Medical Claims | Vhi Healthcare | Health Insurance (2024)

If I have a hospital stay, will I pay an excess?

Yes, if your chosen plan has a hospital excess, you will pay this on admission.

An excess is a portion of the claim that you must pay, and we pay the balance or amount you’re covered for. For example, if you have full cover for an overnight stay in a semi-private room in hospital, but there is an excess of €75 per hospital stay, then you will pay €75 and we will pay the rest. We have an information page on excess, if you would like to learn more about this. Excess cannot be claimed back from Vhi.

If you are interested in finding out about tax relief from Revenue for medical expenses, you will find this on their medical insurance premiums page.

Will I receive a claim statement for my child?

Yes. Benefit Claim Statements for dependants (U18) are issued to the policy holder for paid claims. Depending on your chosen method of contact with us, this is either posted to you or made available online. The online version can be viewed in the documents section of your MyVhi account.

Are hospitals in Northern Ireland covered?

Yes, a limited number of hospitals in the region are covered. To see if a hospital is covered, you can check our hospital directory.

Are consultants’ fees in NI covered?

Consultants’ fees are partially covered, depending on your plan. To avail of this, you will need to pay directly and claim back, provided you attend the consultant in a Vhi approved hospital. We are billed directly for any hospital charges.

Do I need to pay for out-patient tests on the day?

Yes. Certain tests like radiology, diagnostics and pathology are paid for at the appointment.

Depending on your plan, you can claim all, or part of this back in your member account MyVhi or Vhi App. If you would like to find out what you are covered for, you can do this by logging in to MyVhi and choosing the ‘Document’ section. Here you will find a comprehensive view of your benefits in the Table of Benefits document.

Vhi need further information on my claim. How can I submit this?

You can email this information to: [email protected]. Remember to include your policy number and claim or case number. You will find this in your member account, MyVhi in the ‘My Details’ section. This will be sent to the claims team.

Does the day to day excess apply to everyone on the policy?

Yes, excess is applicable per person, per policy year for eligible benefits. Excess is paid once per policy year for each named member on the policy. If you would like to find out more about excess, you can access our excess information page.

Are A&E charges covered?

Public hospitals

Yes, benefit towards this can be claimed on some plans. You can check your plan benefits in MyVhi. Simply log in to your account, select the ‘Documents’ section, then open the Table of Benefits document.

Private hospitals

You can claim some benefit back on this (depending on your plan), as the claim is assessed under your day to day medical expense benefits i.e. radiology, diagnostics and pathology. Note, your receipt will need to include a breakdown of charges.

How to claim

You can submit the claim using Snap & Send in MyVhi or Vhi App.

To make a claim, do I need to submit anything other than a receipt?

No, but the receipt must contain the following details:

· Your name

· Date you received the treatment/service

· Treatment provided

· Practitioner name and details

Note, all practitioners must be registered with the appropriate bodies, as per our Terms and Conditions.

Postal

If you are posting in your claim, you will need to send us the original receipts, so please be advised that you will not receive these back.

Do you issue End of Year Statements?

No. End of Year Statements are not issued. If you wish to make a claim with Revenue, your Vhi Benefit Claim Statement will be accepted. You can find details of your past claims in your MyVhi member’s account. Simply log in to MyVhi and select the ‘Claims’ section.

Can I claim anything back if I attend a centre that isn’t on the approved list?

Yes, you may claim back on the professional fee. This means that if you get an X-ray in a facility that is not on our approved list, you can claim for the radiographer’s fee, but the charge for the unapproved centre is not covered i.e. the use of the X-ray machine.

It is important in this instance that your receipt contains a breakdown of the charges.

You can search through our list of relevant bodies in our Terms and Conditions.

If you need further help with this, you can send us a message on webchat or call us on 056 444 4444. Our lines are open Monday to Friday, 8am to 7pm and Saturday 9am to 3pm.

What is the waiting period for maternity?

If you are a new member, or if you have changed health insurance provider, there may be a 52 week waiting period. This applies if you are a private or semi-private maternity patient. If you need further help with this, you can send us a message on webchat or call us on 056 444 4444. Our lines are open Monday to Friday, 8am to 7pm and Saturday 9am to 3pm.

As a private patient, can I claim anything back on my consultant’s fee?

