Your personal finance questions: How can I avoid gaps in my health insurance plan?

Q I am on the Laya Care Select plan and need to renew soon. I see that I now have a 20% deficit in certain major orthopedic and ophthalmic procedures. Is there any way to avoid this?

AN The shortfall is avoidable, according to Dermot Goode of Totalhealthcover.ie. The renewal cost will be €1,591 per adult. Mr. Goode said this is still a good corporate private room plan, but may no longer be suitable if the member wants to maintain full coverage for these procedures. He recommends contacting Laya and checking out the alternative Simplicity plan, which costs €1,535 per adult. This is a similar plan that covers the same hospitals, down to private room accommodations, but there is no 20% shortfall on these procedures in this plan. Outpatient reimbursements will be subject to an annual excess in the future with which the reader must be satisfied before switching. If the member doesn’t mind taking on a slightly higher deductible for private hospital admissions, there is another alternative scheme called Connect Simplicity which costs €1415 per adult and is also worth considering.

Q I am in the process of applying for a home loan through my credit union. I read that they can help finance home energy upgrade projects. I received my 35% Sustainable Energy Authority of Ireland (SEAI) grant and have my quote from my contractor. Should I borrow the full amount or can I use some of my savings to offset my monthly payments?

AN It’s okay to contribute some of your savings toward upgrade costs, and this is a great way to bring your monthly payments down to a manageable level, according to Credit Union Development Association Executive Director Kevin Johnson. If you are partially financing your home improvement through your credit union, low-interest loans are available to you through the ProEnergy Homes Scheme. This is a scheme where homeowners can take advantage of grant funding of up to 35% for a variety of retrofit measures, including attic insulation, external wall insulation, solar panel installation, boiler upgrades and window and door upgrades, with remaining cost. financed either by savings, by a low-cost loan financed by your credit union (if you participate in the scheme), or a combination of both. Some credit unions offer loan rates as low as 4.25%, particularly when you have savings to “pledge” as collateral against your loan. For participating credit unions, an interest rate of less than 7% applies to amounts over €20,000, while a slightly higher rate applies to smaller loans. For example, if after contributing savings to cover the cost, you borrowed €5,000 at 10.48% over five years, your monthly repayments would be only €107.42, says Johnson.

Q I just purchased dental coverage with DeCare Dental. Do I have to use the dentists listed in your direct pay network or can I use any dentist? I also have health insurance and am wondering if I am overinsured.

AN You don’t have to rely solely on your direct payment network, according to Totalhealthcover.ie’s Mr Goode. You can go to any dentist for your treatment, but the advantage of using your network is that your benefit will be paid directly to the dentist and you only have to pay the balance. If you go to a different dentist, you must pay the full amount and then claim your reimbursement directly from the insurer. On the question of excess insurance, no health insurance plan provides coverage for major dental treatments, such as orthodontics, root canals, crowns, etc., Goode said. If these benefits are important, she recommends maintaining some level of dental coverage in addition to your health insurance plan.

Q I submitted my outpatient claim to Irish Life Health, but some receipts were excluded because they were not submitted on time. Is this correct?

A All Irish Life Health members have a six-month window after their renewal date to submit all eligible outpatient expenses for the previous insurance year, according to Goode. These receipts can be submitted in a blanket claim at the end of the year, or can be submitted online using their “scan and submit” feature. However, if claims are not submitted within the six-month period, they will be denied, Goode said.

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