February 1, 2023
The Ultimate Guide to Private Health Insurance in Ireland
Private health insurance in Ireland offers faster access to high quality care. Learn about it, including how businesses can give employees private health plans.
Article written by
Ireland has a robust public healthcare system.
But many people turn to private health insurance for faster and better quality care.
Some employers also offer health insurance as part of their employee benefits package.
Keep reading to learn everything about private health insurance in Ireland. We'll also discuss how companies can manage employee health insurance easily.
Private health insurance is a contract that ensures the policyholder receives medical coverage from a private entity (insurance provider) and not the government.
Private health insurance covers expenses people incur when seeking private medical treatment.
These health insurance plans are usually available on an individual or group basis — including coverage for families and employees.
Looking to offer private health insurance to your employees? Use Yonder! It helps you manage employees' private health insurance plans effortlessly.
But do all health insurance plans offer the same benefits?
Typically, you can obtain three types of private health insurance in Ireland:
Cash benefit: This plan offers a fixed cash reimbursement for medical events like hospitalisation and surgery that isn't linked to inpatient costs.
Outpatient cover: This policy covers treatments received that don't require overnight hospitalisation. For example, coverage for GP visits, minor diagnostic tests, and emergency care.
Health insurance: A health insurance plan covers inpatient hospital costs and (usually) outpatient costs either fully or partially.
Policyholders can obtain combinations of these covers and customise plans based on their needs.
For example, some health insurance plans cover semi-private rooms in public hospitals. But more expensive plans may provide coverage for private rooms in private or high-tech hospitals.
The good news?
With Yonder, employees can pick the plan that best suits their needs and customise it with add-ons. They can stick with their employer’s budget or pay more (out of pocket) for a higher plan.
Ireland has a comprehensive public healthcare system.
So you may be wondering: What is the need for private health insurance?
Ireland's public healthcare system provides services to Irish residents and EU/EEA and Swiss nationals.
According to the Health Service Executive (HSE), you can access many public health services if you possess a valid European Health Insurance Card (EHIC).
Most services are free, but sometimes you may incur a fee — like when you have to visit a GP or purchase drugs and medicines.
But a major problem with public healthcare?
The long waitlists.
A private health insurance plan can help you skip the queue and receive priority care. It can also help you receive care at a private or high-tech hospital with access to specialised equipment.
Ireland has four leading private health insurance providers:
Irish Life Health
HSF Health Plan (Only provides cash benefit plans)
Besides these companies, you have health insurance providers who deal only with particular employee groups.
Their health insurance plans are called restricted membership schemes and usually serve groups like health services employees or Gardaí.
Looking to set up a corporate health insurance plan for your company? We can help you with that!
Did you know Ireland has strict regulations on health insurance plans offered to its residents?
All private health insurance providers in Ireland are registered with the Health Insurance Authority (HIA).
The HIA monitors these providers to ensure policyholders get access to a minimum level of benefits.
Every insurer must provide a minimum level of benefits for their health insurance plans.
For instance, if you subscribe to a plan that offers inpatient hospital services (like Yonder's Irish Life Health Plans), you get access to a minimum level of benefits for:
Inpatient treatment: Every Yonder plan (except the Kick-off Plan) covers all room and consultant charges at public hospitals.
Outpatient treatment: Yonder fully covers benefits like a digital doctor, nurse on call, sexual health screening, and metabolic testing.
Convalescence: Yonder offers a minimum of €26 for 14 days as a convalescence benefit.
Maternity benefits: The minimum benefit you get via Yonder is €385 for public hospital charges.
Psychiatric treatment: Yonder supports a minimum cover of 120 days.
Substance abuse treatment: Minimum cover of 91 days per 5 years offered via Yonder.
Policyholders get a minimum level of accommodation — a semi-private room in a public hospital.
You can get further information regarding the Irish private health insurance market from the HIA website (https://www.hia.ie/).