Yes, in some instances, depending on your plan. This is also called pre and post-natal fees. You can find details on these benefits in MyVhi. Simply log in, select the documents section and open the Table of Benefits. Please note, this is not the same benefit as your routine everyday visits with a surgeon or Consultant.

Am I covered for a private room?

Yes, if this is on your plan. Check your benefits in MyVhi. Simply log in, select the documents section and open the Table of Benefits. You will find this information in the hospital accommodation section. You can check if the hospital you are attending is covered i.e. on our approved list of hospitals in our Directory of Hospitals and Treatments Centres.

Once you have confirmed cover, this then depends on availability within the medical facility.

What other maternity benefits are available?

There may be some additional maternity benefits you can claim under your policy. These benefits are plan specific and are always per pregnancy, rather than renewal period. This means they can only be used once per pregnancy. Simply log in, select the documents section and open the Table of Benefits. If you are a public patient, you can still avail of the Maternity and Baby Bundle, if this is covered on your plan.

You can claim these benefits using Snap & Send in MyVhi or Vhi App.

Am I covered for maternity care if I’m on holidays?

There is no cover for routine maternity/pregnancy abroad. Nor can you claim back on routine maternity or pregnancy related conditions such as scans, X-rays, blood tests, consultations and delivery if they’re carried out outside Ireland. This is listed in the exclusions section of your rules book Terms and Conditions.

Can I claim for everyday benefits abroad?

Everyday claims that you are eligible to claim for here, can also be used abroad. The medical practitioner i.e. GP needs to be registered with the equivalent of the accredited body in Ireland. You can claim as you would for these benefits here, through Snap & Send in MyVhi or Vhi App.

If I have an accident or emergency abroad, am I covered?

If you are involved in an accident or suddenly become unwell, there is cover for emergency treatment abroad on many plans of up to €65,000/€100,000.

This is called ‘Assist’ care and is available 24 hours a day. You should contact Vhi Assist before you receive any medical treatment. In the event of an emergency or where you are physically unable to make the call, you should appoint a relative to call for you. You won't have to pay any bills upfront as we will arrange for approved hospital treatment to be paid to the hospital directly, up to the amount you are covered for.

You can call ‘Assist’ on:

+353 1 448 24 44 (Worldwide excl. USA & Canada)

1800 364 9022 (USA and Canada)

Can I have a planned procedure abroad?

Most Vhi plans include a level of cover for elective (planned) treatment during a temporary stay abroad. This may be a procedure currently available or not available in Ireland. This is subject to your waiting periods. The treatment must be:

1. Recommended by an Irish based consultant.

2. Approved by Vhi's prior approvals team before travelling.

3. Considered to be a proven form of treatment and must meet specific criteria.

Your consultant must submit a 'Treatment Abroad Applications Form' to [email protected]

Cover outside Ireland is outlined in detail in the Rules, Terms and Conditions of Membership under Rule 6. Benefit is not payable for all treatments and a full list of exclusions is available Terms and Conditions.

If you need further help with this, you can send us a message on webchat or call us on 056 444 4444. Our lines are open Monday to Friday, 8am to 7pm and Saturday 9am to 3pm.

Are other expenses abroad covered?

There may be some cover towards outpatient expenses abroad under a pay and claim back basis as per the Terms and Conditions of your plan.

In relation to transport costs for treatment abroad, there is no cover towards flights, transport or transfers when having planned treatment abroad.

MRIs are not covered abroad, either directly or on a pay and claim back basis. Other exclusions may also apply. Always check your rule book in conjunction with your policy.

I would like to make a claim?

You can submit a claim 24/7 online with Vhi MultiTrip travel claims portal. This link will bring you to the external site of our underwriters, who manage this portal to make claiming fast and simple.You can also claim with Vhi App, which you can download to your mobile phone.An immediate decision is available for certain claims.

Claiming information

The claiming portal is separate to your MyVhi account. You can submit and review your claims here, but no policy details are available on it. If you would like to view your policy details like terms, conditions, limitations or exclusions, select the ‘Document’ section in MyVhi.

It is important to note that Snap & Send cannot be used to claim for MultiTrip.

You can also register your claim over the phone on 046 9077358. Phone lines are open Monday to Friday from 8am – 6pm and 8am – 4pm on Saturday.

