by Susan Mitchel, SBP

The Minister for Health, James Reilly, has been urged to force health insurers to reinstate or maintain full cover for orthopaedic and ophthalmic procedures under the minimum benefits regulation.

With up to 850,000 people set to renew their health insurance policies in December, January and February, brokers have warned many people -and employers are unaware – that only the most expensive plans on offer from the state’s largest health insurer, the VHI, offer full cover for ophthalmic and orthopaedic procedures, such as hip replacements.

Dublin-based insurance broker Patrick Brennan has written to the minister to express “serious concerns” over the reduction of health insurance benefits that are mainly needed by older people.

He said the diminution of certain benefits was blatantly focused on procedures relevant to older people, and that the VHI was trying to make its policies unattractive to older people.

Under community rating, a person’s age should not determine the level of premium they pay for health insurance.

“This is the type of scenario the legislation set out to avoid,” said Brennan, who is director of broker firm Irish Health Insurance.

In February, the VHI increased the cost of premiums that still provided full cover for orthopaedic and ophthalmic procedures in private hospitals by as much as 45 per cent.

Other VHI customers will have to pay shortfalls of between 20 per cent and 40 per cent.

Aviva also reduced the benefits on a number of its existing plans, meaning some customers needing hip operations will have to make a €2,000 co-payment from January.

“By having the same shortfalls, they too will purposefully lose any appeal they had to older customers,” Brennan said. “It is a race to the bottom.”

In his letter to the minister, Brennan warned that the moves would have obvious ramifications for the public health system and its ability to cope.

“If people do not raise any questions or fail to read their new terms and conditions and simply renew, they will be none the wiser.”

“Then, if these older people need orthopaedic or ophthalmic cover, they may not be able to afford the shortfall and could face waiting periods of up to five years in the public system before they can get it,” Brennan said.

Patrick Brennan

Director of Corporate Business

Irish Health Insurance

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