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External violent and visible means leading to a bodily injury or harm.
A person who is either on the professional register of Acupuncture and Traditional Chinese Medicine or the Association of Irish Acupuncturists and/or is accredited to the British Acupuncture Foundation and/or the Academy of Chinese Culture and Medicine, or a person holding an equivalent recognised qualification outside Ireland.
What is covered under your policy as set out in this hand-book and the schedule of benefits for professional fees.
The internal use of chemical substances/agent to treat disease.
A member of the Chiropractic Association of Ireland, or a person holding an equivalent recognised qualification outside Ireland.
A registered medical practitioner who holds a current full registration with the Irish Medical Council and is engaged in hospital practice and who, by reason of his or her training, skill and experience in a designated speciality, is consulted by other registered medical practitioners and undertakes full clinical responsibility for patients in his or her care, or that aspect of care on which he or she has been consulted, without supervision in professional matters by any other person.
In the context of treatment abroad a consultant is defined as a surgeon, physician or anaesthetist who is under 70 years of age and legally qualified to provide the treatment in that country.
A nursing home registered pursuant to the Health (Nursing Homes) Act, 1990 which is approved by us and is named on our list of approved convalescence homes.
Treatment which is intended to improve the patient's appearance for psychological or personal reasons and which is not medically necessary.
A CT (computerised tomography) scanner is a special kind of X-ray machine. Instead of sending out a single X-ray through your body as with ordinary X-rays, several beams are sent simultaneously from different angles. The CT scanner was originally designed to take pictures of the brain. Now it is much more advanced and is used for taking pictures of virtually any part of the body.
In patient hospitals stay where you need to be medically admitted into hospital and which does not involve an overnight stay. This includes side room procedures.
Everyday health costs such as visits to GP's, Dentists, Physiotherapists, alternative practitioners and health screens. Cover is subject to the plan you have purchased.
A dental practitioner who holds a current full registration with the Irish Dental Council who is community based and provides dental care or a person holding an equivalent recognised qualification outside Ireland.
A member of the Irish Nutrition & Dietetic Institute or a person holding an equivalent recognised qualification outside Ireland.
Your husband, wife, co-habiting same or opposite sex partner and any child under the age of 18, or over the age of 18 who is in full time education and dependent on you (up to the age of 23) and who is named on your membership certificate as one of your dependants.
Test to confirm disease and type.
This is where your insurer has an agreement with a hospital or treatment centre to settle your costs directly for the level of cover you have taken out.
Doula is an experienced labour companion who provides emotional, educational, and physical support and assistance before, during, and after birth.
A mental or physical condition caused directly or indirectly by taking any drug substance or solvent unless a General Practitioner or consultant has prescribed it.
Treatment specified in the schedule of benefits for professional fees for a condition that is not excluded in this policy.
An unforeseen circumstance requiring medical or dental treatment.
Treatment that is in the opinion of our medical advisors established clinical practice, that is supported by publication in Irish or international peer reviewed journals and that is carried out in more than one hospital in Ireland.
The amount of money to be payable by the insured member towards any claim(s) made in the policy year.
This is a period of time during which you cannot make a claim, if you have a pre-existing condition, as determined on medical advice.
The Financial Regulator is responsible for the regulation of all financial services firms in Ireland. It also has an important role in the protection of the consumers of those firms. They help consumers to make informed decisions on their financial affairs in a safe and fair market
This is when your insurer has an agreement with a consultant so that their fees are settled directly and you do not have to pay and reclaim.
A person who is fully registered with the Irish Medical Council, who is qualified to practice as a primary medical care physician and who holds a primary medical qualification or a person holding an equivalent recognised qualification outside Ireland.
This is the contribution we will give you towards birth in a private hospital or home birth.
Any dangerous sporting activity including, but not limited to: mountaineering, rock climbing, motor sports including motor cycle sport, aviation other than as a fare paying passenger, ballooning, bungee jumping, hang gliding, microlighting, parachuting, paragliding or parascending, potholing or caving, power boat racing, white water rafting, competitive yachting or sailing; bobsleighing, competitive canoeing or kayaking, judo or martial arts, scuba diving or extreme sports such as free diving, base jumping, shin racing and ice climbing.
