Health insurance, also known as private health insurance, in Ireland is used to pay for private medical care as an inpatient, outpatient, day patient or for care from health professionals.

When you take out health insurance, you will not necessarily be covered immediately. You may have to serve a waiting period before you can make a claim on your policy.

Health Insurance Waiting Period

What is a waiting period for health insurance?

A health insurance waiting period is the length of time you need to wait before your health insurance plan covers you for a claim or will offer a benefit for your medical expense or treatment.

Where you may have to serve a waiting period, cover on your policy may be restricted in certain circumstances and you may not be fully covered for all claims.

If any ailment, illness, or condition has presented signs or symptoms within six months of taking out health insurance, it is deemed a pre existing condition i.e. the ailment, illness or condition existed in those six months.

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When do waiting periods apply?

Waiting periods are quite complex and may apply when you

  • Take out health insurance for the first time.
  • Allow your health insurance cover to lapse for more than 13 weeks.
  • Switch from one health insurer to another.
  • Upgrade your health insurance cover i.e. take out a health insurance plan that offers a higher level of cover, more comprehensive cover, or additional benefits to your original plan.
  • Have a pre-existing condition when you take out health insurance or upgrade your health insurance cover.

Are there any exceptions to these waiting periods?

Generally, waiting periods do not apply if you require emergency care for an injury or accident.

For new born babies or children that have been adopted, there is usually no waiting period provided they are added to your health insurance policy within 13 weeks of birth or adoption.

Which health insurance companies have a waiting period?

The following companies provide private health insurance cover in Ireland subject to waiting periods:

There are two companies that offer health cash plans:

All health insurers offer cover for health related care and expenses (cash plans do not cover inpatient treatment) subject to waiting periods.

New customer waiting periods

If you take out health insurance for the first time, or you have a break in cover of more than 13 weeks since you were covered by a health insurance plan, you will have to serve an initial waiting period.

Generally, you will have to serve an initial waiting period of 26 weeks after taking out a health insurance policy to avail of the cover provided by that policy.

Emergency care for an injury or accident is usually covered immediately by most insurers.

If you have a pre existing condition then you will have to wait for maximum waiting period of 5 years to avail of cover where your treatment relates to that condition only. Health insurance benefits or cover for any new condition that arises should be covered after 26 weeks.

Generally, maternity cover has a waiting period of 52 weeks.

Some insurers offer fertility benefits only after a waiting period of 2 years.

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Day to day benefit waiting periods

Where your health insurance includes cover for day to day medical expenses, there may not be a waiting period for cover for new conditions if you make a claim for day to day expenses.

Day to day medical expenses may cover visits to your G.P., a specialist, or treatment by an allied health professional, such as a physiotherapist, or public A&E cover, depending on the details of your plan.

Irish Life Health applies a waiting period for some day to day expenses for new customers who are over 55. These include claims for post operative home help, convalescence, home nursing, inpatient support benefit, and cancer support benefit.

Day to day benefit waiting periods

Switching/upgrade waiting periods

A switching or upgrade waiting period may apply either:

  • Where you change your health insurance plan to another provided by your current health insurer that offers a higher level of cover or additional benefits.
  • Where you switch health insurers and purchase a new health insurance plan with a higher level of cover than the cover provided by your previous plan without a lapse of cover of more than 13 weeks.

If you have a new condition and you have already served your 26 week waiting period with another insurer, you will not have to serve the waiting period again.

You can also claim immediately from you new health insurer if your new level of cover or the benefit provided on the new plan is the same as or lower than that offered by your current insurer.

A waiting period will apply where you have upgraded your cover with your existing insurer or purchased a health insurance plan with a higher level of cover or additional benefits with a new insurer and you have a pre existing condition.

Generally, you will have to wait 2 years to avail of the additional benefit or higher level of cover to apply to your pre existing condition only. You should still be covered at the level of your previous policy for that condition.

Switching insurers and initial waiting periods

When you switch health insurers, you do not have to serve waiting periods again from scratch if there is less than 13 weeks break. The waiting period only applies if there is an increase in cover or in the benefit that you can claim.

If you switch insurers during the initial waiting period, the time spent with your previous insurer should be included in the waiting period and you would finish the waiting period with your new insurer.

For example, if you switched insurers after two years while serving a 5 year waiting period for a pre existing condition, you would serve the remaining three years with your new health insurer.

Cash plan waiting periods

Laya cash plans

Laya cash plans are subject to a twelve week waiting period when you initially take out cover.

A Laya cash plan is considered to be continuous cover in terms of serving a waiting period for private health insurance.

HSF cash plans

HSF health cash plans have a waiting period of 3 months for new claims and 10 months for the birth and adoption grant. There is a waiting period of 6 months for laser eye surgery and implantable contact lenses.

With HSF, you are covered immediately if your expenses are related to an accident.

Where you have a pre existing condition, there is a maximum waiting period of 5 years for a new customer, and 2 year waiting period applies to any increase in cover with HSF. If you have served waiting periods with a HIA insurer, you may not have to serve these waiting periods with HSF.

Waiting period FAQ

Insurers will tell you that waiting periods are designed to prevent individuals who are already ill purchasing health insurance solely for the purpose of obtaining cover for that illness.

As health insurers are bound by law to offer health insurance cover to all those who apply, regardless of age or health status, waiting periods also serve to restrict cover in order to make health insurance more affordable.

Your health insurance company will, in most cases, have medical advisers that will ascertain when your ailment, illness, or condition first existed on the basis of the signs or symptoms presented in the previous six months. The insurers will be guided on the basis of this medical advice.

If you have had private health insurance in another country, you may not have to serve waiting periods for Irish health insurance if you had a private health insurance policy in that country.

If you are aged over 35 on moving to Ireland, you have to purchase health insurance within nine months to avoid paying a lifetime community rating loading.

No. Everyone is entitled treatment in a public hospital and there should be no charge for inpatient treatment in a public hospital. You should not need to make a health insurance claim if you have been an inpatient in a public hospital.

If you have no pre existing conditions, you will still need to wait until 26 weeks in total have elapsed since you took out your first health insurance policy.

If you have pre existing conditions, you will need to wait for 5 years to avail of cover or benefits for that condition only. You waiting period will include the time served with your first insurer.

It is not always a good idea to switch health insurers before your next renewal date, usually 12 months after you took out the policy. Check with your insurers whether there are charges or penalties for switching during the period of insurance.

In Ireland there are legal protections around provision of health insurance.

Open enrolment means that anyone who applies to a health insurer must be offered cover.

Lifetime cover means that your health insurer must continue to offer you cover, no matter how many times you need to claim.

Lifetime community rating means that you will pay the same for health insurance, regardless of your health or age, although children or young people (aged 18- 25) may be offered discounts.

However, if you first take out health insurance when you are aged 35 or older, you will pay an additional 2% loading for each year that you are older than 34. This is called lifetime community rating loading and is designed to encourage younger people to take out health insurance.

You have to pay the loading for a maximum of 10 years.

Lifetime community rating does not affect waiting periods for health insurance. The only age related difference in waiting periods is for day to day medical expenses with Irish Life Health if you are over 55.

health insurance faqs

Contact us today

Waiting periods are complex and it can be difficult to understand how they may apply to you. If you wish to take out private health insurance, it can be unclear whether you have to serve waiting periods.

The Health Insurance Authority is the statutory regulator or health insurance in Ireland and has information on waiting periods and pre existing conditions.

We can also advise you on health insurance waiting times and how they may apply to you. Get in touch and find out about health insurance waiting times today.

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