Money Smart Rules booklet
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Money Smart
Rules booklet
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Welcome to Laya Healthcare
Thank you for choosing us to look Call 1890 700 890 between 8am and
after your healthcare cover. 7pm Monday to Friday and 10am
and 3.30pm on Saturdays. In the
This rules booklet contains very
interest of customer service, calls
detailed legal information about our
are recorded & monitored.
Money Smart schemes.
Visit our website on
Due to the detail in this booklet we
www.layahealthcare.ie
understand you may have questions,
or email us at
so please feel free to contact our
info@layahealthcare.ie
Customer Care team.
Laya healthcare, Eastgate Road,
Eastgate Business Park, Little Island,
Co. Cork.
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Contents
Serving you online 02
Introduction 03
Definitions 03
Joining the scheme 05
Renewing your membership 06
Your subscriptions 06
Ending your membership 06
What is covered under the scheme 07
What is not covered under the scheme -
waiting periods 07
Making a claim 08
Changes to the agreement 09
General terms and conditions 09
Data Protection Statement 11
Tax relief 12
Making a complaint 12
Table of Benefits 13
Your benefits at a glance 14/15
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Serving you online www.layahealthcare.ie
It’s never been easier for you to get
in touch with us when it suits you. By
visiting our website you can:
• find information on all our schemes as well as
frequently asked questions (FAQs) and answers
• update your address details
• email us with any questions
• download the most up-to-date information (rules
and other literature may be updated from time to
time)
To look at the details of your own scheme, all you
need is your laya healthcare membership number to
register online.
Important note
Please be aware that these Money Smart cash plans
are not included in Lifetime Community Rating. If you
do not hold an inpatient health insurance scheme
before 1st May 2015, a loading may be applied when
you switch to, or purchase inpatient health insurance
cover on or after this date. However, Money Smart
cash plans are still considered continuous cover in
terms of waiting periods.
If you are interested in health insurance schemes that
do qualify for continuous cover under the Lifetime
Community Rating, please contact us on
1890 700 890 or visit www.layahealthcare.ie.
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Consultant
A reminder of your
Money Smart scheme Any registered medical practitioner who meets all
of the following requirements:
Effective from 1st May 2015. • they hold a current full registration with the
This booklet contains everything you need to Irish Medical Council
know about your Money Smart schemes. • they are engaged in hospital practice by
reason of their training, skill and experience
If, however, you have any questions about your in a designated specialty, they are consulted
cover, please contact our customer service team by other registered medical practitioners and
on 1890 700 890. undertake full clinical responsibility for patients
in their care, or that aspect of care on which
they have been consulted, without supervision
in professional matters by any other person
1. Introduction • they hold a public consultant post or are
You need to read these rules along with your eligible to hold a public consultant post
membership certificate and application form. • they are recognised by us as a laya healthcare
Together these documents make up the consultant for the purpose of our insurance
agreement between us laya healthcare and you schemes in Ireland (you can phone or write
(the member). to us if you would like to know whether or not
a particular registered medical practitioner
is recognised by us or you can check our
website). If you need to receive treatment in a
2. Definitions country outside Ireland, a consultant will refer
you to a surgeon, physician, or anaesthetist
It is important for you to understand that some of
who is less than 70 years of age and is legally
the terms we use have specific meanings. These
qualified to provide the treatment in that
terms and their meanings are outlined below and country.
written in bold throughout the remainder of the
booklet. Day-case treatment
Treatment where, for medical reasons, you have
to be admitted into a hospital and occupy a bed
Adoption Cash Back Benefit in that hospital during the day, but not overnight,
for treatment which would be accepted generally
This benefit is paid on the adoption of a child, and by the medical profession in Ireland as day-case
is payable only once per adoption. The benefit treatment as opposed to out-patient treatment.
is only payable after you have adopted a child
and can be claimed once per membership year Dental practitioner
regardless of the number of children adopted. In
order to receive this benefit you are required to A dental practitioner with a current full
submit a copy of the adoption certificate. registration with the Irish Dental Council, who
holds a primary dental qualification. He/She is
Benefits community based and provides dental care.
Payments made to you, for the benefit of you or Dependants
your dependants, in accordance with the Table
of Benefits on page 13. Your husband, wife or partner, son or daughter
who we have agreed with you to accept into
membership of one of the schemes, and who is
also named on your membership certificate as
one of your dependants.
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General medical practitioner/GP Maternity Cash Back Benefit
A registered medical practitioner who is fully This benefit is paid once you have given birth
registered with the Irish Medical Council and who to a child, and is payable only once per birth
is not a consultant and is currently practicing as a regardless of whether you give birth to one baby,
primary care physician in the community. twins or triplets etc. In order to make a claim for
this benefit you are required to submit a copy of
Health insurance contract your baby’s birth certificate.