I am abroad and have a medical emergency. What should I do?

You can call the relevant number below for assistance:

· 1800 364 9022 for USA and Canada (toll free)

· +353 1 448 2444 for the rest of world (collect calls accepted)

Care in this instance is provided by a third party called ‘Assist Cover’. It is recommended to contact the Assist team prior to receiving any medical treatment, or appoint a relative to do so.

How it works

When you take out a MultiTrip policy with us, you must also hold private medical insurance. You cannot purchase MultiTrip without this in place. This should provide emergency cover of up to €65,000 when you are away. If you have an accident or emergency abroad, your private medical insurance is used initially up to the value of €65,000 or whatever your plan permits, and for costs beyond this, your Vhi MultiTrip policy is activated.

Can I get help with a non-medical query?

Yes. For assistance queries while you are away, and claims queries upon your return, you can call our MultiTrip Travel Helpline on: +353 46 9077358. Phone lines are open Monday to Friday from 8am – 6pm and 8am – 4pm on Saturday.

Or you can email: [email protected]

How can I submit a claim?

You can submit a claim online with this dedicated Vhi International claims portal. This link will bring you to the external site of our underwriters, who manage thisportalto make claiming fast and simple.You will need to fill in your details and information on the claim. This includes: policy number, date of birth, bank account details for payment, invoice and other details to ensure the claim can be accurately assessed.

The claims portal is not connected in any way to MyVhi, where you can check your benefits and membership details.

You can speak to a member of our travel claims team on 046 907 7377. Phone lines are open Monday to Friday from 8am – 6pm and 8am – 4pm on Saturday.

Can I use Snap & Send?

No. Snap & Send cannot be used to claim on our International plans. This method of claiming can only be used on our domestic health plans to claim for everyday benefits like GP visits.

Anonline portalis provided by our underwriters to make claiming fast and simple.

Here, you need to provide your details and information on the claim such as your policy number, date of birth, bank account details for payment, the invoice and other information pertinent to the claim to ensure it can be accurately assessed.

You can also speak to a member of our travel claims team on 046 907 7377. Phone lines are open Monday to Friday from 8am – 6pm and 8am – 4pm on Saturday.

I am returning to Ireland - am I covered when I’m home?

Vhi International may cover you, depending on whether you are returning temporarily or permanently to Ireland.

Temporary return

Your Vhi International health plan provides medical cover for up to 179 days per policy year, when you return home.

Permanent return

If you are staying more than 179 days in Ireland or are not planning to return abroad in the foreseeable future, it is recommended you purchase a domestic health insurance plan. You can get a quote with our Plan Finder.

Vhi International plan provides health insurance cover to Irish residents who are travelling, studying or working abroad for more than six months.

If you have any further queries, you can call our travel team on 046 907 7377, Monday to Friday from 8am – 6pm and Saturday from 8am – 4pm.

I have a pre-planned procedure abroad. Do I need to do anything else?

Yes. You should call us on 046 907 7377, as far in advance of the procedure as possible. The team will discuss the treatment process with you. You can call us on 046 907 7377, Monday to Friday from 8am – 6pm and Saturday from 8am – 4pm.

Am I covered to travel to another country outside of my country of residence?

Yes, travel cover is automatically included on your plan for countries within your chosen area, i.e. Europe, worldwide excluding US & Caribbean or worldwide. This may include cover for personal accidents, travel cancellation/curtailment, travel delays and more.

You can check benefits and limitations on your Table of Benefits document and Terms of Conditions in MyVhi under the ‘Documents’ section.

I have a dental policy. How can I claim for dental work?

If you have attended a dentist and paid in full at your appointment, then you can submit a claim with this dental claims portal. Our underwriters provide this to make claiming easy. You will need to log in or register. If registering, you will need your policy number.

The dental portal is not your MyVhi account so the email and password you use for this, will not allow you to log in on the dental portal. You can find your policy number in MyVhi.

If you would rather not claim, then you can attend a dentist who is part of our dental network. The dentists here bill us directly so you only pay the balance, if there is one. For example…

Patricia needs a filling:

• Cost = €80
• Cover = 60%
• Patricia pays €32 at her appointment. The dentist bills us directly for €48.

Note, you will need your policy number when booking your appointment.

