Frequently Asked Questions
Private health insurance in general
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 five such insurers operating in Ireland, namely Aviva Health, GloHealth, laya healthcare, Vhi Healthcare and HSF Health Plan. Only the first four 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 2013 (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 either a public hospital or a private hospital, you or your insurer must pay for your treatment and accommodation.
As of 1st January 2013 hospital charges for treatment and accommodation as a private or semi-private patient in a public hospital are up to €1,008 per day for a semi-private room and up to €1,121 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 as 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.
Buying private health insurance/medical conditions
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.
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.
If you allow your health insurance to lapse for more than 13 weeks you may have to serve your waiting periods again.
Q I have an existing condition; may I switch health insurers? Will I be covered for my condition straight away?
A: You may switch health insurers regardless of your existing conditions. If you have completed your new customer waiting periods, you will be covered immediately for any existing condition. However if you wish to use a benefit on the new plan which is higher than the benefit provided on the old plan, you may have to serve an upgrade waiting period before full cover for this benefit is available. Please see our section on upgrade waiting periods for more details.
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 plans during the 12 month contract term. The insurer may only impose waiting periods for any extra benefits available on your new plan.
Public vs. private maternity services
The public Maternity and Infant Care Scheme provides an agreed programme of care to all expectant mothers who are ordinarilly resident in Ireland. This service is provided by a family doctor (GP) of your choice and a hospital obstetrician. You are entitled to this service even if you do not have a medical card or GP Visit Card. The mother is entitled to free inpatient, outpatient and accident and emergency/casualty services in public hospitals in respect of the pregnancy and the birth and is not liable for any hospital charges. You can find more information from the Citizens Information website or the individual maternity hospital websites.
Private health insurance can cover some of the costs associated with private maternity services. Your plan will typically provide you with a hospital accommodation grant in the range of €2,000 - €5,000. Hospital accommodation costs in a public hospital can range from €1,008 - €3,024 as a semi-private patient, to €1,121 - €3,363 as a private patient, depending on the duration of the stay. Private hospital maternity accommodation costs usually cost from €4,000 for a two night semi-private package to €5,450 for a three night private package. As a result, your health insurance plan may, or may not, cover the total cost associated with the hospital accommodation. Private consultant fees can be partly covered by the pre and post-natal benefit, or the maternity consultant fees benefit on your plan, but you should be prepared to pay a shortfall, as these benefits usually provide benefit for around €250 - €600 depending on the plan. Epidurals, paediatrics and pathology may also be covered by your plan, but you should confirm this with your insurer.
Premiums, tax relief, group discount and levies
There is no price control in health insurance. An insurer decides on the premium but it cannot vary the premium by age, except in the case of children/students. 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.
Private health insurance premiums are subject to income tax relief at source at the standard rate (currently, as at January 2013, 20%). The premium charged by the insurer will automatically take account of this relief.
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% as at 1st January 2013. 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).
The Irish state supports the community rated system by providing age related health credits in respect of older people and less healthy people, to help meet the expected higher cost of health insurance for this group. As a result, all people pay the same premiums net of these tax credits for their health insurance. These tax credits are funded by a levy paid by health insurers. In 2013 this levy is up to €350 for each adult covered by the insurer and up to €120 for each child. The tax credits and levy are administered by the health insurance companies.
An insurer can offer up to a 10% group discount on any plan to a group of persons at the insurer's discretion. Some of the insurers automatically include this discount in the prices quoted for a particular plan. Where an insurer has decided to automatically include this discount in a plan's premium, it will be reflected in the HIA's comparison tool. Currently, insurers do not provide discounts to individuals on company plans, so the prices quoted on our website for company plans do not include it.
Laya Healthcare does not provide group discounts to individuals, except during special promotional periods. Vhi automatically include group discounts on their individual plan premiums, except for their One Scheme. Aviva Health automatically apply the group discount to a large majority of their individual plans. GloHealth sometimes apply a group discount to their plans.
Moving to Ireland/Moving Abroad
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)
Q I currently hold health insurance abroad and I am returning to Ireland to live. Will my foreign health insurance be taken into account for waiting periods on Irish health insurance?
No. Foreign health insurance is not taken into account for waiting periods on Irish health insurance. You will be treated as a new customer when you return to Ireland and waiting periods will apply.
Q I am moving abroad for a period of time but I have held health insurance in Ireland up to now. Will I have to serve waiting periods when I return?
If you break your Irish health insurance cover for more than 13 weeks you may be treated as a new customer when you return, even if you are insured abroad by another insurer. Currently Vhi Healthcare, Laya Healthcare, GloHealth and Aviva Health will waive these waiting periods if you hold Vhi Global travel insurance. Laya will also waive the new customer waiting periods if you hold BUPA International insurance. This is at the insurer’s discretion.
Restricted Membership Insurers e.g. Garda Medical Aid
Q I am a member of a Restricted Membership Insurer (RMI) e.g. the Garda Medical Aid. Can I switch without penalty?
If you are switching from an RMI, the time spent with your current insurer will be taken into consideration when switching to an Open Membership Insurer. Upgrade waiting periods will apply to any higher benefit on the new plan.
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.In the case of HSF Health Plan, you may complain to the UK Financial Ombudsman Service, since they are regulated by the UK Financial Regulator and not the Central Bank of Ireland. Alternatively you may contact the Health Insurance Authority for information.
You also have a right of access to the courts in respect of disputes with insurers.