A health insurance contract to which the Irish Membership start date
Health Insurance Act, 1994, and the regulations
made under that Act, apply. The date on which a person begins his or her
current continuous period of membership of
Hospital Day-case/In-patient their scheme. The membership start date for
Cash Back you and your dependants is shown for each of
you individually on your current membership
The amount that laya healthcare will pay for certificate. We will treat a person’s cover under
each stay you or your dependants have had in the scheme as continuous if there is no break in
hospital for in-patient or day-case treatment. membership of more than 13 weeks.
This benefit does not include any direct costs,
for example consultant fees, room charges, Optician
medication/dressings involved with the hospital
stay. A member of the Fellow of the Association of
Optometrists in Ireland.
Hospital
Everyday medical expenses
A publicly funded hospital other than a nursing
home, which provides services for a person Treatment which is not in-patient treatment or
pursuant to his or her entitlements under Chapter day-case treatment.
II of Part IV of the Health Act, 1970 or any
Hospital listed on page 16. This list of hospitals Participating therapist
may change from time to time so please contact
us prior to any hospital admission to confirm your We will recognise a person who is a participating
cover. therapist and is registered with the relevant
associations at the time of treatment for the
Individual policy versus Family policy purpose of our insurance schemes in Ireland.
We will also recognise registered general
Individual Policy - A scheme that includes you practitioners who are participating therapists
and no dependants. with the relevant associations. These are listed as
Family Policy - A scheme that includes you and follows:
one, or more, dependants. (a) a chartered or State registered
physiotherapist and the Irish Society of
In-patient treatment Chartered Physiotherapists
Treatment where, for medical reasons, you have (b) a person who is either on the Professional
to stay in a hospital overnight. Register of Traditional Chinese Medicine,
the Traditional Chinese Medicine Council
of Ireland (TCMCI) the British Medical
Ireland Acupuncture Society, the Acupuncture
Foundation Professional Association and/or is
Ireland excluding Northern Ireland.
accredited to the British Acupuncture Council
and/or the Academy of Chinese Culture and
Medicine
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(c) a member of the Chiropractic Association of Registered medical practitioners
Ireland (CAI) and McTimoney Chiropractor
Association of Ireland A person whose name appears in the General
Register of Medical practitioners maintained
(d) a member of the Osteopathic Council of
under the Irish Medical practitioners Act 2007.
Ireland and the Association of Osteopaths in
Ireland
Renewal date
(e) a member of the Irish Reflexologists Institute,
the Federation of Holistic Therapists Ireland The renewal date shown on your membership
and/or the National Register of Reflexologists. certificate.
(f) a member of the Association of
Neuromuscular Therapists (ANMT), the Routine dental treatment
Irish Association of Physical Therapists, the
Register of Physical Therapists of Ireland or We refer to routine dental as being a general
the Irish Institute of Physical Therapists check-up, routine scale or polish, routine filling or
extraction (excludes wisdom teeth) carried out by
(You can phone, write or email us if you would a registered dentist.
like to know whether or not someone is a
participating therapist for the purpose of the Scheme
scheme).
The laya healthcare product that is specified on
Prescriptions your membership certificate.
A drug or medicine that can only be issued upon Treatment
the prescription of a licensed particitioner or
dentist and is dispensed by a licensed pharmacist. Any health services a person needs solely for
the medical investigation, treatment, cure, or
Pre-existing condition alleviation of the symptoms, of illness or injury.
Any disease, illness or injury that a person may Year
have which began, or the symptoms of which
began, before that person started his or her The period starting on your membership start
current continuous period of membership of the date or a renewal date and ending at midnight on
scheme. the day before the next renewal date.
Note that an illness or injury may be present
for some time before giving rise to the You/your
symptoms or being diagnosed. So, when
deciding if a disease, illness or injury began This means you the main member and your
before membership started, it is the date when dependants.
it began that counts - not the date when a
person became aware of having the disease,
illness or injury, or its symtoms.
3. Joining the scheme
Quarter (a) Your membership of your scheme begins
on your start date as shown on your
A period of three months, beginning initially membership certificate.
on your membership start date and recurring
every three months thereafter. (b) The membership of each of your
dependants of their scheme begins on their
start date as shown on your membership
certificate.
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(c) The agreement between you and us for your
membership of any of the scheme shall 6. Ending your
be separate from any agreement between
us and you for your membership of any
membership
other laya healthcare insurance scheme or (a) You have the right to cancel your
schemes. membership of the scheme by writing to
us within 14 days of receiving your first
(d) The scheme of which you are a member is membership certificate. We will give you a
shown on your membership certificate. full refund of any money you have paid us as
long as you have not made any claims.
