Get right to the heart of private insurance

How expensive is it to access cardiac services in private and high-tech hospitals and which policies offer the best cover?

CONSIDERING that heart disease is one of the biggest health problems in Ireland, accounting for more than 5,000 deaths a year, ensuring you get the best care available is a priority for many.

While both the Mater Private and the Blackrock Clinic have been providing top-of-the-range cardiac services for some time, in addition to services available in public hospitals, the recent arrival of so-called “high-tech” private hospitals in Ireland – such as the Beacon Hospital in Dublin and the Galway Clinic – gives an additional option for heart patients. But how expensive is it to get treatment in private hospitals and which policies offer the best cover?

The good news is that most private health insurance plans offer comprehensive cover for cardiac treatments, with cover for public hospitals on even the most basic of policies. Moreover, most policies also provide some degree of cover for fixed-price cardiac procedures, such as stenting, heart bypass, angioplasty and catheterisation, in private hospitals.

Two of the most common treatments for heart problems are procedures such as angiograms and angioplasty. Last year, VHI paid for almost 8,500 angiograms and more than 2,000 angioplasties, costing more than €55 million. For patients, however, costs are minimal, as most plans offer good coverage for such procedures.

For example, at the bottom end of the price scale is Quinn’s Essential Starter policy, which is one of the most competitively priced schemes on the market, at just €330 a year. Despite the small price, however, the scheme offers full cover for certain specialist heart surgeries in both the Mater Private and the Beacon, although the policy does not include accommodation in a private hospital. If you increase your policy to Essential Plus, which costs €715, you will get cover for a wider range of hospitals, including the Galway Clinic and Blackrock Clinic.

With VHI, all its plans offer some level of cover for cardiac care in private hospitals. However, the starting-off policy, Plan A, which costs €568 a year, only provides 35 per cent cover for certain cardiac procedures in the Blackrock Clinic and the Mater Private Hospital. As such, VHI recommends that customers with this level of coverage attend a public hospital, as the “shortfalls could be substantial”.

More comprehensive cover is available under its Plan B scheme, which costs €828 a year, and offers 90 per cent cover for major cardiac procedures in the Blackrock Clinic, the Mater Private and the Beacon. If you’re looking for 100 per cent cover in private hospitals with the VHI, which means you wouldn’t have to pay any outstanding fees yourself, you could upgrade to either Plan D or E.

Alternatively, if you just require cover for cardiac procedures at the Mater Private or Blackrock Clinic, you could upgrade your cover from Plan A to Plan A Options or from Plan B to Plan B Options relatively inexpensively (€24 and €72 extra per adult, respectively), and this would give you 100 per cent cover for the cardiac fixed-priced procedures in these two hospitals.

Hibernian Health also offers extensive cover for cardiac procedures in private hospitals, but like the VHI, only covers a proportion of the cost under its cheaper policies. For example, under its Level 1 Hospital plan it offers 35 per cent cover for listed cardiac procedures in all private hospitals. From Level 2 upwards, however, which costs from €717, it covers 100 per cent of the cost of cardiac procedures.

If your heart procedure takes longer than a day, you will also need to check what level of hospital accommodation you are entitled to under your insurance plan. For example, although Quinn’s Essential Starter offers cover for certain surgeries in both the Mater and the Beacon, it does not cover the cost of accommodation in these hospitals, as customers with this plan are only eligible for a semi-private room in a public hospital. Similarly, under Essential Plus shortfalls may apply for a semi-private room in certain private hospitals.

If you would like your own room in a private hospital, you will have to pay top dollar.

For example, although 90 per cent of VHI’s members are now covered at the Beacon, a private room in the hospital is only available on its Plan E scheme, which costs €2,640.10 a year. With Quinn Healthcare, a private room in the Mater Private, Galway Clinic, Beacon Hospital and Blackrock Clinic is available on its premium HealthManager Gold scheme, which costs €2,050, while Hibernian’s Level 5 plan provides full cover for a private room in a “high-tech” hospital, and costs €2,062 a year. While such cover is expensive, on the up side you may have a better chance of getting a private room in a private hospital than you would in a public hospital.

If you’re willing to supplement your cover if need be, Hibernian’s Level 3 policy provides 40 per cent cover for a private room and only costs €1,023 a year.

If you read the fine print of your insurance policy, you will see that some insurers also offer extra benefits for cardiac patients. For example, under its Level 5 plan, Hibernian will contribute €100 a day, for up to three days, towards the cost of a home help assistant following selected cardiac procedures, while customers of the insurance firm can also access a 24-hour nurse-on-call service.

If you also want to have access to the latest technology and treatments, then you might consider getting cover for overseas treatment.

At Hibernian Health, cover is given for new or emerging surgical procedures carried out overseas, which are medically necessary, while under its Level 5 plan, you can also get your treatment abroad if you would prefer.

However, there may be a shortfall in cost as the health insurer will give cover which is equal to the nearest equivalent procedure cost in Ireland. Given the cost of healthcare in the USfor example, this could mean that you will still need to come up with significant funds yourself.

Similarly, VHI offers cover for elective treatment abroad, and will pay between €65,000 and €100,000 depending on your level of insurance, and provided the treatment meets specified criteria.