Table of Benefits - Parents & Kids Plan

Transcription

1 Table of enefits - Parents & Kids Plan pplicable to new registrations or renewals on/or after 1 st September, This Table of enefits must be read in conjunction with your Plans -E and Plans - Option Rules Terms and onditions, including the Directory of Hospitals (and Treatment entres) and the Directory of approved MRI entres. For the purposes of these documents, Parents & Kids Plan information is listed under the same heading as Plan. enefit Provision Section 1 - Hospital charges in participating hospitals Public hospitals Semi-private accommodation enefit Limit % of hospital charges Private accommodation Private hospitals and treatment centres Group 1 (other than for certain investigations & treatments referred to in Section 1c) Semi-private accommodation Private accommodation Radiotherapy (day care & out-patient) Hospital excess (per claim - except maternity & certain cancer treatments) Group 2 (other than for certain investigations & treatments referred to in Section 1c) Semi-private rate, 100% of technical charges Semi-private accommodation 55% Private accommodation 35% Radiotherapy (day care & out-patient) Hospital excess (per claim - except maternity & certain cancer treatments) ertain investigations and treatments herein referred to as Fixed Price Procedures (FPPs) (contact us if you have a question as to whether a procedure falls within this category) lackrock linic, Mater Private Hospital, eacon Hospital, Hermitage Medical linic & Galway linic cardiac FPPs lackrock linic, Mater Private Hospital, eacon Hospital, Hermitage Medical linic & Galway linic non cardiac FPPs Hospital excess (per claim) Section 2 - onsultants fees/gp procedures In-patient treatment, Day-care procedures, Side room procedures & Out-patient procedures 90% 90% Denotes benefit changes

2 Parents & Kids Plan Participating consultant s set out in the Vhi Healthcare Schedule of enefits for Non-participating consultant s set out in the Vhi Healthcare Schedule of enefits for GP procedures Participating GP s set out in the Schedule of enefits for General Practitioners Non-participating GP s set out in the Schedule of enefits for General Practitioners Section 3 Psychiatric cover In-patient psychiatric cover Standard benefit Standard benefit 180 days in accordance with level of cover in admitting hospital. Refer to Section 1 Day care psychiatric treatment Day care psychiatric treatment for approved day care programmes In-patient treatment for alcoholism, drug or other substance abuse Please contact us for further details 91 in-patient days in any 5 year period, in accordance with level of cover in admitting hospital Refer to Section 1 Section 4 - Maternity Hospital charges Normal confinement Public hospital benefit (up to 3 days) Private hospital benefit (up to 3 days) Up to 4,000 aesarean delivery (as per hospital benefits listed) Refer Section 1 onsultants fees Normal delivery fee (part payment) aesarean delivery fee (part payment) We also pay benefits towards the anaesthetist s fee for giving an epidural; consultants fees for in-patient pathology tests; and a paediatric consultation Home births enefits for enefits for enefits for Medical expenses up to 3 days following the birth Up to 4,000 pplicable to new registrations or renewals on/or after 1 st September, This Table of enefits must be read in conjunction with your Plans -E and Plans - Option Rules - Terms and onditions, including the Directory of Hospitals (and Treatment entres) and the Directory of approved MRI entres. For the purposes of these documents, Parents & Kids Plan information is listed under the same heading as Plan.

3 D D Post natal home nursing Following 1 nights stay Following 2 nights stay Section 5 onvalescent care Parents & Kids Plan For the first 14 nights only in single room accommodation ancer care support One night s accommodation up to 100, for each treatment Vhi Healthcare approved medical and surgical appliances Subject to an excess of 300 per member per year - contact us to find out whether a particular appliance is eligible for benefit Vhi Homecare greed charges for out-patient procedures provided by Vhi Homecare in accordance with rule 6 Section 6 Transport costs pplicable to new registrations or renewals on/or after 1 st September, This Table of enefits must be read in conjunction with your Plans -E and Plans - Option Rules - Terms and onditions, including the Directory of Hospitals (and Treatment entres) and the Directory of approved MRI entres. For the purposes of these documents, Parents & Kids Plan information is listed under the same heading as Plan. 1, Up to 51 per night Up to 1,500 per calendar year Up to 3,200 per member per year mbulance costs Refer to rule 6 (q) Taxi costs Refer to rule 6 (q) Section 7 over outside Ireland Treatment outside Ireland Emergency treatment abroad Up to 65,000 Elective treatment abroad Surgical procedures available in Ireland (as per level of cover in Ireland) Treatment not available in Ireland * Subject to prior approval and satisfaction in full of specified criteria Section 8 In-patient MRI scans MRI charges in accordance with the level of cover in the admitting hospital (Refer to the Directory of approved MRI entres) Out-patient MRI scans ategory 1 - approved MRI centres ategory 2 - approved MRI centres (subject to an excess of 125 per scan) Out-patient T scans pproved out-patient centres *Up to 65,000 *Up to 65,000 Refer Section 1 greed MRI charges & onsultant Radiologists fees Refer Section 9e

4 Parents & Kids Plan D PET-T scans Refer to rule 6(t) D E F Section 9 Out-patient medical expenses General practitioner s onsultant consultations Pathology - consultants fees In an approved out-patient centre Radiology consultants fees for professional services pplicable to new registrations or renewals on/or after 1 st September, This Table of enefits must be read in conjunction with your Plans -E and Plans - Option Rules - Terms and onditions, including the Directory of Hospitals (and Treatment entres) and the Directory of approved MRI entres. For the purposes of these documents, Parents & Kids Plan information is listed under the same heading as Plan. Up to 39 per Up to 20 per referral Per procedure Up to 60 Pathology/Radiology or other diagnostic tests (refer to Section 8 for out-patient MRI benefits) Up to 50% of agreed charges in an approved out-patient centre Physiotherapist s G Pre- and post-natal care H I J K L Up to 500 per member per year In the year of the birth Up to 300 cupuncturists, hiropractors, Osteopaths, Physical therapists, Reflexologists s (as defined in the Rules - Terms and onditions) Up to 12 combined s per member per year hiropodists/podiatrists, Dieticians, Occupational therapists, Speech therapists, linical Psychology s (as defined in the Rules -Terms and onditions) Up to 12 combined s per member per year Public hospital out-patient & E levy Per episode of care Up to 13 Out-patient mental health treatment Mental health therapy, maximum of 12 s per member per year, in an approved outpatient mental health centre hild counselling Up to 8 s per child per year Up to 20 per

5 M Paediatrician benefit Parents & Kids Plan Up to 1 in the year of the birth Up to 39 nnual excess - per member per year 300 nnual maximum - per member per year 3,200 Section 10 hild benefits hild nursing Up to 28 days per calendar year Parent accompanying child Up to 14 days per child per calendar year following a stay in excess of 3 days in hospital Vhi Swiftare benefit Up to 2 s per child per year TO P&K V5 Sep10 Up to 100 per day Up to 100 per day Up to 75 per pplicable to new registrations or renewals on/or after 1 st September, This Table of enefits must be read in conjunction with your Plans -E and Plans - Option Rules - Terms and onditions, including the Directory of Hospitals (and Treatment entres) and the Directory of approved MRI entres. For the purposes of these documents, Parents & Kids Plan information is listed under the same heading as Plan.