(b) Your contract is for a period of one year
unless we agree to a different period when
4. Renewing your commencing your policy. If you do cancel
membership mid-year, you will not receive any refund
on your premium. In the event of non-
(a) Your membership of the scheme will payment in accordance with the payment
automatically renew on your renewal date, terms of your contract, such non-payment
each year (subject to Rule 10 on page 9) for a will constitute a breach of contract. In such
further year unless we write to notify you at circumstances we will not pay any benefits
least 30 days before the end of the year that for the contract term and we will seek
we have decided to end the scheme. In that recovery of the losses and expenses incurred
case, your scheme membership will end at by us as a result of your non-payment.
the end of the year in which we notify you of
our decision. (c) You may also cancel the membership of any
of your dependants of their scheme by
(b) You renew your membership of the scheme writing to us within 14 days of you receiving
by continuing to pay your subscriptions after your first membership certificate which lists
your renewal date. them as a member. We will give you a full
refund of any money you have paid for those
dependants, whose membership you have
cancelled within 14 days, as long as no claims
5. Your subscriptions have been made in respect of them.
(d) Your dependants contract is for a period
You must pay the subscriptions you have
of one year unless we agree to a different
agreed with us for your membership of the period when commencing your policy. If you
scheme when it falls due. We may increase the do cancel your dependants contract mid-
subscriptions you have to pay each year (see year, you will not receive any refund on your
Rule 10 on page 9). premium. In the event of non-payment in
You must pay your subscriptions in a way accordance with the payment terms of your
contract, such non-payment will constitute
which is reasonably acceptable to us. We will
a breach of contract. In such circumstances
give details of the ways you can pay your
we will not pay any benefits for the contract
subscriptions in our literature and we will send term and we will seek recovery of the losses
you updated details if you ask us to. A credit and expenses incurred by us as a result of
charge will apply if paying by installments your non-payment.
(e) We can end or refuse to renew someone’s
membership of the scheme if they
have at any time made a fraudulent
misrepresentation which relates to your
contract with laya healthcare or any other
health insurance contract, and which has,
or could have, resulted in us, or any other
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registered health insurer, suffering financial (c) In the case of a person who was covered
loss. This includes information which could under a health insurance contract within
have affected our decision to allow anyone to 13 weeks before their membership start
join the scheme or what subscriptions you date, we will only pay benefits for treatment
have to pay or whether or not we have to pay received during their additional cover
any claim for benefits. waiting period if benefits for the treatment
would have been payable under that health
(f) Your membership of the scheme will end insurance contract. And we will only pay the
immediately if you stop living in Ireland for amount that would have been payable under
more than six months per calendar year or that health insurance contract if the amount
your membership is not renewed. is less than would otherwise be payable by us
(g) We may end your membership of the under the scheme.
scheme by writing to you if you do not
A person’s additional cover waiting period for
pay any or part of your subscriptions on
this purpose shall be:
the date they are due. If your membership
ends because you do not pay your • the first year following their membership end
subscriptions, we may allow you to continue date on Money Smart for maternity.
your membership, as long as you pay the • the first two years following their membership
subscriptions you owe within 30 days. end date on Money Smart for all other
(h) Where a change made to your policy benefits.
increases your subscriptions and we choose • the first five years following their membership
to cancel your policy in accordance with 6(g), end date on Money Smart for all other benefits
we may cancel your policy from whatever for members aged 65 years or over.
period your subscriptions provide cover for.
(i) If a person’s membership of the scheme
This rule will not restrict cover for treatment
ends because we end their membership (e.g.
arising out of any illness, injury or disease which
for fraudulent misrepresentation), we will give
a refund of subscriptions paid for them for originated after the person’s membership start
the period after their membership ends. date. This rule applies both to a person who
becomes a member of the scheme for the first
(j) If you cease to be a member of your scheme time or to anyone changing their scheme to a
for any reason at any time, the membership scheme which generally provides more extensive
of each of your dependants on the scheme cover.
will also end at the same time unless we
otherwise agree in writing at the time. Your
dependants will need to make their own
arrangements with us to continue their 8. What is not covered
membership of their schemes. They can do
this by telephoning or writing to us. We will under the scheme
explain to them what they will need to do.
We will not pay benefits for the following:
(a) Benefit in relation to treatment which a
person requires during the initial waiting
7. What is covered under period that may apply to the treatment
the scheme under their scheme. The initial waiting period
on the Money Smart scheme for members
a) Laya healthcare provides benefits in who have not held another health insurance
accordance with your level of cover and as contract within 13 weeks of the membership
outlined in the table of benefits for your start date of their Money Smart scheme,
scheme. is the first 12 weeks of membership and
commences on a person’s membership start
b) These benefits are provided subject to the
date.
exclusions found in section 8.
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The above waiting periods will not apply:
9. Making a claim
• to any child of yours who becomes a member
of the scheme within 13 weeks of their birth; or (a) Claims can be made on a quarterly basis,
once all outstanding premiums have been
• to any benefit in relation to treatment received paid. Claims will only be paid once the
by a person resulting from an accident or injury accumulated receipts total €150 or more in
which occurred while they were a member of every quarter submitted
the scheme or covered under another health
insurance contract. (b) When possible, you should tell us about any
• The waiting periods shall be reduced by treatment you are going to have. This gives
a person’s continuous period of cover (if us the chance to tell you if you can claim for
any) under one or more health insurance benefits.
contracts prior to their membership start (c) We will not pay benefits while you
date if the period of continuous cover ended are breaking any of the terms of your
within 13 weeks of their membership start membership.
