Health Insurance Cash Plans

These plans provide fixed monetary amounts for a range of medical events, but unlike inpatient private health insurance plans, the benefits payable are not linked to the costs incurred in hospital as a private patient. For example, a cash plan might provide you with an amount per day spent in hospital, but this amount will not be linked to the costs incurred whilst in hospital. Some plans provide:

  • Monetary amounts for out-patient expenses such as GP or physiotherapy visits.
  • Monetary amounts per day spent in hospital.
  • Some policies may provide personal accident cover.

Rules surrounding waiting periods, switching and upgrading of your plan are governed by the same legislation that applies to inpatient health insurance plans. See our Consumer Information section for more details.

Benefits and prices of all health insurance cash plans available on the market can also be easily compared on our comparison tool at www.healthinsurancecomparison.ie

Please see the following FAQs for further information.

Who can provide me with a health insurance cash plan?

As of 22 February 2017, HSF Health Plan, Laya Healthcare and Vhi Healthcare.

Will my age affect my insurance premium?

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 in the following circumstances:

  • The premium may be reduced by up to 10% for members of group schemes.
  • The premium for children must be no more than 50% of the adult premium.
  • The premium for those aged 18-25 may be reduced.
Will my health insurance cash plan cover my consultant's fees?

Health insurance cash plans allow the consumer to claim for a proportion of some expenses, such as GP and physiotherapy visits and consultant’s visits on an out-patient basis. Consultant's fees incurred as part of a hospital stay are not covered by health insurance cash plans. Consumers should check their policy to determine the extent of cover offered by their policy.

What kind of maternity benefits should I expect?

Cash plans may provide benefits such as:

  • A monetary amount per day spent in hospital
  • A birth/adoption grant

You will not normally be able to claim under the maternity section of your contract until you have served a waiting period.

How do I work out my claim for out-patient expenses?

For all insurers you will have to pay for the treatment first, keep a receipt and claim either at the end of your policy year or during the policy year depending on your policy's terms and conditions. Features of this cover often include the following:

  • There is often a maximum level of benefit that is paid in relation to out-patient cover.
  • Usually, you can only claim for a portion of the cost of the visit to your practitioner. This is called the ‘allowable expenses'. For example, a GP's visit may cost €50 but you may only be allowed to claim €20. The €20 is the allowable expense.
What is an exclusion?

Health insurance cash plan contracts normally have a list of exclusions, which are circumstances under which the insurer may not pay a claim. For example:

  • Treatment received during waiting periods.
  • Treatment arising from self-harm of self inflicted injuries.
  • Treatment which, in the view of the insurer's Medical Director, is considered experimental or not medically necessary.
  • Plastic surgery.

The above is not a comprehensive list of exclusions. Your contract may include some or all of the above, which will be set out in your contract details. You should review these carefully.

What kind of cover do I want?

Most health insurance cash plans offer significant out-patient benefits. Monetary amounts towards stays in hospital and personal accident cover may be offered. Out-patient benefits are also provided by some plans that cover hospital in-patient costs, so it may be useful to also consider these plans. If you already have a health insurance plan from Aviva, Quinn or Vhi you may wish to check your current level of hospital and out-patient cover to ensure you are not duplicating your cover.

How much could I benefit?

Sometimes it can be difficult to gauge the value that a benefit can provide, especially when it involves excesses, allowable amounts and maximum claim amounts. It might be useful to consider how often you would expect to make a claim under a particular benefit and work out whether it makes financial sense to opt for this benefit in your policy, based on the number of times you would claim.

How much risk am I willing to accept?

You may choose a policy with a small amount of cover, thereby taking the risk that you will not require an unusual amount of visits to say, your GP or physiotherapist, but allowing you to pay a lower premium.

Can anyone buy a health insurance cash plan?

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

Which product offers the best value for my circumstances?

After considering all of the above, as well as any other factors you feel are relevant, you should look at all the plans that you consider are suitable for your circumstances. You should then consider the differences between the plans and decide whether the differences in benefits provided are worth the differences in premium.

Can an insurer refuse to sell me a particular plan?

No. An insurer must sell you the policy you request.

I have a medical condition. Do I have to serve additional waiting periods before I am covered for this?

If you are taking out a health insurance cash plan for the first time and have a pre-existing condition, the health insurer may impose a waiting period in respect of cover for treatment of this condition.

The maximum pre-existing condition waiting period that can be applied is 5 years:

From 1 May 2015 a pre-existing condition is defined as:

"Pre-existing condition” means an ailment, illness or condition, where, on the basis of medical advice, the signs or symptoms of that ailment, illness or condition existed at any time in the period of 6 months ending on the day on which the person became insured under the contract.

Do I have to serve a waiting period when I take out a health insurance cash plan for the first time?

If you are taking out a health insurance cash plan for the first time or have allowed your cover to lapse for more than 13 weeks, an insurer may apply a waiting period to claims.

The maximum waiting periods that may be applied are 26 weeks for new conditions and 5 years for pre-existing conditions, however, your insurer may apply lower waiting periods for some or all of your benefits.

Can I change my health insurance cash plan or insurer?

You have the right to change your health insurance cash 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 any higher benefit on the new plan.
  • 52 weeks for higher maternity benefits.

However, if you allow your health insurance cash plan to lapse for 13 weeks or more, you may have to start all your waiting periods over again.

If I upgrade my cover do I have to serve a waiting period?

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. The maximum waiting periods that the health insurer can impose in relation to the new benefits are listed in the question above.

What happens if I switch from my current insurer and wish to return to them at a later date?

If you switch insurer and later decide you want to switch back, you may do so. The insurer may only impose waiting periods for any extra benefits available on your new plan.

Will my baby have to complete a waiting period?

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

How do I make a complaint about my health insurance cash plan provider?

If you wish to make a complaint in relation to your health insurance cash plan, 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 but when one party is dissatisfied with the decision, it may be appealed to the High Court. 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.

The Financial Services Ombudsman may be contacted at:

The Financial Services Ombudsman
3rd Floor Lincoln House,
Lincoln House,
Dublin 2.

Tel: 01 6620899
e-mail: enquiries@financialombudsman.ie