The Health Insurance Authority is the regulatory body for private health insurance in Ireland. The Authority's job is to monitor and research health insurance generally; operate the risk equalisation scheme; advise the Minister on health insurance and monitor the operation of other relevant regulations and safeguard the interests of current and future health insurance consumers.
Means a health insurance contract to which the Heath Insurance Acts 1994 to 2003, and any regulations thereunder, apply.
Hospitals that are equipped with the latest high tech equipment.
Home birth is childbirth which occurs outside a hospital or birthing centre, usually in the home of the mother. Most home births are assisted by midwives, but some home births are physician assisted.
A person who is on the professional register of the Irish Society of Homeopaths or the Irish Medical Homeopathic Society or a person holding an equivalent recognised qualification outside Ireland.
Charges for (i) hospital accommodation, (ii) services provided by a private hospital or clinic (such as hospital technical charges for the use of the operating theatre, radiology and pathology and public hospital statutory levies.)
An episode of treatment requiring overnight accommoda¬tion in a private or semi-private room in a hospital.
Ireland excluding Northern Ireland.
These are the lists relating to the cover that is provided to the limits specified under your plan for specific treatment or procedures:
- List of general procedures
- List of special procedures
- List of cardiac procedures
- List of post operative home help (POHH) procedures
- List of clinical indicators for MRI Scans - Consultant List
- List of clinical indicators for MRI scans - G.P. list
- List of clinical indicators for PET & PET CT scans
- List of clinical indicators for Manual Lymph Drainage
A member of the Irish Massage Therapists Association or a person holding an equivalent recognized qualification outside Ireland.
Any information given verbally or in writing on the application form or claim form about any member that may have affected the terms by which we issue this policy, in particular any reference to a previous health insurer cover.
Our medical advisors are fully qualified and registered medical consultants, registered with the Medical Council who provide medical advice to us.
Treatment or a hospital stay, which in the opinion of our medical advisors is generally accepted as appropriate with regard to good standards of medical practice and is:
- consistent with the symptoms or diagnosis or treatment.
- necessary for such a diagnostic or treatment.
- not provided primarily for the convenience of the patient, the doctor or other provider or at the request of the patient and
- furnished at the most appropriate level, which can be safely and effectively provided to the patient.
A person named under a VIVAS Health Insurance contract.
A person who is a fully qualified member of Doula Ireland.
A person who is a full member (not associate) qualified to treat people with lymphoedema. Members have qualified from one of the schools recognized by the British Lymphology Society. Vodder (part 3). LeDuc, Foldi, Casley-Smith, Asdonk or a person holding an equivalent recognized qualification outside Ireland.
The number assigned by us to a member. Each person named on the policy has a separate membership number, as set out in the membership certificate.
The Health Insurance Act, 1994 S.I 83/1996 (Minimum Benefit Regulations, 1996 made pursuant to the Health Insurance Acts, 1994 to 2003 or as amended from time to time.
Magnetic resonance imaging (MRI) uses a strong magnetic field and radio waves to produce detailed pictures of the inside of your body.
MRI scans can show muscles, joints, bone marrow, blood vessels, nerves and other structures within your body. The image from the scan are usually two-dimensional, but in some cases several different scans can be taken to build up a three-dimensional image that can be displayed on a computer screen.
MRI scans are used to examine the spine, brain, pelvis and abdomen.
This is when there is a test conducted involving no breakage of the skin i.e. and X-ray.
A hospital which does not have an agreement with your insurer regarding the services it will provide to members.
A nurse who is registered with An Bord Altranais for midwifery, health visiting and/or nursing.
A member of the Association of Occupational Therapists of Ireland or a person holding an equivalent recognised qualification outside Ireland.
A member of the Irish Osteopathic Association or the Association of Osteopaths of Ireland or a person holding an equivalent qualification outside Ireland.
A hospital visit for a diagnostic service or test, not requiring accommodation as an in patient or day case.
Cover for treatments carried out abroad. Cover is subject to the policy you have purchased.
A hospital which has an agreement with your insurer regarding the fees to be charged for services provided to it’s members.
Positron Emission Tomography, or PET, scan is an imaging technique that uses positively charged particles (radioactive positrons) to detect subtle changes in the body's metabolism and chemical activities. A PET scan provides a colour-coded image of the body's function, rather than its structure. A PET scan may be used to evaluate people with the following illnesses:
- Cancer
- Brain Disease
- Cardiac Illness
A hospital which has an agreement with your insurer regarding the fees to be charged or services provided to it’s members.