date. (A person’s cover shall be treated by us
as continuous even if there is a break in cover, (d) In order to process a claim, we require a
but only if the break in cover does not last fully completed claim form. In the event that
more than 13 weeks.) Please remember that necessary information required to process
we will not pay benefits for any treatment the claim is incomplete or ambiguous on the
which a person receives while he or she is not claim form, our claims department will follow
a member of the scheme. up with the necessary party to obtain this
information. This follow up will take place
(b) Benefit in relation to treatment where injury
over a six-month period, after which if the
or illness is caused by war, civil disobedience
required information is not received the claim
or any act of terrorism or chemical, biological
will be deemed ineligible for benefit.
or nuclear disaster in Ireland or overseas.
(e) When you are submitting receipts please
(c) Benefit in relation to treatment for
make sure that you have included all of the
symptoms which are not due to any
details below:
underlying disease, illness or injury.
(d) Benefit in relation to treatment you receive
• The members name
outside Ireland. • The type of service and items provided
(e) Any penalty charge in lieu of Health Act
• The name, address and qualifications of
practitioner
contributions.
• The date the service was provided
(f) Laya healthcare will have no obligation to
pay otherwise eligible claims where they are
• The original and not a photocopy of your
receipt clearly indicating that payment has
submitted in respect of a spouse, parent,
been made for the service.
child, brother, sister, uncle, aunt, niece,
nephew of a consultant, dentist or alternative • For prescriptions a copy of the form marked
therapist, general practitioner or any other ‘Prescription claim form’ issued by the
provider of service. pharmacist.
(g) Benefit in relation to treatment received
while not a member of laya healthcare
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are personal and specific to you concerning
Important Note medical conditions that started after you
joined the scheme. Changes will only apply
Fraud Policy: to you for the period. following the renewal
date when the change was made. The
• Laya healthcare operates a fraud policy in changes will not apply to the period before
respect of all claims made under our health the renewal date.
insurance contract.
(b) We will write to tell you about any of these
• Members should note that regular audits of
changes at least 30 days before the renewal
claims are undertaken by laya healthcare.
date on which they are to take effect.
• In all instances where fraud is suspected
in respect of a particular claim, a full and (c) We can increase or reduce the subscriptions
comprehensive investigation will be carried out you pay at any time if there is an increase
by us. or decrease in the rate of tax or any other
government or statutory charge or if any
• If, following that investigation, a finding of fraud
new tax or government or statutory charge
is made or if a claim is deemed in any respect
is introduced which is related to your health
fraudulent, the claim shall be disallowed in its
insurance contract with laya healthcare. If
entirety.
we do, we will only increase the subscriptions
• If after, that investigation, a finding of fraud is you have to pay to cover the cost to us of the
made, or if a claim is in any respect fraudulent changes in the taxes or charges. We will write
or dishonest and submitted with a view to to tell you at least 30 days before increasing
obtaining any benefit under this policy, all your subscription.
benefit under this policy shall be forfeited. For
example, overstatement of any medical fees (d) We may make any changes to the terms of
incurred. your membership of the scheme and your
subscriptions at any time if we are required to
• Any member found guilty of submitting
do so by law. We will write to tell you about
a fraudulent claim shall have their health
any such change as soon as is reasonably
insurance contract suspended with immediate
practical and you may end your membership
effect.
of the scheme within 14 days of us telling
• All claims of whatever nature being considered you about the change. If, as a consequence,
under that individual member shall be you end your membership, we will refund
suspended with immediate effect. any subscriptions that you have paid for the
• In addition, if any claim is fraudulent in any period after your membership ends.
respect, laya healthcare reserves the right
to refer the matter and details of the claim to
the appropriate authorities to prosecute the
member. 11. General terms and
conditions
(a) Your policy and all communication between
10. Changes to the you and us will be in English.
agreement (b) These terms will be governed by Irish law and
all matters to do with the schemes will be
(a) We may change any of the terms of your dealt with by the courts in Ireland.
membership of your schemes each year
on your renewal date. These changes (c) We will not return any documents you send
can include, for example, how much your us unless you ask us to do so at the time you
subscription will be and how often you send them to us.
have to pay it. The changes can also include (d) Any changes to these terms will only be valid
changes to the benefits. We will not add any if they are made according to these rules or
restrictions or exclusions to your cover that
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the Table of Benefits, unless we agree any Third Party Claims
changes with you in writing. Nobody else
can change your terms of membership of 1) Please note Expenses which you are entitled
the scheme on our behalf or decide not to to recover from a third party, are excluded
enforce any of our rights. from benefit, but please note the following.