What is Vhi Dental Network and can I check if my dentist is on it?

This is a list of dentists nationwide who have agreed to bill us directly for treatment. So rather than paying the entire bill upfront, you just pay the amount that your plan doesn’t cover. For example, if you get a filling and Vhi covers 70% of the cost, you will pay only the remaining 30% to your dentist.

You can search through our Vhi Dental Network to see if your dentist is listed or find one in your area.

If you would like to check your dental benefits, simply log in to your MyVhi member’s account and select the ‘Documents’ section. Here, you will find your ‘Table of Benefits’ document which provides a comprehensive view of your cover.

What happens if my dentist isn’t on the Vhi Dental Network?

If your dentist isn’t part of our network, you pay in full at your appointment andthenclaim back. The quickest and easiest way to do this is by submitting your claim online.

Our underwriters provide an online portal to make claiming easy. This is available for submitting claims only and will not display any information regarding your benefits. You will need to log in or register. If registering, have your policy number to hand. This is not your MyVhi account so the email and password you use for this, will not allow you to log in on the dental portal.

Here is an example of how it works:

Marian attends a dentist who isn’t in the dental network. She needs some root canal work on a tooth.

• Cost = €700
• Cover = 50%

Marian pays €700 to the dentist. She goes home and creates an account on the dental portal, as she hasn’t used it to claim before. She then submits the details of her claim, including her policy number, receipt, treatment details and her bank account. Later, she receives €350 into her bank account.

If you would like to check out your dental benefits, simply log in to MyVhi, select the documents section and here, you will find a document entitled ‘Table of Benefits’. This will provide a comprehensive view of your benefits.

If I have already registered for MyVhi, do I need to register separately to make a dental claim?

Yes. The dental claiming portal is completely separate to your MyVhi member’s portal and you therefore, need to use a different password/email combination to that used for your MyVhi account.

The dental claiming portal allows members to make dental claims only. It does not provide any membership details like benefit information. MyVhi holds all other information relating to your membership, including a comprehensive breakdown of your benefits.

Our underwriters provide this dental claiming portal. You will need to log in or register/create an account (if you haven’t used this before) here to submit your claim.

Who do I contact if I have a claims query?

If you have a query about a claim, you can contact our dedicated Vhi dental claims team on 046 9077 337 or email us on: [email protected]. All dental claims are handled byCollinson Insurance Services Europe Ltd (CISEL).

You can find more details on this on our Life and Mortgage claims page.

Can I make a claim for X-rays and Ultrasound scans?

To be eligible for a claim, the scan must be carried out by a consultant radiologist in a Vhi approved out-patient centre. You can check the medical centres covered on our Facility Finder.

You will need to pay upfront and claim back after, using Snap & Send in MyVhi or Vhi App. Simply select 'Radiology' as the treatment category.

If you attend a Vhi 360 Health Centre/SwiftCare, you will need to pay an excess on the day, and the Centre will bill us directly.

If you would like to check your cover, simply log in to your MyVhi member’s account and select the ‘Documents’ section. Here, a document called a ‘Table of Benefits’ provides a breakdown of your benefits.

Are CT and Dexa Scans covered?

Yes, depending on your plan.

Many medical facilities have an agreement to bill us directly. This is called a ‘direct pay’ centre. If you choose a centre with this agreement in place, then you won’t need to worry about the bills.

You can check our ‘Facility Finder’ for a list of direct pay facilities. You simply complete the direct payment form when attending for your scan.

If you attend a facility that does not have this in place i.e. a direct pay facility, then you will need to pay upfront and claim back after your scan using Snap & Send.

In order to claim full benefit on this, you should attend a Vhi approved medical facility. If you attend a centre that is not on the approved list, you can claim for the professional benefit i.e. radiologist using Snap & Send, once the receipt has a breakdown of the care provided.

If you would like to check your cover, log in to your MyVhi member’s account and select the ‘Documents’ section. Here, a document called a ‘Table of Benefits’ provides a breakdown of your benefits.

Do you cover Mammograms?

Yes, depending on your plan. First, you need to ensure that you have a referral from a GP or Consultant for this.

Many medical facilities have an agreement to bill us directly. This is called a ‘direct pay’ centre. If you choose a centre who has this agreement in place, then you won’t need to worry about the bills. You can check our ‘Facility Finder’ for a list of direct pay facilities. On many plans, one mammogram is fully covered and paid directly to the approved centre per renewal year. You simply complete the direct payment form when attending for your scan.

