Health insurance in Ireland: All you need to know

Understanding how health insurance works can be complicated, how it works in a foreign country even more so. We compiled the most important information about health insurance in Ireland for you, to make your life easier!

If you are going to live or stay longer in a foreign country, knowing about the health service and health insurance in that country is always a good idea. At some point it also becomes a good idea to get insurance there instead of your home country. Health insurance in Ireland can be complicated to understand, since more people here rely on private health insurance instead of public.

Public or private health insurance?

Everyone who is ordinarily resident in Ireland is eligible for public healthcare. But there are two levels of public healthcare. If your income is below a certain level, you qualify for a medical card, which gives you free access to medical care. If you don’t qualify for a medical card, some services cost money, like a stay in the hospital. The amount you pay is subsidised through the public system, so it is less than what non-Irish citizens need to pay, but it can still be a significant amount.

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Because of that, around 40 percent of the population choose to get private health insurance for coverage that may include treatment in private facilities. Ireland is the country with the highest number of people with private insurance in Europe.

For what do I need health insurance?

Your health insurance is used to pay for your stay in hospitals or doctor’s visits in general. Different companies have different arrangements with hospitals, but normally the company will pay the hospital directly. Generally, you pay the health professional for outpatient costs and then claim your money back from the health insurance company. Check with your own insurance company if you are unsure as to what procedures they use.

Health Insurance Authority (HIA)

The Health Insurance Authority (HIA) is the independent regulator for the private health insurance market in Ireland. It monitors the operation of health insurance businesses in Ireland and advises the Minister for Health by assessing the effect of any regulations or new legislation on consumers. The HIA ensures that consumers are aware of their rights and that everything about health insurance cover is explained in a fair and comparable way.

You can also compare the benefits of different health insurance covers using their comparison tool. All private health insurance providers must be registered with the HIA. They must also satisfy some requirements that relate to matters like their financial operations and their investment policies.

How to apply

You must apply directly to the health insurance company you wish to join. Well-known health insurance companies in Ireland are HSF Health Plan, Irish Life Health, Laya Healthcare and VHI Healthcare. There are general rules that each company must follow, but other than that they are free to operate as they choose. Because of that, the level of cover and rates available vary from company to company.

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The cover you receive through the insurance company depends on the price. For example, you can get either semi-private care in public hospital, semi-private/private rooms in public and/or private hospital or fully private care depending on how much money you spent on it. Usually, health insurance policies are 12 month contracts. If you want to change your insurer or insurance plan, you can do so at your next renewal date, though some insurers may have some restrictions to that. You must give all relevant information to your insurance company, otherwise they may void the contract.

Minimum level of benefits

Health insurance companies that are offering cover for inpatient hospital services must offer a minimum level of benefits for:

• day care/inpatient treatment
• hospital outpatient treatment
• maternity benefits
• convalescence
• psychiatric treatment and substance abuse

Waiting period

When you apply for health insurance for the first time, you may have a waiting period before you are fully covered, although accidents and injuries will be covered immediately. If you change to a health insurance plan with improved benefits there may be a waiting period before the new ones apply. You can find a list of the current initial waiting periods by different insurers on the HIA website.

Community rating

Insurance companies must charge the same rate for a given level of service, regardless of age, sex or health status. This is called the “community rating” and essentially means that all adults pay the same amount for the same benefits. Charges may be lower than the normal rate for people aged under 25, retired people with a special arrangement within their company’s health insurance scheme and people in group health insurances. Charges for children must be reduced by 50% or more.

Other insurance contracts

Insurance companies can offer contracts that are limited to certain health services, e.g., dental and optical services, without being subject to community ratings, open enrolment and lifetime cover.

Who can apply for health insurance?

Currently, health insurance companies must accept everyone that wish to join, regardless of age, sex or health status. This is known as “open enrolment”. There are so-called restricted membership schemes that have certain requirements for people to join. But even they must accept anyone who meets these requirements.

Once you decided to join an insurance scheme and continue to pay for it, the company cannot refuse to provide you with cover. This is called “lifetime cover”. An individual or family that already served both the requisite waiting periods when first taking on a private health insurance and any waiting period for a pre-existing condition can switch from one insurer to another. Also, if you switch within 13 weeks, you won’t have to sit through another waiting period. Therefore, people can normally switch insurers without losing their insurance cover.