be inclusive of any tax reliefs available.

Web Browser

The piece of software you use to read web pages. Examples are Microsoft Internet Explorer, Mozilla Firefox, Safari and Google Chrome.

Waiting periods

A waiting period is the amount of time that must pass from the start date of a health insurance policy before full cover is available.