THE HEALTH Insurance Authority is to review the way the VHI has substantially reduced the cover it offers for certain procedures under its most popular family schemes.
The plans to be downgraded are the Parents Kids schemes to which the company switched many families in 2009.
When introduced, they offered identical cover to the Plan B policies they replaced but from next month, the cover for some treatments will be significantly downgraded.
Under the changes, cover for certain orthopaedic and ophthalmic treatments is being reduced to 80 per cent of the total cost if it is performed in a private hospital. This could leave a person facing a shortfall of at least €4,000 on certain operations. The downgrade is being done as prices for the plans increases by 15 per cent.
“In order to keep the Parents Kids plans as affordable as possible, cover for some medical conditions have been reduced, the VHI admitted yesterday. The procedures include hip, knee and shoulder joint replacement and cataract surgery.
A spokeswoman said that from a customer’s renewal date, benefits for these procedures on the Parents Kids plans would only be covered at 80 per cent in private hospitals and fully covered in public hospitals.
“We have a revised set of benefits and people have not been told about them,” financial adviser and health insurance specialist Róisín Lyons said. “The Parents Kids policy is becoming an inferior product.”
She said a person who had always had a certain level of cover might think they would still have that cover, only to find when they went in for a particular procedure the amount the VHI covered had fallen. “If they are going to launch a new plan, they have to explicitly tell people. It’s not enough to have changes in the small print.”
The VHI spokeswoman denied customers were not properly informed and said they were “clearly highlighted in the table of benefits”.
She said a reference to the benefit changes was also included in the cover letter which, she said, stated: “Your pack also includes details of your cover, along with an explanation of your plan benefits. Please take time to read your table of benefits and any changes which may apply to your cover are highlighted.”
However, in a letter issued by the company to subscribers on January 11th, the second sentence quoted above was omitted.
People on Parents Kids plans who have eye or joint complaints may now have a waiting period enforced on them before full cover is restored should they upgrade to a new plan. The VHI spokeswoman said the company would “review this on a case-by-case basis” but she did not expect many of these cases on these plans.
A spokesperson for the HIA said it was aware of the issue and said it had been in contact with the VHI and the matter was under review.
