Written Answers. - Voluntary Health Insurance Scheme.

Pádraic McCormack

Question:

310 Mr. McCormack asked the Minister for Health and Children his Department's policy regarding Voluntary Health Insurance cover for patients in private nursing home care; if his attention has been drawn to the fact that the VHI only extends convalescent cover to the patients in new nursing homes every three years; his views on whether this discriminates against new nursing homes which will not be considered for cover again until the next review in 2005; and if he will make a statement on the matter. [10879/03]

The position is that the Voluntary Health Insurance (Amendment) Act 1996 gives explicit powers to the VHI board in relation to entering into, or refusing to enter into, agreements with health service providers for the treatment and care of its members. Similarly, the regulatory framework covering health insurance business, the Health Insurance Acts and related regulations, provides for insurers to determine the service providers in respect of whom benefits are payable for the treatment and care of members under their plan.

The VHI, therefore, is entitled to determine its process for selecting which nursing homes it will cover for the purpose of providing convalescent care for members and it would not be appropriate for my Department to intervene. Private health insurance does not cover long-term nursing care. The VHI provides cover towards the cost of convalescent home charges for up to 14 days, as required by the private health insurance regulatory framework, in approved convalescent homes listed in VHI's directory of convalescent homes.

John Cregan

Question:

311 Mr. Cregan asked the Minister for Health and Children the position in relation to the rights of a person who is a client of the VHI and who has a dispute with the company; if there is a statutory or company appeal system; if the person has a right to speak to the manager making the decision; if there is a special independent adjudicator or ombudsman; and if he will make a statement on the matter. [10880/03]

A number of recourses are open to a person who is a client of the VHI. In the first instance, it is open to the person to contact VHI personnel by telephone or through written correspondence. In addition, VHI has an appeals procedure in place which is specified in the members' handbook provided to all subscribers.

The VHI takes part in the Insurance Ombudsman scheme. This means that if there is a dispute about whether the VHI should pay all or part of a claim or a person has any other problems, he or she can ask the Insurance Ombudsman to decide on the matter. The VHI must then accept the Insurance Ombudsman's decision. The VHI's member handbook specifies the name and contact details of the Insurance Ombudsman of Ireland, which are as follows: Ms. Caroline Gill, Insurance Ombudsman of Ireland, 32 Upper Merrion Street, Dublin 2. Tel.: (01) 6620899.
If a person is unhappy with a decision of the Insurance Ombudsman or wishes not to refer a dispute to the Ombudsman, VHI Healthcare may require the person to refer a dispute about the terms of his or her contract to an independent arbitrator. The VHI and the person must then accept their decision. The arbitrator may be any person agreed by the client and the VHI. Where the VHI and the person fail to agree, the VHI will ask the President of the Law Society of Ireland to choose an arbitrator. If the arbitrator refuses to act or cannot act for any reason, the President of the Law Society of Ireland will choose another arbitrator. If a dispute is referred to an arbitrator, the terms of the Arbitration Act will apply.