Health Insurance is used to pay for healthcare should you fall ill or have an accident. In Ireland it will cover you for a stay in a public, private, or high- tech hospital and for outpatient health care, as well as day to day health expenses all to varying degrees depending on the health insurance plan you choose.

The healthcare system in Ireland is complex with parallel private and public hospitals and out patient services, and the wide range and varying levels of cover of private health insurance plans reflects this.

There is no legal obligation to have health insurance in Ireland, the public health system is available to all.

However, the public health system can be difficult to access, with long waiting lists, as well as overcrowding, so for access to private hospitals, and to see a medical consultant privately you will, realistically, need private health insurance.

There are also high- tech hospitals with more advanced treatments which, realistically, you will need private health insurance to access as well.

Tax relief is available for health insurance, your premiums include tax relief at source.

Health insurance Ireland

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What is health insurance?

Health insurance may provide cover for in-patient charges and hospital accommodation in private hospitals as well as provide cover for private hospital day case treatment (public hospital in-patient and day service fees were abolished in April 2023), consultants fees, medical specialists fees, maternity cover, mental health in and out patient care, substance abuse treatment, overseas healthcare cover.

There is a complex array of health insurance policies available and prices also vary widely, depending on what cover you require.

Health Insurance Providers in Ireland

When considering health insurance in Ireland, there are 3 health insurance providers that should be considered.

VHI Health insurance
Laya Health Insurance
Irish Life Health Insurance

What does health insurance cover?

As a minimum, health insurers are legally obliged to cover

  • A minimum level of public day care
  • Inpatient hospital accommodation and treatment
  • Hospital outpatient treatment
  • Maternity benefits
  • Convalescence
  • Psychiatric in patient treatment
  • Treatment for substance abuse

In practice, health insurance plans will offer a wide range of cover in these areas, as well as differing levels of day to day medical expenses, cover abroad, and provider specific health supports eg. minor injury clinics, screening, digital health support etc.

What does health insurance cover

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What else can health insurance cover?

All insurers offer digital nurse and GP services for advice and treatment, with varying access depending on your plan. Laya and Irish Life also offer access to mental health support and advice online or over the phone 24/7.

The three insurers offer access to their own minor injury clinics (or reimburse for access to local clinics). These private clinics offer quick access to medical care for illness or minor injury and can diagnose and treat on site.

laya

Laya Health Insurance Policy

Laya offers health screening with their Healthcoach programme offering personalised fitness, nutrition, and wellbeing programmes. They also offer cardiac screening every two years to members.

Laya also offers Health in the Home, where members can receive treatment and care at home, should they be well enough to leave hospital with this support. Laya and VHI also offer some support for convalescence, depending on your plan.

Laya offers Foundation One CDX, and Oncotype DX test both of which offer advanced services for those diagnosed with cancer or breast cancer.

irish life

Irish Life Health Insurance Policy

Irish Life offers Back Up, Female Health Consultation, and Heart Care, all of which offer individual support for those diagnosed with health issues to receive targeted support from specialised health professionals.

Some health insurance offers cover for hearing care, and laser eye surgery.

Fertility treatments are covered on some plans.

Some plans offer cover for medical tourism or choosing to be treated abroad.

How much does health insurance cost in Ireland?

Example 1

VHI One Plan – from €102.74 monthly

Hospital Accommodation – offers semi private accommodation in a private hospital and semi private accommodation in a public hospital, covers inpatient medical costs, diagnosis, and treatment with a private hospital excess of €125.

Outpatient/ Everyday Medical Expenses

  • €60 per consultant visit
  • €60 for referral to a consultant pathologist
  • €60 per consultant radiography procedure
  • 6 visits to their online GP

Access to core services (€75 excess) and covers a personalised follow- up package following referral from core service.

Offers cover in a public hospital for 3 days, in-patient consultant fees, and a midwife support service.

Offers in-patient treatment for 100 days, cover towards day care psychiatric treatment, 91 days in an approved in-patient treatment centre for alcohol/drug/substance abuse per 5 year period.

Offers up to €65,000 for emergency medical treatment abroad per year, and €65,000 for medical treatment not available in Ireland if approved in advance.

