Ireland operates on a two-tier model of health insurance, with a public and a private sector. The latter is divided between for-profit healthcare institutions and voluntary not-for-profit ones, often run by religious organisations. For-profit health insurance currently covers around 50% of the Irish population, many of whom are either not covered by Ireland’s national health service, run by the Health Service Executive (HSE), or prefer to avoid problems in public healthcare provision, such as lengthy waiting times and overcrowding. We will look at some of your options below.
Personalising your health insurance cover
You may wish to check with your employer whether you are covered under a group health insurance package. This will be a private scheme, but is worth considering depending on what is covered.
Your other option is to pay out of pocket for expenses. For example, a flat fee of €100 is charged for emergency care in Irish A&E departments – this is to prevent time wasters – unless you are referred by your GP, in which case it is free. A night in hospital costs in the region of €80. As with most Western nations, costs can escalate quickly, particularly in the private sector, and it is advisable to arrange some form of private cover.
Selectable options
Check the small print of any private health insurance policy to see whether it covers treatments that you may want to access, such as specialist surgical treatment or advanced dental care.
Remember to check whether your potential policy covers pre-existing conditions, the definitions for which will vary between insurers. Usually the term applies to any conditions that present symptoms or for which you’ve been treated in the last five years. This normally includes any conditions you were diagnosed with over five years ago, but some insurers have different time limits for when the diagnosis must have happened.
You may want to check whether your policy has a ‘hospitalisation’ clause covering you for occasional hospital visits. You may need to discuss this directly with your insurer. You may also wish to check whether there is a medical evacuation clause.
Take a good look at any potential policy for any cover relating to healthcare that does not apply to you. Some policies have provision for maternity care, for instance, and if you are not intending to become pregnant, then you may wish to reduce your policy costs by having such options removed.
Cost sharing
You may also be able to reduce the cost of your premium through ‘cost sharing.’ This means that you and your insurer will share the costs of any treatment. You will pay up to an agreed limit, and your provider will cover the rest. Different insurers will have different ways of arranging cost sharing:
Co-pay
This is where you pay a fixed sum for your treatment and your insurer covers the rest. For instance, if the total cost of your treatment is €85, and your co-pay amount is set at €40, then you will pay €40 and your insurer will pay €45.
Co-insurance
This is where you pay a fixed percentage of the total cost and your insurer covers the rest. For instance, if your coinsurance is set at 20%, you will pay 20% of €85 and your insurer will cover the remaining 80%.
Deductibles
This is where you pay the entire amount allowed for all services provided until the deductible is met. For instance, if your policy has a €1,000 annual deductible, you would pay €85 for each visit to your healthcare clinic and then, once you have had 11 such appointments, your insurance will begin to pay out to the doctor directly.
You may also need to look at whether there is an out-of-pocket maximum that you would be expected to pay after your deductible has been met. Let’s say that your plan above, with a €1000 deductible, also has a co-insurance option of 20% and an out-of-pocket maximum of €1500. In this instance, you would pay €85 for 11 visits to the doctor under your deductible until it is met. You will then pay €17 for each visit as your 20% coinsurance, until you reach the co-insurance ceiling of €500 (€1,500 minus the deductible of €1,000). At that point, you would pay nothing more for the remainder of the plan year.
It is worth doing the maths, especially if you don’t think that you’ll need to make more than a couple of visits to your GP in any one policy period. For example, if you just want dental check-ups and an occasional filling, it might be worth working out whether one or two out-of-pocket costs might be cheaper than full dental cover.
As so many variables have an effect on the cost of international private medical insurance, it is very difficult to give an accurate estimate of how much this might cost you, without knowing the full details of what coverage you require. However, as a very rough guide, using a standard profile of a 40-year-old British male with no deductibles, no co-insurance, a middle tier plan/product, all modules included and worldwide coverage excluding the US, a ballpark price of around £4,000/$5,000 might be expected. If you want your coverage to include the US, the premium could increase to almost double this amount.
Ireland has a Health Insurance Authority (HIA), an independent statutory regulator for the private health market, whose role includes evaluating any new regulations or legislation on consumers. This administers a Risk Equalisation Fund, which pays health credits to insurance providers for people over 60, to help meet their higher claims costs. The amount of health credits given depends on age, gender and level of cover, and they are funded by a community rating health insurance levy paid by health insurers.
Ireland has several local private providers which are governed by the HIA, including:
• Irish Life Health: offers basic plans, which cover treatment in public hospitals, up to more comprehensive plans
• Laya Healthcare
• Voluntary Health Insurance Board (VHI): runs a range of plans, including for individuals, older families and couples
These providers have open enrolment. They must accept anyone who applies, regardless of age, sex or health status. However, you may prefer to take out cover with one of the big international health insurance companies.