Irish consumers are being warned to review their health insurance policies immediately, as a combination of premium increases and significant benefit reductions come into effect from 1st April across the market.
While policyholders are already familiar with regular price increases, further rate hikes are imminent, with providers including Irish Life Health, Laya Healthcare and Level Health implementing additional increases. This is according to health insurance expert and founder of Health Insurance Ireland, Dermot Goode.
Mr Goode warns that the latest round of changes extends beyond pricing. Substantial reductions in benefits, particularly affecting thousands of Laya Healthcare members, are also being introduced and may go unnoticed by many consumers.
From 1st April, Laya Healthcare will alter cover for major orthopaedic and ophthalmic procedures across approximately 30 plans. For example, the Prosper Advanced plan, which currently offers full cover for procedures such as hip, knee and shoulder replacements, will move to a 40% shortfall for these surgeries in private hospitals. With this plan costing €2,564 per adult, affected members renewing from April could face out-of-pocket costs of up to €6,000 for such procedures.
Other widely held corporate plans, including Prosper Care, Inspire Plus, Inspire, Simply Health Extra and Signify schemes, will also see co-payments for restricted procedures increase from 20% to 40%. While some consumers may manage a €3,000 shortfall, doubling this cost is likely to place significant financial strain on many households. Alternative options are also becoming less attractive. Plans such as Total Health Extra will retain full orthopaedic cover, but changes from April include a doubling of the private hospital excess to €300 per admission and a reduced outpatient claims cap of €500 per member.
Meanwhile, plans like Simply Connect and Simply Connect Plus, which have remained popular for their full orthopaedic cover and strong outpatient benefits, will see outpatient excess charges increase from €1 to €10 per claim, despite already rising premiums.
These developments are not isolated. Across the market, insurers including VHI Healthcare and Irish Life Health have already introduced caps on outpatient benefits, while Level Health has reduced benefits on its Plan D offering within months of launch.
Consumers are being advised to look beyond headline premium costs when reviewing their policies.
Dermot Goode, health insurance expert with healthinsuranceireland.ie, said:
“Consumers can no longer focus solely on the price of their premium. It is critical to examine the details of your policy to ensure benefits are not being reduced or removed. If changes are identified, members should engage directly with their insurer and consider a full review of their cover to ensure it still meets their needs”.
For those impacted, alternative plans may be available. Laya members on plans such as Prosper Advanced may need to consider options including Simply Connect, Simply Connect Plus, Control 150 Secure, Control 300 Create or Momentum to maintain full orthopaedic cover. The VHI Advanced Care range may also offer suitable alternatives.
Consumers renewing from 1st April who are moving from a 20% to 40% co-payment may wish to explore the Laya Connect Simplicity corporate scheme, which currently retains a 20% co-payment. However, this plan is also expected to change from 1st May, with the higher co-payment applying thereafter.
Mr Goode added,
“Consumers should remember that switching insurers is always an option, and you will receive full credit for your previous membership, so there is no break in cover. However, if you’re increasing your level of cover, you need to be mindful of the two-year upgrade rule, particularly where pre-existing conditions apply, as this could limit your benefits in the short term.
The key message is don’t auto-renew without reviewing your policy in detail or seeking expert advice. Paying higher premiums is difficult enough, but consumers should never accept paying more for reduced cover without exploring all available options”.