Health insurance

Ongoing medical treatment can be costly. Health insurance covers medical or hospital expenses if you get sick, get injured, have an accident or need an operation. Having a health insurance policy can give you peace of mind in the event of something unexpected happening.

The health insurance market in Ireland is regulated by the Health Insurance Authority (HIA), an independent statutory regulator. The HIA also provides information on consumer rights when it comes to health insurance plans and benefits.

With ‘Lifetime Community Rating’ in place you need to enter the health insurance market before the age of 35 to avoid an extra premium known as a loading. As and from 1 May 2015 a loading of 2% on premiums applies to anyone aged 35 who takes out insurance for the first time. A further 2% loading applies for every year after that.

For example, if you take out a private health insurance policy for the first time at age 40 you will pay an additional 12% on your annual premium every year. You will only pay this additional loading premium for a maximum of 10 years.

However, there are allowances if you previously had health insurance as this would be taken into account if you have proof of cover from your previous provider. For more information on this visit the Health Insurance Authority’s website.

In this section you will find information on the following:

• Types of health insurance
• Getting the right cover
• Who provides health insurance?

Types of health insurance

There are two basic types of private health insurance cover.

• Inpatient hospital cover: this pays for services you receive if you are admitted to hospital, whether you stay the night or are treated as a day-patient. It covers some or all of the cost of treatment by your doctor and costs associated with hospital accommodation, tests and surgery.
• Outpatient or primary cover: this covers the treatment you receive from a health services provider when you aren’t admitted to hospital. It includes treatment in a consultant’s room, in the accident and emergency room of a hospital or from a GP, physiotherapist or specialist.

You can take out both inpatient hospital cover and outpatient cover separately. Health insurance companies’ offer packaged policies that provide cover for both services. Some plans may have limited or no outpatient cover. Plans with limited outpatient cover usually only cover part of your expenses. This part of the expense is often referred to as the ‘allowable expense’.

Example one: a GP visit may cost €50 but the allowable expense may be only €15, in this case you would only be able to claim back the €15. Other policies may include not only the cost of seeing your doctor, dentist or physiotherapist but also alternative treatments such as acupuncture, chiropody or osteopathy. Some plans may also have an excess, which must be reached before you can make a claim.

Example two: the policy may state that it will refund 50% of GP expenses but this may only be on the condition that you pay an excess of €400 for outpatient expenses. For example, if the total expense is €700, you will pay an excess of €400. This leaves €300 of which the policy will refund 50% i.e. €150.

Hospital cover also varies with some plans providing cover for a semi-private room in a public hospital, whereas others will pay for a private room in a private hospital.

Get the right cover

As well as offering different benefits, the packages on offer from health insurance providers vary in cost. The policy offering the lowest premium may not always be the best value for money, so it makes sense to get quotes from each provider and compare the benefits on offer to see what suits you best.

You can find out more information on the different health insurance packages and costs from health insurance providers in Ireland from the Health Insurance Authority.

Consider the following when looking at policies:

• What level and type of cover are you looking for?
• Do you just want basic cover or are you prepared to pay more for treatment in a private hospital?
• What mix of inpatient and outpatient cover best suits your needs?
• Which product is best suited to your stage of life? Younger people starting out may want cover for activities such as sports, physiotherapy or travel, in addition to the basics. Those planning a family may be interested in maternity benefits, with some packages better suited to families than others.
• What services are available in participating hospitals in your local area?
• How do different products compare on cost?
• Are you looking for insurance for yourself or for your family, including any children?

Even if you choose to include cover for private hospital accommodation as part of your plan, you should be aware that there is no guarantee of availability (of private beds) in the hospital.

You should always be aware of the conditions of your cover and any restrictions that apply, these will be outlined in your policy document.

Before signing up to a policy, ask yourself

• Does it cover all treatments I may need? Some policies may not cover dental treatments, outpatient treatments, or experimental treatments. If you need cover for medical treatment abroad – make sure this is included.
• Do I understand all the details of the policy? Read all of the small print. If you do not understand something, you should ask for an explanation.
• Do I have to serve a waiting period for a pre-existing condition? While that waiting period applies, you are not covered for private treatment for pre-existing conditions.
• What happens if my family has a family health insurance policy and the main policyholder dies? Generally, you and the rest of your family covered by the policy will continue to be covered until you inform the insurer that the main policyholder has died. It is important to contact your insurer and tell them as soon as possible. The insurer will then end the original family policy and offer to start a new family policy or individual policies for you and your family.

Generally, you cannot take out private medical insurance for a treatment you know you are going to need in the future. Some policies may not cover fertility treatment, or treatments you elect to have, for example cosmetic surgery, and may only have limited cover for mental or psychiatric conditions.

Who provides health insurance?

In addition to the main health insurance providers (Irish Life Health, Laya Healthcare and VHI Healthcare), there are a number of other groups who provide health insurance but are open only to selected groups of people, for example to employees of certain companies.

Other forms of (health related) insurance

Private health insurance will not provide an income or cash sum while you are ill. It only covers actual medical costs. There are other policies that may pay out a cash sum or regular income in certain circumstances if you become ill or incapacitated.

• Income protection insurance
• Serious illness insurance
• Fixed insurance cash plans

Review your health insurance

You should review your health insurance cover at least once a year, when you receive your renewal notice. You may be able to make significant savings by changing your level of cover, if you are over-insured for your current needs, or by looking for quotes from other health insurance providers.

You can switch health insurance provider during the term of your policy. However, depending on your insurer, there may be charges for doing this, so you should always check before you switch.

Switching – what to look out for

If you switch, your new insurer may impose waiting periods for any extra benefits available on your new plan. Your old insurer may also insist on you paying the government health insurance levy upfront if you switch mid-term. More detailed information on the switching policy of individual providers is available on the Health Insurance Authority’s (HIA) website. It is very important to check this information before you switch.

Reasons why you might want to change your health insurance

There are a number of reasons why you might want to review your cover. These may include:

• Changes in your life or plans for the future, e.g. you may have had children or be planning on having a child
• You need extra precautions against unexpected ill health
• Your health has changed and your existing plan no longer covers you
• You are over-insured and could save money by reducing your level of cover
• You want better value cover

How can you save money?

You could potentially save money by:

• Opting for a cheaper corporate plan that offers similar benefits – though often marketed towards employers, corporate plans can be taken out by individuals. All plans offered by a health insurance company must be available to all consumers. Many insurance websites will specify if a plan is a corporate plan when you are getting a quote online. If you are unable to find information on the corporate plans offered by a health insurance company online you can contact them directly for a quote.
• Putting your children on a different plan to yourself.
• Getting quotes from different providers.
• Paying an excess on any claim you make.
• Downgrading your cover to save money. If you decide to downgrade, you need to consider whether the savings are worth any loss in cover and think about whether a lower level of cover suits your needs. You should be aware that 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. This depends on your insurer, so make sure you check before you decrease your cover. There is more information on the waiting periods that apply on the Health Insurance Authority’s (HIA) website.

How much does it cost or how much will I save?

Any costs or savings will depend on your new level of cover. There is a useful comparison on the HIA’s website where you can compare the cost of plans from different insurers for similar benefits.

What do I need to do when switching provider

If you are switching providers, take the time to read your new policy documents carefully and if you have any questions on your cover, contact your provider. If you are switching to a different insurance provider, you will need to cancel the direct debit to your old insurer. To stop a direct debit you must cancel it by writing to your bank. You should also contact the third-party supplier, in this case your old insurance provider, to make sure that the direct debit has been cancelled.

Last updated on 4 February 2022