Example 2

Irish Life First Cover – from €38.67 monthly

Hospital Accommodation -Semi private and private accommodation in public hospitals, inpatient consultant fees and inpatient scans, day care in public hospitals.

Outpatient/ Everyday Medical Expenses

  • €50 per consultant visit
  • €26 towards convalescence for 14 days, unlimited digital doctor visits
  • €250 for emergency dental treatment
  • €80 for home recovery for 10 days
  • €50 for 5 visits for manual lymph drainage
  • cover for medical and surgical appliances
  • 50% off up to €100 for treatment at their minor injury clinics
  • 50% of consultant pathologist fees and tests
  • 50% off cost of radiology consultant fees and tests
  • Access to their Back Up service, cover towards laser eye surgery, and cover towards an international second opinion

Inpatient maternity consultant fees, €400 in public maternity hospital cover.

100 days in-patient hospital cover (at the level of your plan), 91 days in-patient treatment for alcohol or substance addiction every 5 years.

24hour telephone support when abroad, €55,000 cover for in-patient emergency medical treatment, repatriation expenses up to €1,000,000, €1,000 cover for a companion to remain with the patient or €1,000 for companion repatriation.

Example 3

Laya Flex 250 Choice – €173.20 monthly

Hospital Accommodation- Private accommodation in public hospitals, semi private accommodation in private hospitals, cover for specialist cardiac and specified orthopaedic procedures in high tech hospitals. This is subject to €100 day case excess, and €250 in-patient excess per claim.

Outpatient/ Everyday Medical Expenses

  • €30 per GP visit,
  • €20 per year home testing kits,
  • €60 per consultant visit,
  • €60 per hospital casualty visit,
  • radiologist €50 per scan (up to 4200 per year),
  • pathologist €50 per test,
  • €60 per year towards routine dentistry,
  • €450 for emergency dentistry,
  • €30 optical benefit per year,
  • €25 per physiotherapist visit up to 25 visits per year,
  • €50 per year for travel vaccinations, adult counselling psychologist €40 per visit up to 8 visits per year,
  • osteopath 30 per visit up to 12 visits per year,
  • chiropractor €30 per visit up to 12 visits per year,
  • occupational therapist €20 per visit up to 5 visits per year, chiropodist/ podiatrist €20 per visit up to 5 visits per year,
  • home nursing following in-patient treatment €50 per day for 40 days,
  • Hormone treatment for gender dysphoria is covered up to €500 per lifetime, full refund for approved appliances,
  • Dean Clinic €50 per visit up to 12 visits per year,
  • Lois Bridges €50 per visit up to 12 visits per year.
  • There is an out patient limit of €6,500 per year on this plan.

Offers cover in a public hospital for 3 days, or €3,500 for homebirth costs, in-patient maternity consultant fees are covered, outpatient maternity consultations are covered up to €500 per pregnancy, post natal home nursing is offered up to €1,600 for two nights,. There is cover for fertility treatments in this plan with 50% off approved fertility treatment up to €1,000 per year, and cover for fertility preservation.

This plan offers specific support for cancer patients. With full cover for a breast prosthesis and hairpiece following treatment, €100 per night for accommodation for cancer patients, €500 per year towards manual lymph drainage, and cover for 1 sleeping cap.

Apart from outpatient cover mentioned above, there is cover for 100 days in-patient treatment, and 91 days alcohol/substance/drug or gambling addiction in-patient treatment.

Cover up to €100,000 per episode of illness or injury whilst abroad, full cover in the UK or EU for treatment not available in Ireland, full cover up to the cost of treatment in Ireland for medical tourism in the UK or EU, and €100,000 cover for gender affirmation surgery abroad.

Unlimited GP live consultations, Heartbeat cardiac screening, full cover for MRI, CT, and PET scans, full cover for a bone density dexa scan, €60 per year towards women’s cancer screening, €50 per year towards men’s cancer screening, and €250 cover for an Executive Health Check.

Health insurers must offer cover to anyone who applies (open enrolment).

They must also offer lifetime cover ie. if you have a health insurance policy and you continue to pay your premiums the health insurance company must continue to cover you no matter how many times you claim. Lifetime community rating means that a 60 year old will pay the same for the same cover as a 30 year old.

