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How To Calculate Out-Patient Excess

How do I calculate my out-patient excess?

You must meet your out-patient excess before you can claim on your health insurance plan. The excess is calculated based on the value of the benefits listed in your table of benefits and not on the amount you have paid for your treatment. For example, if you visit a consultant and have a receipt for €150 and your table of benefits states that you are able to claim €60, this is the amount that is deducted from your out-patient excess when assessing your claim.

So if your annual out-patient excess is €150, and the benefit you can claim is €60 in this case, this €60 is deducted from your excess and not the total cost of the treatment which would be €150 in this case. (e.g. €150 - €60 = €90 excess remaining.) Therefore you still need to meet the remainder of your excess, €90 in this case, in order to be able to claim against this treatment.

Once you reach the excess value you will receive the value of benefit available for all eligible claims until your renewal date

Therefore in this example, you would need to visit the consultant three times in one year in order to receive any benefit back (€60 benefit you can claim x 3 = €180) €180 – €150 excess = €30 back.

Excess periods are calculated from renewal date to renewal date.

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