Understanding Health Insurance

Look after yourself – in every way

What is Private Health Insurance

Private health insurance is provided in both public and private hospitals. Health insurance helps cover all or part of your private care in hospitals or from health professionals in hospitals or their practices. It is a contract between you and an insurance company, where you pay a regular monthly or annual premium and the health insurance company agrees to pay for some or all of your medical expenses, subject to the terms of the policy. Health insurance can help you pay for a wide range of medical services, including:

  • Hospitalisation

  • Doctor’s visits

  • Preventive care

  • Mental healthcare

Health insurance can be very important, especially if you have a chronic health condition or are at risk of developing a serious illness or injury. Medical bills can be very expensive, and health insurance can help you avoid financial hardship if you do need unexpected medical care.

The Private Health Insurance Market in Ireland

The number of people with private health insurance at the end of Q3 2023 was 2.48m representing approximately 47% of the overall population. The number of people holding Health Insurance has increased since the onset of the Covid-19 pandemic as people prioritised their health and wellbeing into the future, with timely access to care, swift diagnosis and flexible and convenient care options such as access to remote GPs, mental health and wellbeing supports, which are key considerations for all families.

Health insurers pay over €2.5 billion annually for healthcare treatment and benefits for their consumers and this represents a considerable contribution to the overall spend on healthcare in the country.

Policy Renewals

Over one million consumers are due to renew their health insurance in the coming months so it is important for consumers to shop around to get the most appropriate cover and value for their families. We encourage consumers to give themselves plenty of time to consider their options and review their policy in good time to help make an informed decision on whether to renew their policy, switch insurers or purchase private health insurance.

What are the benefits of having Private Health insurance?

Private Health Insurance comes with a range of benefits. At the same time, each policy has different benefits and excesses, some of the benefits of having health insurance:

  • Peace of Mind – Cover for health issues that arise in the future and avoid large hospital bills

  • Speed of Access to hospitals for procedures, and to consultants. It would be expensive to go to private hospitals without health insurance.

  • Cover for private or semi-private rooms in hospital.

  • Cover for consultant services as a private patient in Private Hospitals and expensive scans, like MRIs or CTs, are usually covered.

  • Other cover such as outpatient benefits, maternity, or psychiatric services.

  • Cover for routine day-to-day medical expenses that can be claimed back subject to the excess.

Can I still use the public health system?

Yes. For example, if your GP refers you to a specialist consultant in a public hospital, you can decide if you want to be treated through the public or the private system. Similarly, if you’re admitted to a public hospital, you will need to tell the hospital whether you want to be treated as a public or a private patient.

Just bear in mind that as a public patient, you don’t have the right to choose your consultant, and you also will have to waive your right to be treated as a private patient.

How and where to buy a Private Health Insurance policy

A good place to start is by visiting the website of the Health Insurance Authority (HIA), the statutory regulator of the private health insurance market in Ireland. There you’ll find an online tool for comparing health insurance plans which can help you to choose the best policy to suit your needs. The HIA also provide useful consumer information.

You should also contact a regulated health insurer or broker directly, either online or over the phone.

There are currently three Private Health Insurers operating in the Irish market:

The insurer will be able to discuss and provide guidance on many aspects of your health insurance, including what is the most suitable plan based on your needs, any ways you might be able to reduce the level of premium (like increasing the level of excess on the policy, for example), and how you can obtain the optimum level of benefits for the premium being paid and the options available.

Can anyone buy health insurance?

Yes. All applicants must be accepted by a health insurer regardless of their health, status or age. That said, waiting periods may apply before some benefits can be claimed. This is known as “open enrolment” and is one of the principles of the Health Insurance Market in Ireland.

Will my age affect my insurance premium?

No. Health insurance is different from other types of insurance, where the price is based on the risk profile of an individual. Health insurers use a system known as a “community rating”. The cost of health insurance is based on services and treatments, not your medical history, your previous claims or your age – this is called Community Rating. Unlike motor insurance or life insurance, matters such as age, health or your past history of claims do not affect the price charged for health insurance. It means that everyone pays the same premium for a given health insurance plan, except in certain situations:

Since the introduction of new legislation in 2015 called Lifetime Community Rating, 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, a loading may apply to your premium.

