Vol. 536 No. 4
152 Mr. Hayes asked the Minister for Health and Children the reason the VHI do not cover MRI scans in the established rule book of their organisation; if this matter has been brought to his attention; the discussion he has had with the VHI in connection with this matter; the way in which it is possible that the MRI scans could be excluded from the clinical category as set out in the rule book; and if he will make a statement on the matter. [14420/01]
I have had inquiries made of VHI concerning the matters raised by the Deputy. The VHI has confirmed that it provides cover for MRI scans. The VHI advised that because MRI scans are a very advanced technology with high costs and specific uses for which it is proven, it has set out specific rules and conditions for which benefit is payable. The benefits are outlined in rule 6K of the VHI's member handbook guide to plans and rules which states:
We will pay the benefits set out in the table of benefits for an MRI scan subject to the following: (i) the member is referred for an MRI scan by a consultant; (ii) the MRI scan is carried out in an MRI centre listed in the directory of hospitals; (iii) the MRI scan is to investigate or rule out certain medical conditions. A list of the approved clinical indications for which benefit is payable appears at the back of the Member Handbook.
The VHI has also advised that the list of clinical indications has evolved over the years and is reviewed on an ongoing basis. This process has resulted in the inclusion of a significant number of additional indications for which the use of MRI scanning has been proven as being clinically effective and also cost effective when compared with competing technologies.
Coverage of benefits under health insurance contracts is subject to the provisions of the health insurance regulatory framework. These provisions include prescribed minimum levels of cover to which insured persons are entitled under health insurance contracts as specified in the Health Insurance Act, 1994 (Minimum Benefit) Regulations, 1996, including the minimum coverage which must be provided in respect of MRI scans. Under the regulations insurers are allowed to apply excesses in the case of out-patient services, including MRI scans.
The VHI complies with the provisions of the regulatory framework as regards coverage for MRI scans. It is a matter for all insurers to determine what benefits they are in a position to provide over and above those required under minimum benefit arrangements.