Anyone with a health insurance plan from an approved insurer can get tax relief on their premiums.
People don't have to claim their tax relief amount from Revenue (aka the Irish Tax and Customs Authority).
Instead, you get it as a reduction in the insurance premium.
This is called Tax Relief at Source (TRS).
For all health insurance policies, tax relief is provided at 20%. However, for plans started or renewed after 16 October 2013, relief is limited to the lower of either:
the premium paid or €1,000 per adult and,
the premium paid or €500 per child.
Anyone under 21 years of age is considered a child for health insurance tax relief purposes.
TRS doesn't apply in certain instances.
For example, if an employer pays health insurance premiums for their employees, the premium is considered a benefit-in-kind, and taxes are due on that amount.
Employees can directly claim tax relief from Revenue when the premium is regarded as a benefit-in-kind.
If you join an insurance scheme on Yonder, you’ll see a TRS amount on your monthly quote. This is the tax relief you receive for being part of an employer scheme.
Short answer: Everyone.
Insurance providers must follow three principles when offering health insurance plans in Ireland:
Let's dig deeper into these principles:
Health insurance companies must accept any person who wants to join a plan regardless of sex, age and health status.
However, new members may be subject to waiting periods of up to 26 weeks.
Restricted membership schemes must accept any person qualified to join the plan.
Lifetime cover means an insurance company cannot refuse to provide cover to any policyholder who joins a plan and pays their premiums.
Want to switch insurers?
You can do so without loss of cover, provided you complete the switch within 13 weeks.
Suppose you served a waiting period due to age or a pre-existing medical condition when you first took out private health insurance. In that case, you don't have to wait again.
The community rating principle ensures that insurance companies charge the same rate for a service from everyone — regardless of age, sex, and health status.
All adults pay the same rate for the same benefits.
However, there may be some exceptions, such as:
Reduced charges for people under 25.
Retirees can have specific health insurance arrangements within their company's scheme.
Costs for children are usually reduced by about 50%.
Wait, we aren’t done yet.
Another aspect of the community rating principle is the lifetime community rating.
What is a lifetime community rating?
A lifetime community rating means your health insurance premium depends on your age when you first bought health insurance.
For example, if you first bought health insurance at 25 and haven’t had a loss of cover for more than 13 weeks, you'd still pay the premium of a 25-year-old — no matter how old you are.
However, if you first bought health insurance at 40, or if you had a loss of cover over 13 weeks, you'd have to pay more than the premium of a 25-year-old.
That's not all.
From 1 May 2015, anyone over 34 who purchases health insurance for the first time, or has a break in cover of over 13 weeks must pay a loading charge on top of the health insurance plan's cost.
You have to pay a 2% loading charge on the gross premium for every year over 34, but it's capped at 70%. This loading charge is payable for 10 years.
For instance, if you buy health insurance for the first time at 50, you'd have to pay 32% more than a 34-year-old.
Now, let's see what types of waiting periods apply for health insurance in Ireland and who's affected by them.
As we mentioned earlier, health insurance providers can't refuse coverage to anyone based on their health condition.
But here's the thing.
They can impose waiting periods and limit the level of cover based on policyholders’ health conditions.
Ireland has three types of waiting periods:
Initial Waiting Periods
Waiting Periods for People With Pre-existing Medical Conditions
Waiting Periods for Upgrading Plans
When an Irish resident first obtains a private medical insurance plan, the insurance provider can impose a maximum initial waiting period of 26 weeks.
For any maternity claims, the waiting period extends to 52 weeks.
However, the insurance provider covers any accidents or injuries within the initial waiting period.
In Ireland, a pre-existing condition is any illness, condition, or ailment where the signs or symptoms existed 6 months before the person became insured under a private health insurance contract.
Have a pre-existing condition?
Your insurance company can refuse to provide cover for that condition until you serve a waiting period.
Here's an example:
If you have diabetes, the insurance provider can refuse coverage for diabetes-related claims until you've served a waiting period.