A member of the Institute of Physical Therapy and Applied Science or a person holding an equivalent qualification outside Ireland.
A chartered physiotherapist who is a member of the Irish Society of Chartered Physiotherapists or a member of the Chartered Society of Physiotherapists or a person holding an equivalent recognised qualification outside Ireland.
Your chosen Insurance Policy
A member of the Society for Chiropodists/Podiatrists, Society of Chiropodists and Podiatrists in Ireland, Institute of Chiropodists and Podiatrists in Ireland, Irish branch of the British Chiropody and Podiatry Association or the Irish Chiropodists/ Podiatrists Organisation Ltd, or a person holding an equivalent recognised qualification outside Ireland.
The health insurance contract between you and us compromising of the following documents:
- Your membership handbook including lists
- Your completed application form
- Your membership certificate
- The schedule of benefits for professional fees
The person who affected the policy as shown on the membership certificate.
The period of insurance cover under this policy as shown on your membership certificate.
Concerned with, or happening, in the period after birth.
This is your personal service number, a tax number issued by the Revenue Commissioners. This number will appear on your pay slip and any other tax documents you may receive.
Any disease, illness or injury that began before the person with the disease, illness or injury started his/her membership under any health insurance contract.
Drugs and medicine can only be claimed where supplied on the prescription of a General Practitioner, Consultant, Dentist or Prescribing Nurse.
Medical treatment that is used to identify whether you are likely to suffer from an illness, injury or disease in the future but in a situation where no clinical symptoms are present.
A hospital listed as a private hospital within the list of public and private hospitals. Level 1 excludes Blackrock Clinic, Mater Private Hospital and Galway Clinic. Levels 2-5 exclude Blackrock Clinic and Mater Private Hospitals.
A room in a private hospital which contains only one bed, or a room in a public hospital which contains only one bed which, under S.I 135/1991 Health Services (In-Patients) Regulations,1991, is designated as a private bed.
A medical process or course of action. We will cover the procedures that are listed in our schedule of benefits for professional fees and that are included in the terms of your plan.
A member of the Irish Association for Counselling & Psychotherapy, a member of the Psychological Society of Ireland or a person holding an equivalent recognised qualification outside Ireland.
A publicly funded hospital other than a nursing home which provides services to a person pursuant to his or her entitlements under Chapter 11 of Part I V of the Irish Health Act 1970 and listed as a public hospital within our list of private and public hospitals.
A member of the National Register of Reflexologists (Ireland), Irish Reflexologists' Institute or a person holding an equivalent recognised qualification outside Ireland.
A person who does not reside outside Ireland for a period of six months or more.
The renewal date shown on your most recent membership certificate.
A room in a private hospital which contains not more than five beds, or a room in a public hospital which contains not more than five beds which, under S.I 135/1991 Health Services (In-Patient) Regulations, 1991, are designated as private beds.
The schedule which details the amount we shall pay a consultant in relation to treatments provided to you. The schedule also specifies the amount we shall pay your G.P for any surgical out patient treatments he or she may carry out. The schedule includes the rates which we shall pay both participating and non-participating consultants and GP's.
Treatment or investigation which is marked as day case in the schedule of benefits for professional fees.
Out patient treatment consisting of a surgical procedure listed at the time of treatment in the schedule of benefits for professional fees.
The treatment of disease, injury or deformity by physical, manual or instrumental intervention.
The transfer of tissue or organ(s) from its original position to a new position(s) necessary to treat irreversible end stage failure of the relevant tissue or organ(s) including heart, combined heart and lung, kung (single an bilateral), simultaneous pancreas and kidney, liver, small bowel, kidney, simultaneous small bowel and liver, bone marrow or stem cells.
A stay outside of Ireland for any period up to but not exceeding 180 days per calendar year.
Any health service a person needs solely for the medical investigation, cure, or alleviation of the symptoms of illness or injury for which benefits are payable.
The period of time during which you cannot claim. Waiting periods are in place to prevent people from finding out they have something and rush out to buy insurance and availing straight away of such benefits. The waiting periods depend on age, illness history and again can differ for maternity benefit. A full table of waiting periods can be found here
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