(e) If we do not use our legal rights it does not 2) Legal Action Proceedings Where a claim is
mean we have given them up. We may use submitted to laya healthcare in respect of
them in the future. treatment required as a result of an injury
caused through the fault of another person,
(f) If you write to us about anything, you known as a third party, and where you
must send it by pre-paid post or deliver it propose to pursue a legal claim against that
personally to: laya healthcare, Eastgate party, laya healthcare will pay benefit in
Road, Eastgate Business Park, Little Island, accordance with these rules provided that
Co. Cork. you (or the subscriber if you are under 18
If we change this address, we will write to tell years):
you about the change in advance. (i) Complete in full the third party section
We will send any letters to the address you and sign the claim form, which includes
an undertaking to include all benefit paid
last told us about. You and we can assume
by laya healthcare relating to any claim
that the letter is received on the day after it
made against another party.
has been delivered, if delivered personally,
or three days after posting if it was sent by (ii) Submit a fully completed undertaking,
pre-paid post. which will be relied on by laya
healthcare once a copy of the
(g) You must write and tell us as soon as Authorisation Form is received from
possible if you have claimed benefits for the Personal Injuries Assessment Board
any treatment which you needed because (refer to rule 4), or from your solicitor, in
somebody else was at fault. the form prescribed by laya healthcare:
(h) You should write to tell us if you have any “In consideration of laya healthcare
other insurance cover for benefits that discharging the eligible hospital and
you have claimed from us. If you do have medical expenses of my/our client, I/
insurance cover with someone other than we hereby understand to include as part
laya healthcare, we will only pay our share of my/our client’s claim the monies so
of any benefits. paid by laya healthcare (details of which
will be supplied by laya healthcare)
(i) We will pay benefits in accordance with the and subject to any court order to the
rules for treatment which was due to the contrary to repay to laya healthcare, out
fault of someone else. of proceeds that come into our hands, all
such monies paid by laya healthcare.’’
However, if you claim benefits for treatment
which was due to the fault of someone else, (iii) Notify laya healthcare in writing prior to
you must take any steps we may reasonably the legal closure of the case.
ask you to take to recover the cost of the
(iv) Provide laya healthcare with full written
benefits we have paid from the person
details of any settlement.
whose fault it was. You must also claim
interest if you are entitled to interest. You 3) No Legal Action Proceedings If in the
must pay us the money (and any interest) future, you (or the subscriber if you are
that you recover from that person up to the under 18 years) choose to proceed with a
amount of the benefits we have paid for the third-party claim, or if your legal advisors
treatment. advise us that expenses are recoverable from
a third party, we will require you to:
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(i) Complete in full and sign the claim form 6) Unsuccessful/Withdrawn Claims If a
which includes an undertaking to include claim against a third party is not successful
all benefits paid by laya healthcare in or is withdrawn, laya healthcare will not
any claim which may subsequently be seek a refund of the benefit paid provided
made against a third party responsible for that you arrange for full written details of
causing the injury. the case to be supplied by you from your
solicitor outlining to the satisfaction of laya
(ii) Immediately notify laya healthcare in healthcare the reasons why the case was
writing of the outcome of any such claim unsuccessful or was discontinued.
and to repay the benefit paid by laya
healthcare in full, subject to any court 7) Disclosure It is the responsibility of a
order to the contrary. member to disclose to laya healthcare full
details of any action to be taken against
4) Injuries Board Where you submit a claim a third party in relation to any incident/
to the Injuries Board, laya healthcare accident in respect of which laya healthcare
will pay benefit in accordance with these has paid full benefit. Failure to do so will
rules provided that you (or the subscriber result in the refusal of any subsequent claims
if you are under 18 years) complete in full relating to the accident/incident.
and sign the accident section of the claim
form. This undertaking provided by you
also authorises laya healthcare to provide 12. Data Protection
Injuries Board with details of all monies paid
by laya healthcare relating to your claim,
Statement
and for you to provide laya healthcare Laya Healthcare Limited and Elips Insurance
details of Injuries Board’s assessment. Where Limited act as joint data controllers in relation to
Injuries Board decides that the case is more information held about you for the purposes of
appropriately dealt with by the courts, due the Data Protection Acts. You should show this
to some legal dispute, and issues a letter of notice to anyone who may be covered by your
authorisation, laya healthcare will rely on the insurance policy with laya healthcare.
undertaking that has been provided by your
solicitor, in accordance with point (ii) above We will use the information you provide to
under Legal Action Proceedings, and a copy manage and administer your insurance policy,
of the authorisation from Injuries Board to including underwriting and claims handling and
proceed to the courts. for money laundering prevention purposes. In
order to provide you with products and services,
5) Criminal Injuries Compensation Tribunal
Claims If you are pursuing a claim through this information will be held in the data systems of
the Criminal Injuries Compensation laya healthcare and Elips Insurance Limited or by
Tribunal, laya healthcare will pay benefit our agents or subcontractors.
