Private health insurance in general

What is private health insurance?

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.

Are critical illness policies or income protection policies private health insurance?

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.

Who can provide me with private health insurance?

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.

Can anyone buy private health insurance?

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.

I have a medical card. May I also hold private health insurance?

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.

What is the difference between a public patient and 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.

Will my age affect my insurance premium?

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.