Health insurance - cover for medical care
Health insurance helps cover medical or hospital expenses if you get sick, have an accident or need an operation. In this section you will find information on:
- Who provides health insurance?
- Types of health insurance cover can you get
- How to get the most suitable cover
- Know what you are buying
- Other forms of (health related) insurance
Who provides health insurance? In addition to the main health insurance providers (VHI Healthcare, Quinn Healthcare and Hibernian Aviva), there are a number of other groups who provide health insurance but are open only to selected groups of people e.g. to employees of certain companies.
Types of health insurance
There are two basic types of private health insurance cover available.
- 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 covers some or all of the cost of treatment by your doctor and other costs associated with hospital accommodation, tests and surgery.
- Outpatient or primary cover - this covers the treatment you receive from a health services provider although you are not admitted to hospital. It includes treatment in a consultant's room, in the accident and emergency room of a hospital or from a GP, physiotherapist or specialist.
You can take out both in-patient hospital cover and outpatient cover separately. Health insurers also offer packaged policies that provide cover for both services. Some plans may have very limited or no outpatient cover. Plans with limited outpatient cover usually only cover part of your expenses. This part of the expense is often referred to as the ‘allowable expense'.
Example one: a GP visit may cost €50 but the allowable expense may be only €15. Others include not only the cost of seeing your doctor, dentist or physiotherapist but also alternative treatments such as acupuncture, chiropody or osteopathy. Some plans may also have an excess, which must be reached before you make a claim.
Example two: the policy may state that they will refund 50% of GP expenses but this may only be on the condition that you pay an excess of €400 for out-patient expenses.
Hospital cover also varies with some plans providing cover for a semi-private room in a public hospital, whereas others will pay for a private room in a private hospital.
How to get the most suitable cover
As well as offering different benefits, the packages on offer from health insurance providers vary in cost. So it makes sense to get quotes from each provider and compare the benefits on offer to see what suits you best.
You can find out more information on the different health insurance packages and costs from health insurance providers in Ireland from the Health Insurance Authority. Consider the following:
- What level and type of cover are you looking for?
- Do you just want basic cover or are you prepared to pay more for treatment in a private hospital?
- What mix of in-patient and out-patient cover best suits your needs?
- Which product is best suited to your stage of life? 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.
- What services are available in the participating hospitals in your local area?
- How do the different products compare on cost?
- Are you looking for insurance for yourself or for your family, including any children?
Even if you choose to include cover for private hospital accommodation as part of your plan, you should be aware that there is no guarantee of availability (of private beds) in the hospital.
Know what you are buying/get the right cover
You should always be aware of the conditions of your cover and any restrictions that apply. Before signing up to a policy, ask yourself:
- Does it cover all treatments I may need? Some policies may not cover dental treatments, out-patient treatments, or experimental treatments. If you need cover for medical treatment abroad - make sure this is included.
- Do I understand all the details of the policy? Read all of the small print. If you do not understand anything, you should ask for an explanation.
- Do I have to serve a waiting period for a pre-existing condition? While that waiting period applies, you are not covered for private treatment for pre-existing conditions.
Generally, you cannot take out private medical insurance for a treatment you know you are going to need in the future. Some policies may not cover fertility treatment, or treatments you elect to have, e.g. cosmetic surgery, and may only have limited cover for mental or psychiatric conditions.
Other forms of (health related) insurance
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.