Private health insurance

Health insurance is used to pay for private care in hospital or from health professionals in hospitals or in their practices.

Before accessing a health service or getting a referral from a GP for a particular hospital or clinic, you should contact your insurer directly to check that the health service and hospital or clinic are actually covered under your policy. If you are not covered by your insurance, you may have to pay for the treatment yourself.

Depending on which insurance company you are using, they may pay the hospital directly, if you are admitted into hospital.

If you are a private patient using the out-patient service at a hospital, you may have to pay the health professional and then claim back from the health insurance company. You should ask your own company about their procedures.

The following companies offer voluntary private health insurance in Ireland:

• Irish Life Health
• Laya Healthcare
• VHI Healthcare
• HSF Health Plan (provides cash plans but not in-patient health insurance)

Restricted member schemes

There are also some health insurance providers that deal only with particular groups of employees, for example, Gardaí or prison officers.

These schemes are known as restricted membership schemes. The rules governing health insurance apply equally to all providers, with some limited exceptions for the restricted membership schemes.

You can have a medical card and private health insurance at the same time. If you get a referral from your GP, you must decide if you want to be treated as a public or private patient.

If you are ordinarily resident in the Republic of Ireland, you can buy health insurance regardless of age, sex, health status or medical history.

There are 4 principles that must be in place for private health insurance in Ireland:

1. Open enrolment
2. Lifetime cover
3. Community rating
4. Minimum level of health insurance benefits

1. Open enrolment

Health insurance companies must accept anyone who wishes to join, subject to any waiting periods that apply, regardless of age, sex or health status. This is known as open enrolment. Restricted membership schemes must accept everyone who is qualified to join.

2. Lifetime cover

When you join and continue to pay your premiums – the amount you must each month or yearly - the insurance company cannot stop providing cover or refuse to renew your insurance as long as you live in Ireland, except in very limited circumstances. This is called lifetime cover.

Switching insurers

In general, health insurance policies are 12-month contracts. All insurers must provide a 14-day cooling-off period from the start of the contract. During these 14 days, you can cancel or switch insurance company and get a full refund. No claims will be paid for these 14 days. See below for more information about waiting periods when you switch.

Waiting periods if you switch insurance company

You can usually switch your health insurance company without a loss of cover if you complete the switch within 13 weeks of the previous policy ending.

In this case, you do not have to serve a waiting period again if you have already served a waiting period for a pre-existing condition, or a waiting period due to your age when first taking out private health insurance. See below for more information about waiting periods when you switch.

3. Community rating

Community rating means that the insurance company must charge the same rate for a particular level of service, regardless of your age, sex, health status or medical history. So, all adults pay the same amount for the same benefits.

Unlike motor insurance or life insurance, your age, health or past record of claims do not affect the price charged for insurance.

Charges may be lower than the normal adult rate for:

• People aged under 25
• Retired people with a special arrangement within their company's health insurance scheme
• People in group health insurance schemes

Charges for children must be reduced by at least 50% of the adult premium.

Lifetime community rating

Lifetime community rating means that the amount you pay for health insurance does not depend on the age you are now but can be higher depending on the age you were when you first took out health insurance. This applies only to people from age 35 and above.

For example, a 50-year-old who has held insurance since they were aged 30 would pay the same as a 30-year-old, but a 50-year-old who purchases insurance for the first time would pay more than a 30-year-old.

Charges if you start health insurance at 35 years or older

Higher charges apply if you are 35 years of age or older when you first take out health insurance. If you are aged 35 or above but you already have health insurance, the cost of your health insurance will not change based on your age.

There is a 2% increase in price (known as a loading) for each year over 34 years of age. For example:

• If you are 35, the cost is 2% higher than for a person aged 34
• If you are 44, the cost is 20% higher (2% x 10 years).

The longest you will have to pay a loading for is 10 years.

Breaks and stops in health insurance

If you previously had health insurance, you can be given credit for the time you were insured. This will reduce your loading.

If you have a break in cover of less than 13 weeks this will not affect your loading.

If you stopped your insurance cover for periods of unemployment since 1 January 2008, up to three years of credits can be provided.

Moving to Ireland from abroad

If you live outside Ireland and move to Ireland, a loading will not apply if you get health insurance within nine months and continue to be insured. Read about getting health insurance after you move to Ireland.

For more information, see the HIA website section Lifetime Community Rating Explained.

4 Minimum level of health insurance benefits

Private insurers must offer a minimum level of cover.

