Health insurance

To insure or not to insure?

What is health insurance?

Health Insurance is a form of insurance that people take out to cover healthcare costs. In Ireland, health insurance offers cover for hospital stays (including maternity cover), consultant and GP visits, psychiatric care (including inpatient and outpatient stays) and drug and alcohol rehab. It also covers the cost of non elective surgery (i.e. necessary surgery). Hospital cover includes both private and semi-private accommodation. A semi private bed is a bed in a ward shared with three other people and a private bed is a bed in a room of your own.

Health insurance companies in Ireland do not cover the cost of prescriptions, as it is assumed that patients use the government subsidised Drugs Payment Scheme. If you sign up to this scheme, you will never have to pay more than €132 a month for your meds. This may not be much use to you if you only require the odd antibiotic, but if you are on regular medication it can save you significant amounts of money.

How does it work?

If you would like to purchase health insurance you can choose from any one of the main health insurance companies in Ireland – VHI, Quinn Healthcare and Aviva. Some jobs offer subsidised health insurance also.

There are tons of different plans with different levels of cover i.e. some plans cover private accommodation in hospitals, while others only cover semi private accomadation. Various plans are marketed towards different groups also i.e. businesses, families etc. However, BY LAW, insurance companies must sell you any plan that you request, even if it isn’t marketed towards your specific group.

If you want to look at all the different companies and plans available, click here to go to healthinsurancecomparison.ie.

Once you have decided on the type of plan you want to go for, you can contact the insurance company and request an application form. You can pay for your health insurance in one lump sum for the year or you can arrange for a direct debit to come out of your bank every month.

If you change your mind within 14 days, you can cancel your insurance contract. This is known as a ‘cooling off period’.

Generally, most costs involved in staying in a hospital are covered. However GP and consults visits are only partially paid for by health insurance. So, for example, if your GP visit costs €60, your insurance provider may pay only €30 of that.

You need to pay your doctor at the time of the visit and get a receipt. You then fill out a claim form and send it to your insurer, along with your receipt. Information on what your plan covers can be found in your introductory ‘welcome' package, on the company’s website or by phoning up their customer service line.

Pros

If you are hospitalised, private insurance will get you a private or semi private bed. You cannot be guaranteed a semi private or private bed however, as sometimes all private and semi private beds are full in busy hospitals.
If you need to see a consultant, you will not have to wait on the public waiting list (which can be as long as one year for certain consultants in certain areas) and can instead choose to see a consultant privately. With a private consultant, you will usually not need to wait as long. Also, you can generally choose to see whichever consultant you prefer.
If you need surgery, you will not have to wait as long to get it; as you will be able to choose to get the operation done privately, with much of the costs covered by your insurer.
It has been suggested that private consultants and hospitals are more likely to offer new treatments, however this cannot be guaranteed and really depends on the individual doctor.
If you have a high level of cover, you can go to clinics such as the Blackrock Clinic, The Beacon Clinic and The Mater Private. This can be an advantage if you wish to see a certain consultant.

Cons

It costs. You can shop around for value, but health insurance costs have risen in recent years. In particular, VHI raised their prices significantly in 2011 and are likely to do so again in 2012. The government announced in Budget 2012 that it would cut the subsidies of private beds in hospitals, so health insurance costs are likely to rise again.
It's not all covered. If a procedure or test is considered ‘experimental’, your insurance may refuse to pay for it. Normally, if a doctor is doing an unconventional procedure or treatment however, he should inform you of this issue beforehand so that you can decide if you want to pay for it yourself.
If you are generally healthy and have no chronic disease or conditions, you may not really use it. You might be just as happy to go with the public system if you ever do need a consultant or an operation. You may not want to pay hundreds of Euro a year for something you rarely use.
Legally, you are entitled to public healthcare. Your taxes pay for it, so you may feel that you should get what you pay for. Public healthcare covers the cost of hospital stays, consultant visits and operations.
Private health insurance doesn’t usually cover alternative medical practitioners, so if you are more into the alternative route than conventional one, it won’t be of much use to you.

Further Information

Health Insurance Authority

Insurance ‘jargon’ buster

Citizens Information

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