Your personal financial questions – How do I avoid defaults in my health insurance?

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Q I am a member of the Laya Care Select program and will soon be renewed. I see that I now have a 20 percent deficit in certain major orthopedic and ophthalmic procedures. Is there any way I can avoid this?

A The deficit can be avoided, according to Dermot Goode from Totalhealthcover.ie. The renewal costs are € 1,591 per adult. Mr Goode said this is still a good business plan for private rooms but may no longer be suitable if the member wants to cover these procedures in full. He recommends contacting Laya and trying out the alternative Simplicity program, which costs € 1,535 per adult. This is a similar plan that covers the same hospitals all the way through to private room placement, but there are no 20 percent amounts with these procedures in this plan. In future, outpatient reimbursements will be subject to an annual deductible, with which the reader must be satisfied before switching. If the member doesn’t mind paying a slightly higher deductible for a private hospitalization, there is another alternative called Connect Simplicity for € 1,415 per adult that should also be considered.

Q I am currently applying for a home loan for retrofitting through my credit union. I have read that you can help finance energy renovation projects for houses. I received my 35 percent grant from the Sustainable Energy Authority of Ireland (SEAI) and I got my offer from my contractor. Do I have to borrow the full amount or can I use some of my savings to offset my monthly repayments?

A Contributing some of your savings towards your upgrade costs is no problem, and this is a great way to bring your monthly repayments to manageable levels, according to Credit Union Development Association executive Kevin Johnson. If you are co-financing your home upgrade through your credit union, affordable loans are available through the ProEnergy Homes Scheme. This is a program that allows homeowners to get up to 35 percent grant funding for a range of renovation measures, including loft insulation, exterior wall insulation, installation of solar panels, boiler upgrades, and upgrades to windows and doors, with the remaining cost incurred Financed either through savings, through low-cost loan financing from your credit union (if participating in the program), or a mixture of both. Some credit unions offer loan interest rates as low as 4.25 percent, especially if you “pledge” savings as collateral for your loan. For participating credit unions, an interest rate of less than 7 percent applies to amounts over € 20,000, while a slightly higher interest rate applies to smaller loans. For example, if you borrowed $ 5,000 10.48 percent over five years after contributing to the cost, your monthly repayments would be only $ 107.42, says Mr Johnson.

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

A According to Mr. Goode at Totalhealthcover.ie, you don’t have to rely solely on their direct payment network. You can go to any dentist for your treatment, but the advantage of using the network is that your service is paid directly to the dentist and you only have to pay the balance. If you go to another dentist, you will need to pay the full amount and apply for reimbursement directly to the insurance company. In terms of overinsurance, no health insurance policy offers coverage for major dental procedures like orthodontics, root canal, crowns, etc., Goode said. If these benefits are important, he recommends that you keep some coverage in addition to your health insurance.

Q I sent my outpatient application to Irish Life Health but some receipts were excluded because they were not submitted on time. Is that right?

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, Goode said. These documents can either be submitted as a single application at the end of the year or they can be submitted online using the “Scan and Send” function. However, if claims are not filed within the six month window, they will be denied, Goode said.



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