Pay and claim back

If you attend a facility that does not bill us directly, you will need to pay upfront and claim back after your scan using Snap & Send. In order to claim benefit on this, you will need to attend a Vhi approved medical facility.

If you attend a centre that is not on the approved list, you can claim for the professional benefit i.e. radiologist using Snap & Send, once the receipt has a breakdown of the care provided.

If you would like to check your cover, log in to your MyVhi member’s account and select the ‘Documents’ section. Here, a document called a ‘Table of Benefits’ provides a breakdown of your benefits.

Do you provide cover for an MRI?

Yes, depending on your plan. First, you need to ensure the following are in place:

• You must be referred by a Consultant or GP.
• You must attend an approved MRI centre.
• The clinical indicator must be one that is approved by us.

Many medical facilities have an agreement to bill us directly. This is called a ‘direct pay’ centre. If you choose a centre who has this agreement in place and you have the applicable referral, then you won’t need to worry about the bills. You can check our ‘Facility Finder’ for a list of direct pay facilities.

If you attend a facility that does not have a direct pay agreement in place, then you will need to pay upfront and claim back after your scan on the eligible benefits. A €125 excess applies to all pay and clam back MRI claims. To claim benefit on this, you will need to attend a Vhi approved MRI centre.

To claim back you must complete anon-direct MRI claim form.

Can I claim for a PET-CT scan?

Yes, depending on your plan.All approved PET centres have an agreement to bill us directly. This is called a ‘direct pay’ centre. You will find a list of approved centres in our Directory of Hospitals.

Your Consultant will submit an application on your behalf outlining the detail required.

Claims are subject to the following criteria:

• All scans must be prior approved.
• You must be referred by a Consultant.
• PET-CT is carried out in a PET_CT centre covered by your plan, and specified in our PET-CT directory.
• The PET-CT scan is carried out for an approved clinical indicator.

Is urgent care covered in Vhi 360 or SwiftCare?

Yes, it is on most plans, but you will have to pay an excess. If there is no cover for this on your plan, you can still attend as a Vhi member and use this on an outpatient basis. This means you will need to pay upfront and claim back using Snap & Send later.

To find out what cover you have on your plan for this, log in to MyVhi, select the documents section and open the Table of Benefits.

Can I claim anything back on medical and surgical appliances?

Yes, many of our plans provide some cover toward this. You simply print, fill and post the Appliance Claim Form to us. In most cases, you will need to pay upfront and then submit the claim to us.

To find out what cover you have on your plan for this, log in toMyVhi, select the 'Documents' section and open the Table of Benefits item.

If you need further help with this, send us a message on webchat or call us on 056 444 4444. Our lines are open Monday to Friday, 8am to 7pm and Saturday 9am to 3pm.

There may be an excess to be met on medical and surgical appliances and they may be subject to payment conditions which can all be discussed with our advisors.

Can I claim for convalescent care?

Yes, many of our plans provide some cover toward this. You will need to pay upfront and then claim back for this benefit.

Convalescence is not the same as rehabilitation. It is a step down for recuperation immediately after a medically necessary inpatient hospital stay or procedure. Convalescence must be deemed medically necessary by your admitting consultant.

To find out what cover you have on your plan for this, log in toMyVhi, select the 'Documents' section and open the Table of Benefits item.

If you need further help with this, send us a message on webchat or call us on 056 444 4444. Our lines are open Monday to Friday, 8am to 7pm and Saturday 9am to 3pm.

Do you cover health screenings?

Yes, depending on your plan. We have a dedicated medical screening team, who look after medical screening as a preventive measure inVhi's medical screening centre.

You will usually need to pay an excess, but there may be a deficit in cost, depending on the health check you select. Any deficits will need to be paid upfront.

It is important to note that this is not a medical diagnostic service. Rather it is an overall proactive health check.. It cannot be used on an emergency basis, and you must be registered with a GP in Ireland to avail of the service. It is not a second opinion service.

To find out what cover you have on your plan for this, log in toMyVhi, select the 'Documents' section and open the Table of Benefits item.

You can contact the team directly on (056) 7753010.