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 and ESB employees. Approximately 2,000,000 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 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.
It was announced in 2013 that the amount of tax relief allowable on health insurance premium would be limited to €1,000 for adults and €500 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.
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
- 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
Sample Plan Cost
|under 55||26 weeks|
|65 or over||26 weeks|
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 enrolment||Waiting period|
|under 55||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.