Private health insurance is insurance that helps cover all or part of the medical and hospital costs incurred. Other benefits may also be provided as part of your policy.

No. These types of insurance are not licensed by the Health Insurance Authority. The sums of money provided by these plans are not based on the cost of the medical expenses incurred. These types of insurance are regulated by the Central Bank of Ireland.

There are two types of private health insurer in Ireland:

Open Membership Insurers must provide insurance to everybody who requests it from them. Currently there are four such insurers operating in Ireland, namely Aviva Health, Quinn Healthcare, Vhi Healthcare and Hospital Saturday Fund HSF. Only the first three provide cover for hospital in-patient costs.

Restricted Membership Insurers provide insurance to people who are members of a particular group, normally a vocational group or employees of a particular organisation and their dependants. For example, such schemes are operated for members of the Garda Síochána and their dependants and for employees of the ESB and their dependants.

Yes. All applicants for private health insurance cover must be accepted by a private health insurer, regardless of their health status or age. However waiting periods may apply before benefits can be claimed.

Beds in public hospitals are designated as either public beds or private beds. If you are receiving treatment as a public patient you are entitled to free maintenance apart from a charge of €75 per day, up to a maximum of €750 in a year from 1st January 2011 (this is referred to as the public hospital inpatient charge). If you hold a medical card you do not have to pay any public hospital charges. If you are a public patient you do not have the right to choose your consultant.

Private and semi-private hospital care in Ireland is provided for in private hospitals and also in public hospitals. If you opt for private care in a either public hospital or private hospital, you or your insurer must pay for your treatment and accommodation.

As of 1st January 2011 hospital charges for treatment and accommodation as a private or semi-private patient in a public hospital are up to €985 per day for a semi-private room and up to €1092 per day for a private room. Private hospitals are free to set their own charges. You or your insurer will also have to pay medical consultant's fees.

No. The health insurance system applying in Ireland is called community rating. In a community rated system everyone pays the same premium for a given health insurance plan, except ias follows:

• The premium for children must be no more than 50% of the adult premium.
• The premium for full-time dependent students under the age of 23 may be reduced. The reduced premium must   not be more than 50% of the adult premium.
• The premium may be reduced by up to 10% for members of group schemes.
• Pensioners who are members of restricted membership insurers may have their premiums reduced.

There is no price control in the health insurance industry. An insurer does not require approval for price increases from a regulator. If you are unhappy with the premium you are paying, you may switch plans or insurers at your renewal date. In some cases insurers allow policy holders to switch contracts during the 12 month contract term.

Yes. Company plans are available to all regardless of whether you are an employee or not.

No. An Open Membership Insurer must accept all applicants for insurance. Some plans are marketed towards certain groups such as companies or professions. You are entitled to these plans regardless of whether you are a member of the group to whom it is being marketed.

No. Health insurance is available to all, regardless of age, sex or health status. However a waiting period may apply in respect of cover for treatment for the medical condition.

If you are taking out health insurance plan for the first time or have allowed your cover to lapse for 13 weeks or more, you will be covered for accident and injury claims immediately. However an insurer may apply a waiting period to all other claims.

The maximum waiting periods that an insurer may apply in these circumstances are as follows:

• 26 weeks in respect of a person who is under the age of 55 years.
• 52 weeks in respect of a person who is of or over the age of 55 years and under the age of 65 years.
• 104 weeks in respect of a person who is 65 years and over. They impose a waiting period of 52 weeks in respect of maternity benefits

If you are taking out health insurance for the first time and have a pre-existing condition, the health insurer can impose a waiting period in respect of cover for treatment for this condition. The maximum waiting periods that the health insurer may impose in this case are as follows:

• 5 years, for a person who is under the age of 55 years.
• 7 years, for a person who is of or over the age of 55 years and under the age of 60 years.
• 10 years for a person who is 60 years or over

These waiting periods apply from the date cover commences. It should be noted that whether or not a condition existed at the time that an insured person began serving a waiting period is decided on the basis of medical advice. Whether or not the insured person was aware that they had the condition at the time that they started serving the waiting period may be considered not to be relevant by the insurer. If this matter is important to you, you should consider clarifying it with your insurer.

If you allow your health insurance to lapse for more than 13 weeks you may have to serve your waiting periods again.

