Laya Orthopaedic Cover Changes

As of April 1, 2026, Laya Healthcare has altered coverage for major orthopaedic procedures on approximately 30 plans, increasing costs for members. These changes involve significant shortfalls or excesses for procedures like hip and knee replacements in private/high-tech hospitals, with potential added costs of up to €6,000. 

Key Details of Laya Orthopaedic Cover Changes:

• Reduced Coverage: Several plans, including within the "Control" range, have introduced or adjusted to a 20% to 40% shortfall on specified orthopaedic and ophthalmic procedures in private and high-tech hospitals.
• Effective Date: These changes apply to new and renewing customers from April 1, 2026.
• Impact on Costs: Members may face a "shortfall" (a percentage of total costs) rather than just a fixed excess, significantly increasing out-of-pocket expenses for surgeries.
• Targeted Procedures: The restrictions specifically target major, high-cost orthopaedic surgeries (e.g., hip/knee replacements). 

What You Should Do:

Contact Dooley Insurances to discuss your queries with one of our professionally qualified Health Advisors.