This depends on when you first took out cover as, if you are 35 or older on first taking out health insurance, you will pay more initially for cover.

You will in this case, pay your basic premium and a loading, which is an increased payment based on the age you first took out health insurance (this starts at 2% at age 35 and 2% is added every year after).

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Why should you have health insurance?

Everyone should consider health insurance as there is nothing more important than prioritizing health. Health insurance provides the following benefits:

  • Cover unexpected medical bills
  • Private health care

  • Day to day medical treatment

  • Maternity benefits

  • Covered while overseas
Why should you have health insurance

Cover Unexpected Medical Bills

Most hospital and medical bills are unexpected and can be extremely expensive. Health insurance will give you the peace of mind that you are covered should you need to pay for healthcare for yourself, your spouse, or your children.

Private Health Care

Access to private healthcare will usually mean that you are not faced with long waits for tests or treatment and can be treated by a medical consultant privately.

Day to Day Medical Treatment

Some health insurance plans offer benefits for day to day medical treatments, with GP visits and allied healthcare included in your plan as well as health screening. This allows you to take more control of your health and receive care for chronic conditions.

Maternity Benefits

Maternity benefits offer private care in your maternity hospital as well as care from an obstetrician at each stage of pregnancy and birth as well as private accommodation in the hospital.

You can also receive benefit for a home birth from Laya healthcare. Fertility treatments are included in some plans also from approved fertility services.

Covered While Overseas

Many plans offer overseas cover, both for emergency medical treatment abroad and for treatment unavailable in Ireland.

Health Insurance FAQs

An excess is the amount you will pay out-of-pocket to your healthcare provider before you are covered by health insurance.

In-patient excesses are usually an amount eg. €150 which is not covered by health insurance each time you are admitted to hospital.

Out patient excesses vary and may vary within your plan for different treatments eg. there may be an annual outpatient excess of €1 in you plan or you may have to pay an excess each time you attend the minor injury clinic.

Sometimes you have to reach an excess or threshold per year before you can claim back expenses.

There can also be annual limits in cover eg. a total outpatient limit or you may be covered only for a certain number of treatments per year.

A waiting period is the time before you are covered when you first take out health insurance or you increase your cover.

Usually, you are covered immediately for an accident. However, for new or pre- existing illnesses you may need to be covered by and paying for your health insurance policy for some time before you are covered for treatment for this condition.

There may be a waiting period of 5 years for a pre-existing condition.

This may also apply where you upgrade your cover, a waiting period may apply for the increased level of cover for a pre-existing condition. There are usually also waiting periods for maternity cover.

In-patient and day patient hospital treatments are usually paid directly to the hospital (less any excess which you will have to pay to the hospital yourself).

Outpatient tests and treatments may vary, depending on your insurer and plan.

Everyday expenses eg. GP, physiotherapy will usually be paid by you and reimbursed by the insurer at the end of the year, but again it is best to check.

It is also important to note that some treatments have to be pre-approved by your insurer.

This can vary between insurers and plans so it is always best to check this.

Health insurance plans vary in what they cover. It is possible to have health insurance that covers public hospitals only (although some of these have been removed from the market since April 2023, as public hospital in-patient charges have been abolished eg. VHI Plan P).

Hospitals are differentiated into public hospitals, private hospitals, and high tech hospitals, with different health insurance plans offering different levels of cover for each.

Further to this, health insurance plans differ in the levels of outpatient and/or everyday medical expenses they cover and you may access these health providers privately with the appropriate level of cover.

On taking out health insurance for the first time, or upgrading your cover, you will be subject to certain waiting periods.

Waiting periods for pre-existing conditions can be 5 years so, although you may be covered for an accident immediately, unfortunately, you will receive any benefit for your terminal or critical illness for that time.

You may be able to obtain health cover for an accident or injury or for a new condition though.

A Lifetime Community rating refers to an additional charge on your health insurance premiums (premium loadings) if you do not have a health insurance plan before the age of 35.

The lifetime community rating premium loading is 2% added to the premium for each year that you are over 34.

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