in accordance with these rules provided In addition to the routine administration of your
that you (or the subscriber if you are under policy we may also use your data to:
18 years) complete in full and sign the
accident section of the laya healthcare claim • invite you to events we are sponsoring
form and provide laya healthcare with a • invite you to various events we run exclusively
copy of the written confirmation from the for our members
Criminal Injuries Compensation Tribunal. The
undertaking provided by you also authorises • gauge satisfaction with the service you
laya healthcare to seek details of any received from us. We may use your data in
settlement directly from the Criminal Injuries such a manner for a period of 18 months after
Compensation Tribunal and for the Criminal your membership ends
Injuries Compensation Tribunal to release this • perform Market research. We may use your
information to us. In circumstances where data in such a manner for a period of 18
such a case is unsuccessful, laya healthcare months after your membership ends
will not seek a refund of the benefit paid. Information may also be shared with other
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insurers, either directly or through people acting We may use the information about you that
for the insurer such as Investigators, where we we hold (both personal and sensitive personal
are entitled to do so under the Data Protection information) for the following purposes:
Acts. We may share your personal information
with hospitals and/or consultants to aid the
• for managing and administering your insurance
policy
efficient processing of claims. We may pass
contact details of female members aged between • for underwriting and claims handling
50 and 64 years of age to the National Breast • for money laundering prevention purposes
Screening Programme. If you would prefer us not • to analyse and examine the claims processes
to do so please let us know. We may contact you and treatment/over-night stay/convalescence
with a reminder that your insurance is due to be options applied/utilised by medical service
renewed. In the interest of customer service, calls providers
are recorded and monitored. • to audit medical service providers generally
We take our security responsibilities seriously, • to examine the handling of claims by a medical
employing the most appropriate physical and service provider.
technical measures, including staff training and It may be necessary for us to collect sensitive
awareness. We review our security measures and information (such as medical conditions) about
procedures regularly. you and others named on the insurance policy.
It may be necessary for us to collect sensitive By going ahead with this insurance you will be
information (such as medical conditions) about agreeing to us or our agents or other insurers
you and others named on the insurance policy. processing that information. Before you provide
sensitive information about others, you should
We collect information about you, to include all make sure they have given their express consent.
necessary information as laya healthcare or
its authorised agents may obtain (or seek from Medical information will be kept confidential and
your physician or a hospital) in connection with may be disclosed, on a strictly confidential basis,
any treatment or other services provided to you to those involved with your treatment or care
or your dependant(s). This may include (with or their health professional agents. However,
respect to any claims under this Policy) copies of anonymised data - that is, information which does
hospital/medical records, by which we mean the not identify an individual - may be used by laya
following in particular: healthcare, or disclosed to others, for research
or statistical purposes.
• records of physical or mental illness or ill-
health; Access to non-medical information may be
granted by laya healthcare to others on a
• medical histories;
strictly confidential basis in the course of and
• records of treatments obtained by you; for the purpose of the efficient administration
• length of any stay in a hospital ; of laya healthcare (for example, in connection
• other treatments or services received by you with audit, systems development, managing or
or your dependant(s); and improving our services).
In general will also include other relevant and It is our policy to only take instructions to change
pertinent information which we require to a policy from the main member or from company
administer your policy and/or manage, assess or secretaries where the company is administering
administer any claims thereunder from time to or contributing to the cost of the scheme. In
time. some cases we may also deal with other people
who call on your behalf with your consent.
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LAYA-MSmart-Rules-005-0315-v2.indd 12 12/03/2015 14:2713
Laya healthcare, would like to keep you
informed about products and services they 12. Tax relief
provide. If you would prefer not to receive this Under current Irish tax legislation you are
information please contact us. You will be given entitled to income tax relief in respect of your
an opportunity to opt-out of receiving such subscription. Relief is given by us at source which
messages and information on each occasion means all our subscriptions are shown net of the
we contact you by post, e-mail and sms text applicable rate of income tax.
message.
Your information may also be used for these
purposes for a period of 1 year after your policy
has lapsed. Thereafter we will only contact you if 14. Making a complaint
you expressly request us to do so.
We aim to provide a first class service to our
You have the right to request a copy of the members at all times. However, if you are in any
information we hold about you by writing to way dissatisfied, please phone or write to: The
our Information Protection Manager, at laya Head of Customer Service,
healthcare, Eastgate Road, Eastgate Business laya healthcare, Eastgate Road, Eastgate
Park, Little Island, Co Cork. Please review your Business Park, Little Island, Co. Cork.
information and contact us if you wish to make Phone: 1890 700 890
changes.
If you remain dissatisfied you may appeal to the
Managing Director by writing to him at the same
address.
If you are not satisfied with our decision or if we
haven’t given you a decision after 40 business
days, you have the right to refer your complaint
to the Insurance Ombudsman at: The Financial
Services Ombudsman Bureau, 3rd Floor, Lincoln
House, Lincoln Place, Dublin 2.Phone: 1890
882090.