Companies that offer cover for inpatient hospital services must offer a minimum level of cover for:

• Day care/inpatient treatment
• Hospital outpatient treatment
• Maternity benefits
• Convalescence
• Psychiatric treatment and substance abuse

The minimum covered accommodation level is a semi-private room in a public hospital, although this may not always be available if you are admitted to hospital.

This does not apply to cash plans (pdf) or out-patient only plans.

Companies can offer contracts that are limited to certain health services, such as dental and optical services. These limited contracts do not have to meet the general principles of community rating, open enrolment and lifetime cover.

They may also offer contracts in relation to GP and out-patient services only without having to meet minimum benefit requirements (described below).

Alternatively, cash plans (pdf) provide money for certain medical events for example, a physiotherapy visit. Unlike in-patient health insurance policies, they don’t provide cover for a hospital stay as a private patient.

The health insurance company cannot refuse to accept you on the basis of your health status.

When you take out health insurance for the first time, you may have to serve a waiting period before you are fully covered, but accident and injury will be covered immediately.

If you are changing to a health insurance plan with improved benefits there may be a waiting period before the higher benefits apply.

The Health Insurance Authority (HIA) lists the current waiting periods that are applied by insurers.

There are 2 types of waiting period:

• New customer waiting periods for the first time you take out health insurance, or if you have a gap in cover of more than 13 weeks
• Upgrade waiting periods if you are switching to a plan with higher cover

New customer waiting periods

Insurance companies can apply a new customer waiting periods before you have full cover. The maximum waiting periods are:

• 26 weeks if you have an illness that starts after you join:
• 5 years if it is to pay for a pre-existing condition
• 52 weeks for maternity-related claims

You can find more about pre-existing conditions on the HIA website. You should also check with your insurer.

Upgrade waiting periods

If you are switching health insurance plans, you may have to wait for up to 2 years for use of any higher benefit on the new plan.

For maternity benefits, the maximum waiting period is 52 weeks.

Insurance companies do not always apply the maximum waiting periods. You should check with your insurer about their waiting periods.

You must apply directly to the health insurance company that you want to join. Each company must follow certain laws but, after that, they are free to make their own rules.

The level of cover available and the rates charged vary from one company to another.

Health insurance policies are usually 12-month contracts. If you want to switch insurer or insurance plan, you may do so at your next renewal date. Insurers may charge you a cancellation fee if you want to switch plans or cancel during the 12 month term .

You must give all relevant information to the insurance company. If you do not, then the entire contract may be void. An insurer cannot charge you extra if you have a medical condition.

Cooling-off period

All insurers must provide a 14-day cooling off period from the start of the contract. The cooling off period of 14 days is when you can cancel and get a full refund. No claims are paid for these 14 days.

If you are experiencing problems with getting cover, you should contact the Health Insurance Authority (HIA).

The Health Insurance Authority (HIA) is the independent regulator for the private health insurance market in Ireland.

It monitors the health insurance business in Ireland. It also advises the Minister for Health on the health insurance market and assesses the effect of any regulations or new legislation on consumers.

The HIA aims to provide:

• Inform people on the health insurance market in Ireland
• Provide knowledge and tools to help you choose appropriate private health insurance
• Enforce and monitor compliance
• Build public trust in private health insurance
• Plan for changes in the health insurance market, technology, and consumer demands

The HIA has useful publications about health insurance, including Health Insurance Explained, Choosing a Health Insurance Policy, and Health Insurance Waiting Periods. You can read them online or request a hard copy.

All health insurers in Ireland are regulated by the Central Bank of Ireland for conduct of business rules.

Compare health insurance products

You can compare the benefits and prices of different health insurance products using the HIA’s free and independent health insurance comparison tool.

Risk equalisation

The costs for insurers are different depending on the age and health profile of their members. The HIA tries to balance out these differences in insurers' costs through the Risk Equalisation Scheme.

Under the Risk Equalisation Scheme, the HIA pays health credits to insurers to compensate them for the higher costs of insuring members over 65 and members who make more health insurance claims.

Each insurer pays an annual levy on each policy to help fund the health credits.

If you have a complaint about a health insurer, you should speak first to your health insurer. If it is not resolved, you should contact the relevant regulator.

Read more about in-patient and out-patient services.

The Health Insurance Tax Credit reduces the amount of the health insurance premium that you pay.

You can get further information on the rules about private health insurance from: