Health Insurance | Choosing a Policy

Health insurance in Ireland

Health insurance is used to pay for the care you get in private hospitals or from private health professionals. Depending on the plan you have, other benefits may be covered as well. Having health insurance means you are mostly covered for private and semi-private hospital accommodation depending on your policy and whether the rooms are available. Consultant services you receive as a private patient in hospital are included too.
Your cover can be expanded to include everyday medical expenses such as maternity, dental, overseas, psychiatric and outpatient costs.
Most insurance companies will pay the hospital directly.
In the case of the costs of outpatient procedures, such as MRIs, you pay and then claim the money back from your insurance company.
Health insurance is available to everyone in Ireland. It doesn't matter how old you are or how healthy you are, though there may be a waiting period before you can claim for treatment.

Choosing your policy

Let’s face it, choosing health insurance is a difficult task. It is hard to know what level of cover suits your needs so here is some advice that might help to make that decision a little easier.

Here is some advice to help you select the right health insurance policy for you.
Take the time to shop around. There are lots of policies available to you. Some will suit you better than others. Please don't be afraid to ask us. We're here to help you get the right cover. We'll give you open and honest advice.
Switching health insurers is really simple. It can be done in minutes over the phone. Keep in mind, though, that you can only switch when you are renewing your annual policy. So, it's a good idea to start looking at your options 2-3 weeks before your annual renewal date.
Most policies focus on inpatient and day-patient benefits. Some provide you with substantial outpatient benefits too. "Inpatient" is when you are admitted to hospital for one or more nights. "Outpatient" or "day-patient" is when you can go home on the same day as the procedure or treatment.
You should ask yourself what kind of hospital cover you want. Would you like a semi-private room or would you prefer a private room? Do you want to be covered for private treatment and facilities in public or private hospitals, or both? If you'd like to be covered for private hospitals, which ones would you like?
Take a moment to consider which benefits are most relevant to you. Think about your lifestyle. You might be the sporty type or be planning a family, for instance. Some policy benefits fit these circumstances much better than others.
Also think about how often you are likely to claim a particular benefit. You might find that it wouldn't really be that often at all. So, you might be better off leaving it off your policy and saving the money.
Once you've narrowed down what you need to cover, look at the policies you think would suit you.
When you're comparing policies and weighing up the differences, consider whether the differences are worth a higher premium.
You'll find an independent health insurance comparison at www.hia.ie.

Market decline and why it matters

Private healthcare is based on a community-funded model. All of the premiums go into a central fund and members take money out when they become ill. If fewer people pay into the fund, there will be less money available to pay for treatments for people who need them.
The principle of private health insurance is that the young and healthy help to fund the needs of the older/less healthy.
The economic downturn had a serious impact on the number of people who could afford private health insurance and almost 300,000 people opted out of having health cover between 2008 and 2014.
There were other reasons too. The cost of health insurance has increased significantly as a result of the introduction of the Health Levy and the reduction of Tax Relief. Health premiums make it harder for people to afford health insurance.
Furthermore, the introduction of public bed charges in 2014 means that private patients admitted through A&E in a public hospital will be asked to waive their rights to be treated publicly, meaning that the private patient’s insurer pays up to €813 for each night of their stay rather than the €80 it would cost if they were treated as a public patient. That’s over 10 times the cost for potentially no additional services of benefits.
It’s important that you understand your rights as a private patient. If you’re being asked to pay extra, you should ask what additional services and benefits you’ll receive if you waive your rights to be treated publically. Make an informed decision before you sign.
More widely, the decline of the health insurance sector in recent years has had a considerable knock-on effect.
It means more people have to rely on an already over-stretched public healthcare system, leading to longer waiting lists and this isn't good for anyone.
The introduction of Lifetime Community Rating in May 2015 has helped to address the decline, encouraging more people, particularly younger people, back into the system.
But we are still a long way off from where we were pre-2008 and the Government, health insurers and health providers need to continue to work together to ensure health insurance is an affordable option now and into the future.

272,000

people dropped their health insurance between December 2008 and December 2013

24,000

people bought health insurance between June 2016 and June 2017 Source: Health Insurance Authority

What Affects the cost of Health Insurance?

People often ask about the cost of health insurance premiums and why these costs increase from time to time. The simple answer is that as more people claim on their health insurance having received more advanced and more expensive treatments, the cost to the insurer rises. Here we look at three factors that can impact on the price of premiums in more details.

The cost of claims

Advanced medical treatments, particularly in the areas of oncology, orthopaedics and cardiac care are good news for patients
Advancements in medical technologies can significantly reduce the time it takes to recover, whilst improving patient outcomes
However, new and better technology means that the cost of providing these advanced treatments has increased significantly and this directly impacts the cost of claims
At laya healthcare, the cost of claims climbed by 37 per cent between 2013 and 2016

Medical inflation

Medical inflation outpaces general economic inflation the world over. In 2014 it was estimated that medical inflation stood at 8.3% compared to 7.9% in 2013
This means that whilst we are seeing a general decline in the cost of consumer goods (economic inflation), we are equally experiencing increases in the cost of hospital services and pharmaceutical drugs, together with a rise in the cost of medical professional fees
This rise in medical inflation results in a rise in the cost of claims

Increase in the number of claims

More people claimed on their health insurance in the past year than in previous years. Laya healthcare alone experienced an increase of 40 per cent in the volume of claims in 2015
So whilst more people are being looked after and whilst better practices, high-spec technology and improved treatments are all translating into better outcomes, they are driving medical costs higher and this can have a negative impact on premiums
There has been a significant increase in the cost and volume of claims from public hospitals in recent years, largely driven by the introduction of the public hospital bed charges, which changed in the way public hospitals charge private health insurers. Before, health insurers were charged 10 times the overnight accommodation rate if their member was accommodated in a semi-private or private room. Now, all privately insured patients are being asked to sign a Public Hospital Waiver Form when being admitted to hospital via A&E, effectively waiving their right to be treated publically and in so doing agreeing to be charged €813 a night, that’s 10 times the cost, regardless of whether they secure a semi-private or private bed or not.
Sounds unfair, right? Well for many it can be, and the most important thing is to know your rights and entitlements as a private patient when being admitted to a public hospital and to ask one key question before signing the waiver form: “what additional services and benefits will I receive if I sign and waive my right to be treated publicly”.

Government Policy Decisions

The Health Levy was introduced in 2009 and increased by 178% for adults and 179% for children in the eight years to 2017. From April 1st 2017 the two levy rates for adults are €222 and €444; and two rates for children are €74 and €148. The rate applied is dependent on the level of insurance cover purchased with those on more advanced policies paying the higher levy. Reduced rates can apply to some policies depending on health credits gained due to age and general health. Everyone pays the same amount, regardless of what they are paying for their level of cover. The Health Levy has played a big part in pushing up premiums in recent years. Higher premiums are making people turn their backs on private health insurance.
Public bed charges, first introduced by the Government in 2014, cost health insurers approximately €200m a year, four times the initial cost estimate. The charges have directly contributed to an increase in claim costs in public hospitals, and this has a knock-on impact on the cost of health premiums. Simply explained, public bed charges are incurred when private patients admitted through A&E in a public hospital are asked to waive their rights to be treated publicly, meaning that the private patient’s insurer pays up to €813 for each night of their stay rather than the €80 it would cost if they were treated as a public patient. That’s over 10 times the cost for potentially no additional services of benefits. It’s important that you understand your rights as a private patient. If you’re being asked to pay extra, we advise you to ask what additional services and benefits you’ll receive if you waive your rights to be treated publically. It’s important to make an informed decision before you sign.

[1] 2014 Global Medical Trends Survey Report, Towers Watson

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