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Information : Health Insurance |
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Private health insurance is here to help you cover the bills or expenses of hospital treatment if you have an accident or get a sickness and need hospital care like an operation.
The Health Insurance Authority is the regulatory body for private health insurance in Ireland although VIVAS Health is regulated by the financial regulator.
If you want to make a complaint in relation to your health insurance, you should first contact the company or intermediary (broker) or agent who you bought the health insurance from and make your complaint to them.
If you are not satisfied with their final response, you have the right to refer your complaint to the Financial Services Ombudsman for review.
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Types of Health Insurance |
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There are two basic types of private health insurance cover available
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In-patient hospital cover - this pays for any services you receive if you are admitted to hospital, whether you stay the night or are treated as a day-patient. It can also cover some or all of the cost you may have that would be associated with your treatment like hospital accommodation, tests, surgery etc. With Health insurance from Vivas you can choose from five levels of hospital cover, which lets you decide what type of accommodation you'd like should you have to go to hospital. |
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Outpatient or primary cover - this covers the treatment you receive from a health services provider although you are not admitted to hospital. So your health insurance covers anything from
consultants fees to radiology, emergency dental care or even home nursing. |
Hospital cover is the cover you receive for any in patient treatment you may need which means you have to stay in hospital or have a day case procedure. You will be covered for your hospital costs, from getting
your tonsils out to cancer and cardiac treatment - all you have to do is decide the type of accommodation you would like. The advantage with this is that you control of the level of cover you wish to take out obviously you pay for extra cover. You can make your choice based on whether you'd like to stay in a semi-private room in a public hospital right up to a private room in a High-tech hospital
such as the Blackrock Clinic, Mater Private and Beacon Hospital. Vivas Health currently has direct payment agreements with all of the hospitals they are associated with for cover or the hospitals under your chosen level of cover. This is great as so you don't have to worry about paying the bill, Vivas Health will settle it directly with the hospital.
You can take out both in-patient hospital cover and outpatient cover separately. Health insurers also offer policies that provide cover for both services. You should always be aware of the conditions of your cover and any restrictions that apply. Before signing up to a policy, asking yourself:
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Does it cover all treatments I may need?
Some policies may not cover dental treatments, out-patient treatments etc. |
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Do I understand all the details of the policy?
If you do not understand anything, you should ask for an explanation. |
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Do I have to serve a waiting period for a pre-existing condition?
Check out the waiting periods for pre existing conditions.
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Generally speaking don't expect to be covered, if you take out private medical insurance for a treatment you know you are going to need in the future. Some health insurance policies may not cover fertility treatment, or treatments you do elect to have e.g. cosmetic surgery and may only have limited cover for mental or psychiatric conditions.
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Other forms of (health related) insurance |
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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 if you become ill or incapacitated, in certain circumstances, such as: Private health insurance will not provide an income if you are out of work because of an accident or sickness. Private health insurance only covers actual medical costs. If your occupation allows it taking out an income protection plan can be very beneficial as this pays out a regular income if you make a claim on the policy. There are extra benefits on the some of the policies depending on what company you choose like assistance for rehabilitation etc. The added bonus is that premiums are deductable against tax just like your pension. For further information on income protection talk to a consultant from our preferred insurance broker 'Responsible Insurance' on 1890 333 123
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Costs |
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Shop around for the best quote and cover as health insurance cover varies from provider. You can find out more about the different health insurance packages from The Health Insurance Authority, which regulates the private health insurance sector. Its publication, Understanding and Comparing Private Health Insurance Products, describes the main benefits of the various products on the market. Health insurance packages can be difficult to compare but you should consider the following:
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What level and type of cover are you looking for? |
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Do you just want basic cover or are you prepared to pay more for treatment in a private hospital? |
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Which product is best suited to your stage of life? |
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Younger people starting out may want cover for activities such as sports or physiotherapy and travel in addition to the basics. Those planning a family will be interested in maternity benefits while some packages are better suited to families than others. |
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Questions and Answers Private Health Insurance |
Q What is private health insurance?
Private health insurance is insurance that helps cover the health costs incurred as a private patient. Subject to the terms and conditions of health insurance contracts, the insurer may cover all or part of the medical and hospital expenses that a private patient incurs.
Q What is the difference between a public patient and a private patient?
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 €66 per day, up to a maximum of €660 in a year from 1st January 2008. You are entitled to free consultant treatment. You do not have the right to choose your consultant. If you hold a medical card you do not have to pay any public hospital charges. 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 a public hospital, you, or your insurer, must pay for your maintenance, in addition to the public hospital in-patient charges. From 1st January 2008 maintenance rates for treatment as a private or semi-private patient in a public
hospital will range from €184.80 per day for a semi-private room to €757.90 per day for a private room. Private hospitals are free to set their own charges and can be significantly higher. You, or your insurer, will also have to pay medical consultant's fees.
Q Are hospital cash plans, critical illness policies or income protection policies private health insurance?
No. These types of insurance are not licensed by the Health Insurance Authority. The sums of money provided by these plans are not based on the cost of the medical expenses incurred.
Q Who can provide me with private health insurance?
There are two types of private health insurer in Ireland:
Open Membership Insurers must provide insurance to everybody who requests it from them. Currently there are three such insurers operating in Ireland, namely Quinn Healthcare, VHI Healthcare and VIVAS Health. Restricted Membership Insurers provide insurance to people who are members of a particular group, normally a vocational group or employees of a particular organisation and their dependants. For example, such schemes are operated for members of the Garda Síochána and their dependants
and for employees of the ESB and their dependants.
Q Can anyone get private health insurance
Yes. All applicants for private health insurance cover must be accepted by a private health insurer, regardless of their risk status, age or sex.
