Frequently Asked Questions
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.
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 2014 (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 2014 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 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.
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.
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.
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)
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.
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 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.
Health Insurance Regulations
The business of private health insurance in Ireland is regulated by:
- The Health Insurance Act, 1994
- The Health Insurance (Amendment) Act, 2001
- The Health Insurance (Amendment) Act, 2003
- The Health Insurance (Amendment) Act, 2007
- The Health Insurance (Miscellaneous Provisions) Act, 2009
- The Health Insurance (Miscellaneous Provisions) Act, 2012
The European Union “Third Non-Life Insurance Directive” sets out the requirements for the internal market for member states regarding non-life insurance, including health insurance. It allows individual member states to adopt these requirements in a manner most appropriate to their particular national legal systems and national healthcare systems.
The Health Insurance Acts, 1994 – 2009 legislate for the four principles of private health insurance in Ireland. They are:
- community rating,
- open enrolment,
- lifetime cover,
- minimum benefit.
The principal objective of the Authority in performing their functions under this Act is to ensure, in the interests of the common good, that access to health insurance cover is available to consumers of health services with no differentiation made between them (whether effected by income tax or stamp duty measures or other measures, or any combination thereof), in particular as regards the costs of health services, based in whole or in part on the respective age range and general health status of the members of any particular generation (or part thereof).
Health Insurance Levy/Risk Equalisation
Risk equalisation is a process that aims to equitably neutralise differences in insurers’ costs that arise due to variations in the age profile of the insurers. Risk equalisation involves transfer payments between health insurers to spread some of the claims cost of the high-risk older and less healthy members amongst all the private health insurers in the market in proportion to their market share. In the absence of an effective risk equalisation system, there is a threat to the existence of a community rated market when significant differences in risk profiles exist between competing insurers. Risk equalisation is a common mechanism in countries with community rated health insurance systems.
The Health Insurance Authority recommended to the Minister for Health in October 2005 the commencement of risk equalisation payments. In December 2005, the Minister for Health and Children decided that risk equalisation payments would commence from 1 January 2006. A stay on payments was imposed by the Courts until it ruled on a constitutional challenge to the Risk Equalisation Scheme. On the 16th of July 2008, the Supreme Court ruled that the Risk Equalisation Scheme was unconstitutional.
The Government announced, in November 2008, an initiative of an interim age related tax credits and community rating health insurance levy to support the cost of health insurance for older people. This interim system commenced in 2009 and was designed to be exchequer neutral.
The Government, on 27th May 2010, announced a comprehensive strategy and set of actions for the health insurance market. These actions included the development of a full, robust, new risk equalisation scheme to start in 2013. The Health Insurance Authority published a consultation paper on risk equalisation on 21 June 2010 and submitted a report to the Minister for Health in December 2010.The Government announced details of the scheme in January 2012. Legislation was published in October 2012 and enacted in December 2012 to apply from January 2013.
The legislation creates a Risk Equalisation Fund administered by the Health Insurance Authority. The Risk Equalisation Fund supports the community rated market by providing age related health credits in respect of those over the age of 60 that help to meet their higher claims costs. The health credits vary by age, gender and by Level of Cover. Credits are also provided in respect of each overnight stay in a hospital bed in private or semi-private accommodation. These credits are funded by a community rating health insurance levy paid by health insurers which vary by Level of Cover.
The health credits and the community rating health insurance levy are administered by the health insurance companies and the Risk Equalisation Fund. Community rating health insurance levy payments for renewals from 1 January 2013 are paid by insurers to the Revenue Commissioners who in turn pass the money to the Risk Equalisation Fund. Health credits are paid out of the Fund to the insurers. Any surpluses or deficits in the Fund are carried forward and allowed for in setting future levy amounts.
The health credits and community rating health insurance levy for renewals from 2009 to 2012/Q1 2013 are as follows:
Interim System credits and community rating levy amounts for renewals in 2009-2012/Q1 2013
|Age Range||2009||2010||2011||2012/Q1 2013|
Stamp Duty Table
The health credits and the community rating health insurance levy for renewals occurring from 1 January 2013 to 31 March 2013 are the same as applied for renewals under the interim system in 2012.
Health Credits and community rating stamp duty for policies renewing from 31 March 2013 to 28 February 2014.
The amounts of the health credits and community rating health insurance levy for policies renewing from 31 March 2013 to 28 February 2014 are as follows:
|Age Range||Non-Advanced||Advanced Contracts|
Stamp Duty Table
For policies commencing between 31/03/2013 to 28/02/2014, a hospital bed utilisation payment of €75 is paid in respect of each night spent in private or semi-private accommodation by an insured person.
Health Credits and community rating stamp duty for policies renewing from 1 March 2014 to 28 February 2015.
The amounts of the health credits and community rating health insurance levy for policies renewing from 1 March 2014 to 28 February 2015 are as follows:
|Age Range||Non-Advanced||Advanced Contracts|
Stamp Duty Table
For policies commencing between 01/03/14 to 28/02/2015, a hospital bed utilisation payment of €60 is paid in respect of each night spent in private or semi-private accommodation by an insured person.
Health Credits and community rating stamp duty for policies renewing from 1 March 2015 to 28 February 2016.
The amounts of the health credits and community rating health insurance levy for policies renewing from 1 March 2015 to 28 February 2016 are as follows:
|Age Range||Non-Advanced||Advanced Contracts|
Stamp Duty Table
For policies commencing between 01/03/15 to 28/02/2016, a hospital bed utilisation payment of €90 is paid in respect of each night spent in private or semi-private accommodation by an insured person.
Source :The Health Insurance Authority .