Good to know:

  • 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.

What happens if I have to make a claim?

Each health insurer makes their own arrangements, however, for inpatient costs, most health insurers have agreements in place to pay the hospital directly. Generally, for outpatient costs, you pay the health professional and then claim back from the health insurance provider. If in doubt, contact your provider to clarify how it works for you.

Once you purchase health insurance and continue to pay your premiums, the insurance company cannot refuse to provide you with cover regardless of the claims experience you have, subject to the monetary limits of the policy. This is called lifetime cover.

When can I cancel or switch my policy?

Private health insurance contracts are 12-month contracts. All insurers must provide a 14-day cooling-off period from the renewal date of the policy. During this 14-day period, you can switch to a different policy or get a full refund if you decide to switch insurer.

I have a pre-existing condition, can I switch insurer?

If you have completed your waiting period as a new consumer, you can switch insurer and be covered immediately for any pre-existing conditions. Waiting periods are applied by all insurers so if you start your waiting period with one insurer and then switch, you will have to finish your waiting period with the new insurer.

If you upgrade your plan to one with higher benefits you may have to serve upgrade waiting periods.

Do I need to serve a waiting period before I am fully covered?

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

Waiting periods applied in other circumstances can vary depending on the nature of the claim. For illnesses that start after you take out your health insurance, a waiting period of up to 26 weeks applies. For illnesses that existed in the six months before you joined, a maximum 5-year waiting period applies. Maternity-related claims are subjected to a maximum waiting period of 52 weeks.

You can read more about the maximum waiting periods here.

What happens if I allow my health insurance to lapse for more than 13-weeks?

In this situation, you may have to serve your waiting periods again and a loading may be applied to your premium if you are age 35 years or older. This is called a break in cover.

What if I have a pre-existing condition?

A pre-existing condition is an ailment, illness or condition, which existed at any time within the six months before you took out health insurance for the first time, or before you took out health insurance after a break in cover of 13-weeks or more.

Where you make a claim for a pre-existing condition, a waiting period may apply before you can access cover. This means that you will have to wait a certain amount of time before your insurance company will start paying for treatment for your pre-existing condition. The length of the waiting period can vary depending on your health insurance policy.

During the waiting period, you will still be able to access other benefits under your health insurance policy, such as cover for accidents and emergencies. However, you will have to pay for any treatment for your pre-existing condition out of pocket.

If you have a pre-existing condition, it is important to talk to your health insurance company about the waiting period. They will be able to tell you how long the waiting period is and what benefits you are entitled to during that time.

Can I switch to a new provider?

Yes. Generally speaking, a health insurance policy is a 12-month contract so it’s possible to switch once that period is up. In some cases, however, an insurer will allow you to switch plans during the 12-month contract term with or without conditions, so it’s worth asking the question if you’d rather not wait. Bear in mind that you might be subject to new waiting periods for any extra or higher benefits.

I have an existing condition. If I switch health insurers, will I be covered for my condition straight away?

If you’ve completed your new consumer waiting periods with your existing insurer, you’ll be covered immediately for any existing condition when you switch. That said, if you’d like to use a benefit on the new plan which is greater than the benefit provided on the old plan, you may have to serve a waiting period before full cover is available.

Can I buy a corporate plan even if I am not an employee?

Yes. Corporate or company plans are available to everyone regardless of whether or not you are an employee.

You can add an excess to your corporate of company plan if you want to reduce your costs further. Remember, the higher the excess, the bigger the savings, but the bigger the risk you are accepting.

Can I upgrade my policy to a higher level of additional Benefits/Cover?

If you decide to upgrade your cover in the future, waiting periods of up to a maximum of two years can apply for all ages. During the waiting period, you will not be able to make a claim for extra benefits on your new plan.

I have a medical card. Can I also purchase 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.

PLEASE NOTE

Insurance is a very detailed subject and the outlines above are not intended to be exhaustive. Instead we recommend that you ask your insurer or broker to explain each one in detail.