Q Will my age affect my insurance premium?
No. The system applying in Ireland is called community rating, where a person's age does not determine the level of premium that they pay. There are a number of exceptions namely:
- Children, where the premium must be no more than 50% of the adult rate.
- Full time dependent students under the age of 23, where the premiums may be reduced. The reduced premium must not be more than 50% of the adult premium.
- Members of group schemes, where the premium may be reduced by up to 10%.
- Pensioners who are members of restricted membership insurers may have their premiums reduced.
Q Can my health insurer refuse to renew my contract if I get sick?
No. A system of lifetime cover operates in Ireland. This is a system that protects you by guaranteeing all consumers the right to renew their policies, irrespective of factors such as age, risk status or claims history. Once you have health insurance, an insurer cannot stop cover or refuse to renew your insurance,
except in very limited circumstances.
Q Can I change my health insurance plan or insurer at any time?
You have the right to change your health insurance plan, or insurer, without penalty. The insurer may not impose additional waiting periods unless you are upgrading your cover. Even when you are upgrading your cover, an insurer may only impose an extra waiting period in respect of the additional cover in the new policy. However, if you allow your health insurance to lapse for 13 weeks or more, you may have to start your waiting periods all over again. The maximum waiting periods that can be applied in relation to new benefits are as follows:
- 2 years for a person under 65 when first named under the higher contract.
- 5 years for a person of 65 and over when first named under the higher contract.
Q What happens if I switch from my current insurer and wish to return to them at a later date?
If you switch insurer and later decide you want to switch back, you may do so without penalty as long as you switch to an equivalent level of cover. However, the insurer may impose waiting periods for any extra benefits available on your new plan.
Q Do I have to serve a waiting period when I take out health insurance for the first time?
If you are taking out health insurance for the first time or have allowed your cover to lapse for 13 weeks or more, you will be covered for accident and injury claims immediately. However an insurer may apply a waiting period to all other claims. The waiting periods that an insurer may apply in these circumstances are as follows:
- 26 weeks in respect of a person who is under the age of 55 years.
- 52 weeks in respect of a person who is of or over the age of 55 years and under the age of 65 years.
- 104 weeks in respect of a person who is 65 years and over. If you are pregnant when taking out health insurance for the first time, a health insurer may impose a waiting period of 52 weeks in respect of maternity benefits.
Q I have a medical condition. Do I have to serve additional waiting periods before I am covered for this?
If you are taking out health insurance for the first time and have a pre-existing condition e.g. diabetes, the health insurer can impose a waiting period in respect of cover for treatment for this condition. The maximum waiting periods that the health insurer may impose in this case are as follows:
- 5 years, for a person who is under the age of 55 years.
- 7 years, for a person who is of or over the age of 55 years and under the age of 60 years.
- 10 years for a person who is 60 years or over.
It should be noted that whether or not a condition existed at the time that an insured person began serving a waiting period is decided on the basis of medical advice. Whether or not the insured person was aware that they had the condition at the time that they started serving the waiting period may be considered not to be relevant by the insurer. If this matter is important to you, you should consider clarifying it with your insurer.
Q If I upgrade my cover do I have to serve a waiting period?
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. The maximum waiting periods that the health insurer can impose in relation to the new benefits are:
- Up to 2 years for a person under the age of 65 years.
- Up to 5 years for a person who is 65 years and over.
Q Will my baby have to complete a waiting period?
Infants born to policy holders will not serve a waiting period if they are added to a policy within 13 weeks of their date of birth.
Q Can I claim tax relief on my health insurance premium?
Private health insurance premiums are subject to income tax relief at source at the standard rate (currently, as at November 2007, 20%). The premium charged by the insurer will automatically take account of this relief. When an insurer quotes you a premium, you should make sure that you are aware whether the premium quoted is net or gross of this tax relief.
Q Can I claim tax relief on the portion of my bill which isn't covered by the health insurer?
You can claim tax relief on the cost of certain qualifying medical expenses incurred by you, your spouse or your dependants at your marginal tax rate (currently, as at November 2007, 41% for those paying tax at the higher rate, 20% for those paying tax at the standard rate). Those not subject to taxation will
not be able to claim this relief. You should note, however, that you cannot claim relief in respect of sums already received or due to be received from any public or local authority (e.g. a health board), a private health insurance policy or any other source (e.g. compensation). For example, your health insurance policy gives you €20 for each doctor's visit. However the visit actually costs €50. You can then claim tax relief on the €30 which wasn't covered by your health insurer. You must keep copies of all your receipts for 6 years to avail of this tax relief. Further details of these reliefs, including details of medical expenses that qualify for tax relief, are available from the Office of the Revenue Commissioners
(Lo-call 1890 60 50 90 and www.revenue.ie).
Q I am moving to Ireland. Can I get private health insurance?
You can take out insurance if you become a resident of Ireland. You may, however, have to serve a waiting period. If you are an EU national and you become ill or have an accident during a visit to any EU country you can get free or reduced cost healthcare on production of a European Health Insurance Card. You can obtain this card from your country of usual residence.
Q How do I make a complaint about my private health insurer?
If you have a problem with your private health insurance, you should first discuss it directly with your insurer. If you are unable to resolve your complaint, you may contact the Financial Services Ombudsman. The decision of the Financial Services Ombudsman is binding on all parties but when one party is dissatisfied with the decision, it may be appealed to the High Court. You also have a right of access to the courts in respect of disputes with insurers.
If you are unsure of any details, wording etc in your policy a member of the team at Bumblebee.ie would be delighted to help you. Just call our support team on 1890 333 123 or e-mail us @ info@Bumblebee.ie
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