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LAYA-MSmart-Rules-005-0315-v2.indd 13 12/03/2015 14:2714
Individual benefits
Money Smart 20 Money Smart 30 Money Smart 40
Money Smart Benefits
Individual Individual Individual
Up to €20 for up to 6 visits Up to €30 for up to 6 Up to €40 for up to 6 visits
Routine Dental & Optical Cover
combined per year visits combined per year combined per year
Up to €20 for up to 6 visits Up to €30 for up to 6 Up to €40 for up to 6
GP & A&E
combined per year visits combined per year visits combined per year
Day to Day Therapies including
Physiotherapy, reflexology, Up to €20 for up to 6 visits Up to €30 for up to 6 Up to €40 for up to 6 visits
acupuncture, osteopathy, combined per year visits combined per year combined per year
physical therapist, chiropractor
Up to €10 for up to 2 Up to €10 for up to 3 Up to €10 for up to 4
Prescriptions
prescriptions per year prescriptions per year prescriptions per year
Up to €20 per day for Up to €30 per day for Up to €40 per day for
Hospital day-case or Hospital day-case or Hospital day-case or
Hospital day-case/In-patient
in-patient stay up to a in-patient stay up to a in-patient stay up to a
Cash Back
maximum of 40 days per maximum of 40 days per maximum of 40 days per
year year year
Up to €200 per birth/ Up to €300 per birth/ Up to €400 per birth/
Maternity/Adoption Cash Back
adoption per year adoption per year adoption per year
Up to €20 for up to 6 visits Up to €30 for up to 6 Up to €40 for up to 6
Consultant Fee
per year visits per year visits per year
Up to €20 for up to 6 scans Up to €30 for up to 6 Up to €40 for up to 6 scans
Scan Cover
per year scans per year per year
GPLine Full cover Full cover Full cover
Nurse Line Full cover Full cover Full cover
HeartBeat screening Full cover - every 2 years Full cover - every 2 years Full cover - every 2 years
Family benefits
Money Smart 20 Money Smart 30 Money Smart 40
Money Smart Benefits
Family Family Family
Up to €20 for up to 10 visits Up to €30 for up to 10 Up to €40 for up to 10
Routine Dental & Optical Cover
combined per year visits combined per year visits combined per year
Up to €20 for up to 10 Up to €30 for up to 10 Up to €40 for up to 10
GP & A&E
visits combined per year visits combined per year visits combined per year
Day to Day Therapies including
Physiotherapy, reflexology, Up to €20 for up to 10 visits Up to €30 for up to 10 Up to €40 for up to 10
acupuncutre, osteopathy,physical combined per year visits combined per year visits combined per year
therapist, chiropractor
Up to €10 for up to 4 Up to €10 for up to 6 Up to €10 for up to 8
Prescriptions
prescriptions per year prescriptions per year prescriptions per year
Up to €20 per day for Up to €30 per day for Up to €40 per day for
Hospital day-case or Hospital day-case or Hospital day-case or
Hospital day-case/In-patient
in-patient stay up to a in-patient stay up to a in-patient stay up to a
Cash Back
maximum of 40 days per maximum of 40 days per maximum of 40 days per
year year year
Up to €200 per birth/ Up to €300 per birth/ Up to €400 per birth/
Maternity/Adoption Cash Back
adoption per year adoption per year adoption per year
Up to €20 for up to 10 Up to €30 for up to 10 Up to €40 for up to 10
Consultant Fee
visits visits visits
Up to €20 for up to 10 Up to €30 for up to 10 Up to €40 for up to 10
Scan Cover
scans per year scans per year scans per year
GPLine Full cover Full cover Full cover
Nurse Line Full cover Full cover Full cover
HeartBeat screening Full cover - every 2 years Full cover - every 2 years Full cover - every 2 years
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LAYA-MSmart-Rules-005-0315-v2.indd 14 12/03/2015 14:2715
Health Insurer only the unpaid portion of the cost
Your benefits at a glance of the scan is eligible for benefit. This grant is not
Routine Dental & Optical cover paid on a direct payment basis.
As a laya healthcare member you may claim GP & A&E
money back on your dental and optical receipts Laya healthcare will give you money back on
each year. visits to your GP and hospital accident and
Your dental benefit covers visits to the Dentist emergency department. Your total number of
for routine dental treatments such as general visits is your GP, and hospital accident and
check-up, scale or polish, routine filling or emergency visits combined.
extraction(excluding wisdom teeth). Your optical
cover can be used for visits to an Optician for Day to Day Therapies
sight test, fitting fees, prescribed glasses or With laya healthcare you can claim money
contact lenses. back on your visits to participating therapists.
Participating therapists include; physiotherapist,
Prescriptions reflexologist, acupuncturist, osteopath, physical
Laya healthcare will contribute towards the cost therapist, chiropractor. This benefit does not
of prescriptions. Please note we will only pay include the cost of any medication or any
benefit for prescriptions up to the limit as set out surgical appliances supplied or prescribed by the
under the drug payment scheme. participating therapists.
Maternity/Adoption cash back Hospital Day-case/In-patient
Cash Back
This benefit is paid once per birth regardless
of whether the member has one baby, twins or This is the benefit that laya healthcare will pay
triplets etc. This benefit is also applicable in the for each stay you or your dependants have had
adoption of a child/children. In order to pay in hospital for in-patient or day-case treatment.
this benefit we require copy of the baby’s birth This benefit does not include any direct costs,
certificate or hospital claim form before payment for example consultant fees, room charges,
is made. In the case of adoption we require a medication/dressings involved with the hospital
copy of the adoption certificate. This Money stay.
