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 Irish Life Health, Laya Healthcare, Vhi Healthcare and HSF Health Plan. 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.
Yes. You may have a medical card and hold private health insurance at the same time. If attending your GP for a referral you will need to decide whether you want to go publicly or privately. Similarly, if admitted to hospital, you will need to tell the hospital whether you want to be admitted as a public or a private patient.
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 €80 per day, up to a maximum of €800 in a year from 1st January 2016 (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 2015 hospital charges for treatment and accommodation as a private or semi-private patient in a public hospital are up to €813 per day for a semi-private room and up to €1,000 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 lifetime community rating. In a lifetime community rated system everyone pays the same premium for a given health insurance plan, except as follows:
- From 1 May 2015, if you first buy health insurance at age 35 or over, or allow your insurance to lapse for more than 13 weeks at age 35 or over, an age at entry loading may apply to your premium.
- 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.
- Pensioners who are members of restricted membership insurers may have their premiums reduced.
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.
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.
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 and a Lifetime Community Rating loading may be applied to your premium if you are age 35 or older.
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. The maximum waiting periods that the health insurer can impose in relation to the new benefits are listed in the question above. You can view the different waiting periods currently applied by the insurers to new or existing conditions, under our section on upgrade waiting periods.
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.
The public Maternity and Infant Care Scheme provides an agreed programme of care to all expectant mothers who are ordinarily 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 three nights cover in a private room (subject to availability) in a public hospital, although some plans have limited cover of €381 - €400. There may also be a home birth grant in the range of €2,000 - €5,000, depending on which plan you're on. Hospital accommodation costs in a public hospital range from up to €813 per day as a semi-private patient, up to €1,000 per day as a private patient. There are currently no private maternity hospitals in Ireland. As a result, your health insurance plan may, or may not, cover the total cost associated with the hospital accommodation.
Inpatient delivery consultant's fees, incurred at the time of delivery, are always covered by your plan. Higher plans will also cover the anaesthetist, pathology and a paediatric consultation in hospital (covered under Delivery Consultants' Fees on our comparison tool).
Outpatient private consultant fees, which cover the routine visits to your consultant prior to the birth, can be partly covered by the pre and post-natal benefit, or the outpatient 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 and outpatient consultant fees may cost several thousand.
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. The tax relief (of 20% premium) has been restricted to €1,000 gross premium in respect of adults and to €500 gross premium for children and full time dependant students aged 18 - 22. This applies to policies commencing or renewing on or after 16 October 2013. For policies commencing prior to 16 October 2013, full tax relief at 20% continues to apply. 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 2014. 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 health insurance levy paid by health insurers. From 1 March 2014 this levy is up to €399 for each adult covered by the insurer and up to €135 for each child. The tax credits and levy are administered by the health insurance companies and the Risk Equalisation Fund.
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.
Young adult rates may be offered to persons aged 18-25. Where an insurer chooses to apply young adult rates to a plan, they must do it for all age ranges from 18-25.
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 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 and Irish Life 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 or BUPA UK insurance. This is at the insurer’s discretion.
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. 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,
Tel: 01 6620899