Private Healthcare Services

Not sure how the private healthcare system operates in Ireland? The summary below will give you a good understanding of how the market works and how the health insurers must provide their services.

Overview – Private Health Insurers

Vhi Healthcare is the largest provider of voluntary private health insurance. It is a statutory body whose board is appointed by the Minister for Health. The other health insurers are; Laya Healthcare, formerly QUINN-healthcare, Irish Life Health (formerly Aviva Health / GloHealth). There are a small number of ‘restricted membership undertakings’ that deal only with particular groups of employees such as the Gardai, Prison Officers etc.. Approximately 2,400,000 people hold private health insurance and having this cover doesn’t preclude you from your entitlements under the public healthcare system. However, many citizens prefer to go privately when accessing medical care.

Using private health insurance

Health insurance is used to pay for private care in hospital or from various health professionals in hospitals or in their practices. Most companies operate direct payment agreements for all in-patient and day-case treatment. For out-patient treatments, you pay the expensel yourself and then claim from the health insurance company at year end. Cover for these ‘out-patient’ expenses depends on the plan held. For example, many of the earlier plans provide little cover for these expenses whereas the latest corporate plans tend to provide guaranteed refunds subject to certain limits, e.g. 50%.

Risk equalisation

Risk equalisation is a process that aims to equitably neutralise differences in insurers' costs that arise due to variations in the health status of their members. All consumers pay health insurance levies as part of their premium which are used to fund our risk equalisation system through a complicated system of health insurance tax credits.

Tax relief

It was announced in 2013 that the amount of tax relief allowable on health insurance premium would be limited to €200 for adults and €100 for children (including students aged 18–23 years in full-time education). This change applied to all new and renewing policies effective from 16 October 2013. This is subject to change and should always be checked with the relevant tax authority.

Regulation of health insurance in Ireland

All private health insurance providers must be registered with the Health Insurance Authority and also the Central Bank of Ireland depending on their authorisation status. The Central Bank ensures that certain prudential requirements are adhered to - these are requirements that apply generally to all insurance and financial services companies and relate to matters like their financial operation, minimum solvency levels and their investment policies.

Minimum Benefits for Private Health Insurance

At present, companies that are offering cover for in-patient hospital services must offer a minimum level of benefits in respect of:

  • Day care / in-patient treatment
  • Hospital out-patient treatment
  • Maternity benefits
  • Convalescence
  • Psychiatric treatment and substance abuse

The minimum accommodation level is semi-private in a public hospital.

Companies are allowed to offer contracts limited to certain health services, e.g., dental and optical services, without being subject to the general requirements about community rating, open enrolment and lifetime cover. They may also offer contracts in relation to GP and out-patient services without having to meet minimum benefit requirements.

Open enrolment for Private Health Insurance

Health insurance companies must offer cover to everyone who wishes to join, subject to any applicable waiting periods before cover takes effect, regardless of age, gender or health status. This is known as "open enrolment".

Lifetime cover for Private Health Insurance

Once you join and continue to pay your premiums, the insurance company must offer to renew your cover each year subject to the same terms and conditions as other members, i.e. they cannot refuse to provide you with cover. This is called "lifetime cover".

Community rating for Private Health Insurance

"Community rating" means that the insurance company must charge the same rate for a given level of cover, regardless of age, gender or health status. It is the opposite to ‘risk-rating’ which applies in the motor industry. The legislation permits discounts for certain categories such as dependents aged under 18 or full-time students aged 18 to 23.

Waiting periods for all New Members

Initial waiting periods

Health insurers cannot risk-rate the premium, but they are entitled to apply an initial waiting period before private health insurance cover becomes effective:

Waiting period before private health insurance cover becomes effective

Age Waiting period
under 55 26 weeks
55-64 26 weeks
65 or over 26 weeks

Pre-existing conditions

In addition, the health insurer is allowed to exclude cover for any in-patient treatment of pre-existing conditions that are present on joining. This is to prevent people only joining when they have been diagnosed with an illness and now require medical treatment.

Waiting times for pre-existing medical conditions

Age at enrolmentWaiting period
under 55 5 years
55-59 5 years
over 60 5 years

If you have an existing condition but are treatment, drug and symptom free and this is supported by medical evidence, pre-existing conditions may be covered by the health insurers.  If in any doubt, this must always be checked with your preferred insurer prior to joining.  All claims are assessed based on the medical evidence provided and may be subject to review by the medical panel appointed by the health insurer.

Private Hospitals in Ireland

Click here for full details on the main private hospitals in Ireland including their location and full contact details.

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