Frequently Asked Questions

Confused? Here we will demystify some of the terms that are often associated with the health insurance industry in Ireland. If we’ve missed anything or you’d like to know more, please let us know.
What is Universal Health Insurance?

Universal Health Insurance (UHI) is a scheme in which everyone has a mandatory, minimum level of private health insurance. It’s often referred to as a “basket of minimum benefits”.

  • UHI allows you to choose your insurance provider.
  • Everyone has equal access to health services.
  • Your access to treatments and procedures is based on your needs.
  • You can upgrade your minimum UHI cover.

While UHI had been considered by government (2014/2015), currently there are no plans for its introduction in Ireland.

If UHI is introduced, the Government would subsidise or pay premiums for people on low incomes.

What is Community Rating?

Community Rating is a system in which everyone pays the same amount of money for the same level of cover and benefits, regardless of age, sex or health.

What is Lifetime Community Rating (LCR)?
  • Lifetime Community Rating (LCR) was introduced in Ireland on 1st May 2015 with the objective of encouraging more young people to take out private health insurance and to stabilise premiums in the market.
  • Under LCR, the cost of your policy depends on how old you are when you take out private health insurance. If you take out cover before you are 35, no additional loading (or penalty) will apply to your premium.
  • However, LCR will see customers aged 35 and over pay an extra 2% loading per year, rising with age, in addition to their normal health insurance premium on joining the market. That means that if you take out your first health insurance policy when you are 40, you’ll be looking at a 12% loading. If you’re 50, the loading will be 32%. This loading is applied to your premium for as long as you hold your health insurance.
  • If you had health insurance in the past and let it lapse, this will be taken into account if you take out a new policy. You’ll receive credits for the years you had insurance.
  • If you have lived abroad and are returning home to Ireland, you’ll be given a 9-month grace period in which you can arrange health insurance without your age being taken into account. In other words, over-35s won’t be liable for any loading as long as they put insurance in place within those 9 months.
What does Risk Equalisation mean?

Generally speaking, health costs and claims increase as people get older.

So insurers with larger numbers of older members incur the greatest costs.

But, because everyone pays the same premium for the same level of cover, older people aren’t charged more for their insurance.

Risk Equalisation helps balance the books. It spreads the cost of claims made by older people across all the insurers.

This is done by way of transfer payments between the health insurance providers.

Who gets what is calculated based on each insurer’s share of the market of older people.

What's the difference between public and private healthcare?

Public health services are provided by the hospitals run by the Health Service Executive (HSE) and public voluntary hospitals and can be accessed by both private and public patients

They are operated with little or no charge to the public as they are funded by taxes and charges for services such as A&E (Accident and Emergency).The drawback is that being seen by a healthcare professional can take a while and we are all familiar with the problem of hospital waiting lists.

Private hospitals are quicker to access. They are also allowed to set their own patient charges.

Private health insurance may cover some or all of the costs of private hospital stays, treatments and procedures.

How do I know what level of cover I need?

Click here for more information about choosing the right cover for you.

What kind of tax relief am I entitled to?

You are entitled to tax relief on your private health insurance premiums, which reduces the amount of income tax that you pay. In other words, the taxman deducts some of what you pay for your cover from your income tax.

What is a waiting period?

Insurers are allowed a bit of “wait-and-see time” when you take out cover for the first time. They also get this time if it’s been more than 13 weeks since you last had health cover from a provider in Ireland.

Here’s an overview of waiting periods that might apply to you:

Waiting Periods   
Your Age on Joining Accident or Injury Illnesses that develop after you join Illnesses that develop before you join
Under 55 None 26 weeks 5 years
55 – 59 None 52 weeks 7 years
60 – 64 None 52 weeks 10 years
65 or over None 104 weeks 10 years

The waiting period before you become eligible for maternity and infertility benefits is 52 weeks.

If you upgrade to better cover and benefits for a health or medical condition that started before you arranged the upgrade, you have to wait two years before you can avail of the better cover and benefits.

What happens to my waiting periods if I transfer to Laya Healthcare?

If you’ve served all your waiting periods then you don’t have to wait when you transfer to us.

If you still have some time left on your waiting period, we’ll only expect you to see out the remainder before your cover and benefits kick in. You won’t have to start the waiting period all over again.

What is Medical inflation?

Medical inflation is the increase in the cost of medical care in any given year.

What are we doing about Medical Inflation?

We take this really seriously as it affects everyone.

So, for starters, we have a medical costs management programme, that has led to a significant reduction in hospital admissions through the promotion of better practices and efficiencies.

We also run a review programme with the hospitals, to help make sure you get looked after better, getting the best possible outcome for your condition or illness.

At laya healthcare, we’re also involved in negotiations with hospitals about the rates they charge. And we talk to our members. We make sure that they have received the treatments they were meant to get so that we are not paying out for procedures that never took place.

And it has paid off. We’ve been able to use the money we’ve saved and invest it in new and better services for our members such as providing healthcare at home, rather than in a hospital. We have also invested in a number of important health promotion programmes such as Super Troopers for primary school children and we have launched Head On, a baseline concussion screening programme in partnership with Leinster Rugby.

What is the Young Adult Rate (YAR)?

Young Adult Rate

The Health Insurance (Amendment) Bill provides for ‘Young Adult Rates’ of premiums. This was designed to address the sudden increase in premium rates that occurs for most young adults after their 21st birthday, where premiums can increase by 100% or more. This came into effect on 1st May 2015.

The rates are now age-based rather than student-based and are designed to graduate the premium payable between the child rate and a full adult rate.

Insurers will retain the discretion whether or not to provide Young Adult Rates on some or all of their products. Where an insurer chooses to provide them, they must provide the full range of rates within the specified bands:

 

Age % of Full Adult Rate
18-20 up to 50%
21 51% to 60%
22 61% to 70%
23 71% to 80%
24 81% to 90%
25 91% to 100%
26 100%

 

This policy change also removed the requirement for young people to be insured as dependents on a parent’s policy or regarded as a full-time student dependent on parents.