Understanding insurance plans

If you are choosing or switching an insurance plan, we offer some information which you might find helpful.

At St Patrick’s Mental Health Services (SPMHS), we understand that there are lots of factors to bear in mind when you are considering a health insurance plan, switching providers or changing your cover.

To help you with your decision, below, we gather some helpful tips and a list of useful questions to ask about how the insurance company covers mental healthcare.

You might also find it helpful to visit the Health Insurance Authority (HIA) website for information and guidance. Other helpful sources of information include the Citizens Information service and the Department of Health

Choosing an insurance plan

Choosing an insurance plan

The set of laws behind voluntary health insurance is called Minimum Benefit Legislation. It is useful to know that mental healthcare is specifically provided for in these laws.

Minimum Benefit Legislation states that every health policy must provide a minimum level of cover for hospital services. For general mental healthcare or general psychiatric cover, the minimum benefit amounts to 100 days of care in any given calendar year. 

Some insurers provide extra cover of up to 180 days; this depends on the insurance plan you choose. Insurance cover is also provided for alcohol and substance abuse treatment; this is restricted to 91 days in any five-year period.

Before settling on a plan, be sure to ask for full details of the benefits. For example, not all policies include cover for every hospital. You can check that SPMHS is covered with your insurer when taking out a policy for the first time or switching insurance companies or plans. 

It is also important to know that a health insurer cannot refuse to sell you insurance, even if you have an existing medical or mental health condition. However, there may be a waiting period from when you begin the plan to when you can claim benefits under it. 

Understanding your plan

Understanding your plan

You might find it helpful to ask the questions below of your insurer to be confident that they will provide the cover you would like or need. 

  1. What are the benefits for mental healthcare provided by this policy?
  2. Are these benefits the minimum you are obliged to provide, or do you provide extra mental healthcare benefits?
  3. How do I distinguish between different mental healthcare providers? Is there a quality standard?
  4. Do you cover or provide benefits for day care and/or care in the community (for example, in the Dean Clinics)? If so, what are these benefits? Will I be required to pay a shortfall for day care or treatment in the Dean Clinics and, if so, how much?
  5. Do you provide cover for adolescents in the Willow Grove Adolescent Unit in SPMHS?
  6. Can I decide how I use benefits under this plan, using guidance from my care team on my mental healthcare needs? For example, can I use these benefits for inpatient and/or day care?
  7. Are any terms of the policy dependent on age for the people named on it?
  8. What are the limits, if any, to my cover in any given calendar year?
  9. Is there a waiting or exclusion period before I can claim mental healthcare benefits if I join or switch my policy? 

If you have additional questions that you would like to ask before contacting an insurer, please call our Finance Department on 01 249 3533. Our team will be happy to help you.

Support and Information

Take your first step by making a call: speak to a mental health professional today.

01 249 3333 info@stpatsmail.com

Referral and Assessment Service

Contact us for queries regarding referrals to our service.

01 249 3635 Referrals & Admissions