Smart benefit does not pay any costs associated
with your maternity directly to providers for Consultant Fees
example, consultant fees, room charges, Laya healthcare members can claim money back
medication/dressings involved with the hospital on nonmaternity consultant visits. Claims must be
admission. for consultations in a hospital or clinic as an out-
Scan Cover patient only and carried out by a Consultant.
This is the amount that laya healthcare will GPLine
contribute towards costs incurred by you in Members on the Money Smart schemes have
receiving an MRI, CT, X-ray and Ultrasound access to our free and confidential GP telephone
carried out in an approved laya healthcare consultation service. This service provides advice
centre. Please refer to the table of benefits for and, where appropriate, diagnosis about your
your chosen scheme for details of this benefit. health concern. The GPLine number is
You are not eligible for this benefit if you have 1890 907 648.
been reimbursed by your Health Insurer for the
full cost of the scan or had the full cost paid by
your Health Insurer directly to Medical Service
Provider who has provided the scan. If the cost
of the scan has been partially covered by your
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LAYA-MSmart-Rules-005-0315-v2.indd 15 12/03/2015 14:2716
Nurseline
Laya Healthcare members can avail of a 24 hour
confidential Nurseline on all schemes, offering
advice and assurance to members day or night.
Contact 1850 923 500.
HeartBeat screening
‘HeartBeat’ screens for the detection of
underlying conditions that may lead to or cause
Sudden Adult Death Syndrome. This benefit is
available once every 2 years.
Note
(i) Please refer to our website
www.layahealthcare.ie/formembers/
hospitalnearyou for our list of participating
hospitals and scan centres.
(ii) In the event of claims on the above benefits
being partially covered by your Health
Insurer, only the unpaid portion of these
costs may be submitted for benefit subject
to the terms & conditions of your private
health insurance scheme.
(iii) The amount you can claim per year for each
benefit for your chosen scheme is detailed
on the table of benefits on page 13.
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LAYA-MSmart-Rules-005-0315-v2.indd 16 12/03/2015 14:27Hospital, Clinics & Treatment Centre list for
Money Smart members
Private Hospitals Private Clinics
CLARE CORK
Cahercalla, Ennis Cork Clinic (Western Road)
CORK DUBLIN
Bon Secours Cork Hampstead Clinic
Mater Private Cork Highfield Private Hospital
DUBLIN National MS Centre
Beacon Hospital Park West Clinic
Blackrock Clinic Eccles Street Clinic
Bon Secours Glasnevin UPMC Beacon Cancer Centre
Hermitage Medical Clinic WATERFORD
Mater Private UPMC Whitfield Cancer Centre
Sports Surgery Clinic LIMERICK
St. John of God’s Hospital Stillorgan Mid Western Radiation Oncology
St. Patrick’s Hospital
St. Edmundsbury Hospital
St. Vincent’s Private Hospital
Treatment Centres
GALWAY
CLARE
Bon Secours Galway
BushyPark Treatment Centre
Galway Clinic
CORK
KERRY
Cuan Mhuire Farnanes
Bon Secours Tralee
Tabor Lodge
KILDARE
DONEGAL
Clane General Hospital
White Oaks Treatment Centre
KILKENNY
DUBLIN
Auteven Hospital
Rutland Centre
SLIGO
GALWAY
St. Joseph’s Garden Hill
Cuan Mhuire Coolarne
WATERFORD
KERRY
Whitfield Clinic
Talbot Grove Centre
WEST MEATH
KILDARE
St. Francis Mullingar
Cuan Mhuire Athy
Private Hospitals Northern Ireland
KILKENNY
DERRY
Aislinn Treatment Centre
NorthWest Independent
LIMERICK
BELFAST
Cuan Mhuire Bruree
Ulster Independent
MAYO
Hope House
TIPPERARY
Aiseiri Centre, Cahir
WEXFORD
Aiseiri Centre, Roxborough
LAYA-MSmart-Rules-005-0315-v2.indd 17 12/03/2015 14:27WEBSITE
V-CARD
Eastgate Road, Tel 1890 700 890
Eastgate Business Park, 021 202 2000
Little Island, Co Cork. E-mail info@layahealthcare.ie
Website www.layahealthcare.ie
At laya healthcare, we For information on your
take particular pride in consumer rights, please
the quality and value of contact the Health Insurance
our schemes. Nowhere Authority at 01 406 0080
is this more important or visit www.hia.ie
than in the benefits we
have developed for our
members.
In the interest of customer service, calls are recorded and
monitored.
Your insurance is provided by Elips Insurance Limited trading
as Laya Healthcare. Laya Healthcare Limited trading as Laya
Healthcare is regulated by the Central Bank of Ireland.
LAYA-MSmart-Rules-005-03/15
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