No. A system of lifetime cover operates in Ireland. This is a system that protects you by guaranteeing all consumers the right to renew their policies, irrespective of factors such as age, risk status or claims history. Once you have health insurance, an insurer cannot stop cover or refuse to renew your insurance, except in very limited circumstances.

Yes. You have the right to change your health insurance plan, or insurer. The insurer may not impose additional waiting periods unless you are upgrading your cover. Even when you are upgrading your cover, an insurer may only impose an extra waiting period in respect of the additional cover in the new policy. The maximum waiting periods that can be applied in relation to new benefits are as follows:

• 2 years for a person under 65 when first named under the higher contract.
• 5 years for a person of 65 and over when first named under the higher contract
• 52 weeks for maternity

Inpatient benefits

As of Jan 2012 Quinn Healthcare and Aviva only apply the waiting periods above to inpatient benefits when used for conditions which existed prior to the upgrade in cover and for maternity benefits. Vhi will apply waiting periods to inpatient benefits when used for new conditions (below) and those that existing prior to the upgrade in cover (above waiting periods).

Vhi upgrade waiting periods for new illnesses using higher inpatient benefits are:

Outpatient benefits

Insurers currently apply lower waiting periods to outpatient benefits when you upgrade your cover. These waiting periods apply to both new and existing conditions.

If you upgrade your cover you may have to serve an additional waiting period in respect of the extra benefits you receive as a result of the upgrade in cover. These waiting periods currently only apply to those conditions which existed prior to the upgrade in cover. The maximum waiting periods that the health insurer can impose in relation to the new benefits are listed in the question above.

In general, health insurance policies are 12 month contracts. If you switch insurer and later decide you want to switch back, you may do so at your next renewal date. In some cases the insurers allow policy holders to switch contracts during the 12 month contract term.  The insurer may only impose waiting periods for any extra benefits available on your new plan.

Infants born to policy holders will not serve a waiting period if they are added to a policy within 13 weeks of their date of birth.

Private health insurance premiums are subject to income tax relief at source at the standard rate (currently, as at January 2011, 20%). The premium charged by the insurer will automatically take account of this relief.

The Irish state supports the community rated system by providing age related tax credits in respect of older people to help meet the expected higher cost of health insurance for this group. As a result, older people pay the same amount net of these tax credits for their health insurance as younger adults pay. These tax credits are funded by a levy paid by health insurers. In 2012 this levy is equal to €285 for each adult covered by the insurer and €95 for each child. The tax credits and levy are administered by the health insurance companies.

You can claim tax relief on the cost of certain qualifying medical expenses incurred by you, your spouse or your dependants at the standard tax rate of 20% from 1st January 2010. Those not subject to taxation will not be able to claim this relief. You should note, however, that you cannot claim relief in respect of sums already received or due to be received from any public or local authority (e.g. a health board), a private health insurance policy or any other source (e.g. compensation). For example, your health insurance policy gives you €20 for each doctor's visit. However the visit actually costs €50. You can then claim tax relief on the €30 which wasn't covered by your health insurer. You must keep copies of all your receipts for 6 years to avail of this tax relief. Further details of these reliefs, including details of medical expenses that qualify for tax relief, are available from the Office of the Revenue Commissioners (Lo-call 1890 60 50 90 and www.revenue.ie).

You can take out insurance if you become a resident of Ireland. You may, however, have to serve a waiting period. If you are an EU national and you become ill or have an accident during a visit to any EU country you can get free or reduced cost healthcare on production of a European Health Insurance Card. You can obtain this card from your country of usual residence. (www.ehic.ie)

If you are over 23 and are switching from an RMI, other than the ESB Medical Provident Fund, to an Open Membership Insurer (OMI) then you are treated as a new entrant to the system and full waiting periods can be applied, even if you have already served your waiting period with your current RMI.

If you wish to make a complaint in relation to your private health insurance, you should first discuss it directly with your insurer. If you are unable to resolve your complaint, you may contact the Financial Services Ombudsman. The decision of the Financial Services Ombudsman is binding on all parties unless the decision is appealed to the High Court. Alternatively you may contact the Health Insurance Authority.

You also have a right of access to the courts in respect of disputes with insurers.