Q. What is private health insurance?

Answer. 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.

Q. Can anyone buy private health insurance?

Answer. 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.

Q. What is the difference between a public patient and a private patient?

Answer. 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 2016 (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.

Q. What should a patient do if asked to sign a Private Insurance Patient Form which means they waive their right to treatment as public patients?

Answer. Understand more here. https://www.insuranceireland.eu/consumer-information/health-insurance-and-public-hospital-access

Q. I have a medical card. May I also hold private health insurance?

Answer. 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.

Q. Will my age affect my insurance premium?

Answer. 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, or allow your insurance to lapse for more than 13 weeks 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.

Q. What is a pre-existing condition?

Answer. From 1 May 2015 a pre-existing condition is defined as:

“Pre-existing condition” means an ailment, illness or condition, where, on the basis of medical advice, the signs or symptoms of that ailment, illness or condition existed at any time in the period of 6 months ending on the day on which the person became insured under the contract.

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

Answer. If you allow your health insurance to lapse for more than 13 weeks you may have to serve your waiting periods again and a Lifetime Community Rating loading may be applied to your premium if you are age 35 or older.

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

Answer. 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. Take a look at the maximum waiting periods here. https://www.hia.ie/consumer-information/waiting-periods/new-customer-waiting-periods

Switching Health Insurance Plan

Q. Can I switch Health Insurance Plan?

Answer. In general, health insurance policies are 12-month contracts. If you switch insurer or plan and later want to switch back, you may do so at your next renewal date. In some cases, insurers allow policyholders to switch plans during the 12-month term. Currently only Laya Healthcare and Irish Life Health allow their customers to switch to another of their own plans mid-term without penalty. The insurer may impose waiting periods for any extra benefits available on your new plan.

There is no penalty for switching insurers at your renewal date. If you switch insurers mid-term, the insurer may apply a cancellation fee.

Q. If I switch insurance provider, will I need to serve the waiting period again before I am fully covered?

Answer. Once you serve these waiting periods you will not have to serve them again if you switch to another insurer, as long as you haven’t had a break in cover of more than 13 weeks

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

Answer. If you allow your health insurance to lapse for more than 13 weeks you may have to serve your waiting periods again and a Lifetime Community Rating loading may be applied to your premium if you are age 35 or older.

Q. If I upgrade my cover do I have to serve a waiting period? 

Answer. 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. You can view the different waiting periods currently applied by the insurers to new or existing conditions, under our section on upgrade waiting periods.

Links to relevant Articles for further FAQs on Health Insurance

HIA

https://www.hia.ie/frequently-asked-questions

https://www.hia.ie/consumer-information/selecting-a-health-insurance-plan