4D Health 2

Table of Cover effective from August 1st 2017

This table of cover must be read in conjunction with your member certificate and Tailored Health Plans
membership handbook effective from August 2017. The hospitals and treatment centres covered on this
plan are set out in List A in Part 12 of your Tailored Health Plans membership handbook.
IN PATIENT BENEFITS
Hospital cover
Consultants fees Covered
Inpatient scans Covered
Public Hospital
Semi-private room Covered
Private room Covered
Day case Covered
Private Hospital
Semi-private room Covered subject to €150 excess per claim subject to
€2,000 co-payment on certain orthopaedic
procedures1
Private room Semi-Private Rate subject to €150 excess per claim
subject to €2,000 co-payment on certain orthopaedic
procedures1
Day case Covered subject to €75 excess per claim
High-tech Hospital
Semi-private room Covered (Beacon only) subject to €150 excess per
claim. 50% Cover in Blackrock and Mater
Private room Semi-Private Rate (Beacon only) subject to €150
excess per claim. 50% of Semi-Private Rate in
Blackrock and Mater
Day case Covered subject to €75 excess per claim
Listed cardiac procedures1 Covered subject to €150 excess per claim
Listed special procedures1 Covered subject to €150 excess per claim subject to
€2,000 co-payment on certain orthopaedic
procedures1
Maternity
Public hospital cover for maternity 3 nights accommodation
Inpatient maternity consultant fees As per schedule of benefits for professional fees 2
Out-patient maternity consultant fees €400
Home birth Covered up to €4,000
Newborn free till next renewal Yes
A&E abroad
Hospital bill for inpatient treatment Covered up to €100,000
Repatriation expenses Covered up to €1 million
Expenses for companion who remains with you Covered up to €1,000
Companion repatriation expenses Covered up to €1,000
24 hour telephone assistance Yes
Elective overseas referral
Benefit abroad for surgical procedures that are not Yes – up to the amount for the most similar surgical
available in Ireland procedure to treat the same condition in Ireland
Benefit abroad for surgical procedures that are
Yes - subject to level of cover available in Ireland
available in Ireland
International Second Opinion Service Covered – refer to your Membership Handbook
Psychiatric treatment
Not related to substance abuse 100 days
Related to substance abuse 91 days per 5 years

Other inpatient benefits

Oncotype DX Covered
Health in the Home Covered (Immediately following an inpatient stay)
Post-Operative Recovery Benefit €120 cash benefit
Convalescence benefits €50 x 15 days
€100 x 14 days (following inpatient stay of minimum
Child home nursing care
5 days)
Parent accompanying child €40 x 14 days (not payable for the first 3 days)
Point of Care: Day case procedure for
Covered
Rheumatology & Chemotherapy
Cancer Support Benefit (for accommodation Up to €100 per day for up to a maximum of €1500
expenses when travelling more than 50km) per calendar year
Medicall ambulance costs Covered (refer to Membership Handbook)
Stress management line 365 days stress line
Employee assistance program 6 face to face follow up counselling sessions

OUT PATIENT BENEFITS – not subject to excess

Nurse-on-call Yes
Unlimited. See irishlifehealth.ie for further
Digital Doctor
information.
Nutrition Recovery Benefit €50 contribution
Health screening & allergy testing Up to €200 per policy year
Out-patient scan cover (in approved centres)
PET-CT Covered
MRI Covered
CT Covered

OUT PATIENT BENEFITS – subject to excess

Individual excess €1
Maximum amount of outpatient benefits per
€4,000
member per policy year
Consultant fees 50% per visit, unlimited
Public A & E cover 50% up to €50 per visit
Psycho-oncology counseling 50% up to €25 x 8 visits

Manual lymph drainage 50% up to €25 x 5 visits

Home nursing €40 x 20 days
Emergency dental care Up to €250
 As per specified list3 (subject to €200 per person
Medical and surgical appliances
excess)
Pathology-cost of test 50% Covered
50% As per schedule of benefits for professional
Pathology consultant fees
fees2
Radiology - cost of test 50% Covered
50% As per schedule of benefits for professional
Radiology consultant fees
fees2

DAY TO DAY BENEFITS

Individual Day-to-day excess €1
Day to day Practitioners
GP visits 50% of each visit
Dentist Visits 50% up to €150 per policy year

Physiotherapy visits €30 x 7 visits

Alternative Practitioners

Acupuncturist 50% x 7 combined visits

Chiropractor 50% x 7 combined visits

Homeopath 50% x 7 combined visits

Massage therapist 50% x 7 combined visits

Osteopath 50% x 7 combined visits

Reflexologist 50% x 7 combined visits

Reiki practitioner 50% x 7 combined visits

Other day to day benefits

Chiropodist 50% x 7 combined visits
Clinical Psychologist €25 x 10 visits
Dietician 50% x 7 combined visits
Hearing test Up to €25 x 1
Nutritionist 50% x 7 combined visits
Occupational therapist 50% x 7 combined visits
Optical (eye test and/or glasses/lenses combined) 50% up to €75 per policy year
Orthoptist 50% x 7 combined visits
Physical therapist 50% x 7 combined visits
Podiatrist 50% x 7 combined visits
Prescriptions €15 x 3 prescriptions
Speech therapist 50% x 7 combined visits

Personalised Packages
Choice of 2 Personalised Packages from range of 6
 MEMBER BENEFITS
Allen Carr Smoking Cessation Back Up

Laser Eye Surgery Smiles Dental Access Package

For full details on the above member benefits please visit the ‘Member Benefits’ section
on www.irishlifehealth.ie

Footnotes
(1) All procedure lists are available on www.irishlifehealth.ie or available on request by calling Irish Life
Health on 1890 717 717.
(2) The schedule of benefits is available on www.irishlifehealth.ie or available on request by calling Irish
Life Health on 1890 717 717.
(3) The medical and surgical appliances list is available on www.irishlifehealth.ie or available on
request by calling Irish Life Health on 1890 717 717.