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 five such insurers operating in Ireland, namely Irish Life Health, 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 dependents. For example, such schemes are operated for members of the Garda Síochána and their dependents and for employees of the ESB and their dependants, Prison Officers Medical Aid Society 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 2015 (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 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.
Can I buy a company plan even though I am not an employee?
Yes. Company plans are available to all regardless of whether you are an employee or not.
Can my insurer refuse to sell me health insurance?
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.
Can an insurer refuse to sell me insurance because I have a medical condition?
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.
Can my health insurer refuse to renew my contract if I get sick?
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.
Switching
What happens if I allow my health insurance to lapse for more than 13 weeks?
If you allow your health insurance to lapse for more than 13 weeks you may have to serve your waiting periods again.
I have an existing condition; may I switch health insurers? Will I be covered for my condition straight away?
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 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. You can view the different waiting periods currently applied by the insurers to new or existing conditions, under our section on upgrade waiting periods.
What happens if I switch from my current insurer and wish to return to them at a later date?
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.
For more information please go directly to the HIA website