New limits on nursing-home cover are to be introduced by the Voluntary Health Insurance. Proposals that benefits for convalescent care will in future be paid according to the member's VHI plan have been passed by the company board.
In future members will only be able to choose nursing homes for convalescent care according to which VHI plan they subscribe. Currently the company pays nursing homes charges for up to 14 days for patients who need convalescent care immediately after being in hospital.
The move is part of a review of this area by the VHI. A company spokeswoman said yesterday it was the first such review since the mid-1980s. In future, benefit paid by VHI will relate to the plan held by the subscriber. The purpose of the review was to standardise benefits and address the significant variations in daily rates charged by the homes "and to control costs to maintain premiums at an affordable rate for VHI's 1.44 million members".
The VHI is setting up a limited directory of approved convalescent/nursing homes "selected on basis of objective criteria". Asked what subscribers who have health care plans which do not match the nursing home in their area would do, she said the VHI had been meeting the Irish Registered Nursing Homes Association and had invited submissions from individual homes about setting up a system to select homes for approval.
More than 100 nursing homes are on the VHI approved list and the company hopes to add to this. A small number are already balance-billing patients. "There will be a list of homes where the charges will mirror the benefits." Another meeting has been scheduled between the association and the VHI later this month. The spokeswoman said the benefits will range from £35 a day for plan A and A option; £40 a day for plan B and B option; £45 a day for plan C and C option; £50 a day for plan D and plan D option and £55 a day for plan E and E option. She denied the company was attempting to discourage members or their doctors from using convalescent homes.
According to a report in yesterday's Irish Medical News, correspondence to some nursing homes from the VHI said the new benefits "may encourage members and their medical advisers to review the need for and cost of convalescent accommodation in their own individual cases in a way that they are not encouraged to do where full cover is automatically available at all approved homes".