However, they must provide coverage for any other illness after your initial waiting period.
The current maximum waiting period for pre-existing conditions is 5 years.
If you switch from one insurer to another within 13 weeks, you won't have to serve any completed waiting periods again.
If you first obtained health insurance before 1 May 2015, the waiting periods would be a little different:
If you were between 55 and 59 years old when you first purchased health insurance, you'd have to serve a maximum waiting period of 7 years.
If you were over 60 when first buying health insurance, you'd have a maximum waiting period of 10 years.
If you upgrade from your current health insurance plan, you may need to serve a maximum waiting period of 2 years for the higher benefits to apply.
We've covered a lot about private medical insurance in Ireland, but the question remains…
Many employers in Ireland provide private health insurance plans for their teams.
A Glassdoor Economic Research survey found that health insurance as an employee benefit correlated highest with job satisfaction.
Companies that focus on their employees' health show that they value their employees — improving their trust in the organisation.
Providing health insurance can make employees more satisfied with their job since it's one less thing for them to worry about. They can instead focus on improving your business' bottom line.
Sick employees severely impact your company's productivity.
It's not just the cost of sick days you have to deal with.
You also must consider reduced productivity — when employees work while recovering from illnesses or have to look after a sick family member.
How does health insurance help here?
Employees get fast and easy access to better healthcare. Plus, they can decide where to receive the best treatment.
This results in a healthier team that calls in sick less often, leading to more productive and profitable results for your business.
How does private health insurance contribute to reduced turnover?
It helps you build a healthy workforce and improves loyalty, contributing to employee retention.
Prioritising retention is essential since replacing employees can be very costly for companies — especially small businesses.
Investing in private employee health insurance can increase employees' sense of job security. This can help you retain employees for longer and reduce employee turnover costs.
Providing private health insurance to your team could set your business apart.
Job seekers tend to look for places that offer more than a salary and fringe benefits — especially in an industry dominated by small businesses.
When potential employees see that you provide health insurance, you have a better chance of landing highly-skilled and motivated employees.
Okay, employee health insurance is essential.
But how do I manage each employee’s private health insurance?
That's where Yonder comes in.
Yonder is an employee benefits platform that helps you manage your health insurance across global teams.
You can pay and scale your benefits as needed and give your employees complete flexibility over their health insurance packages.
Here's how it works:
First, you create plans for various contribution levels on Yonder. Then, add your employees to these plans.
They get the freedom to choose the plans and benefits they need. Employees can stick with the budget or pay more for a higher plan.
It's that simple!
What you get with Yonder:
Access to insurance plans in over 160 countries.
Easy integration with your Payroll & HR software.
Access to reputed financial institutions and insurance providers.
Automated, scalable benefits with minimal paperwork.
Benchmark data comparing your benefits package to other local plans.
Flexibility for individual employees to control their options.
Yonder (Yonder Technology Limited) is based in Dublin and is a Tied Intermediary of Tailored Finance Limited for Insurance and Pensions.
Here are some common questions employers and residents have about Irish health insurance:
1. What is the Health Insurance Levy?
The government charges the Health Insurance Levy on every health insurance policy.
It accounts for about 33% of the total insurance premium.
2. How Are Health Insurance Providers Regulated?
The Central Bank of Ireland regulates health insurers financially, while the Health Insurance Authority regulates the legal and statutory aspects.
3. Do My Employees Need Private Health Insurance for Maternity Services?
The Maternity & Infant Care program gives all expectant mothers in Ireland access to GP and hospital care.
Expectant mothers are entitled to free outpatient, inpatient, emergency, and accident services in public hospitals throughout pregnancy and birth.
But here’s the thing:
Giving your employees access to health insurance can significantly improve their maternity experience as they’ll get quicker access to better quality care.
If you want to manage employees’ maternity benefits hassle-free, Yonder is the only tool you need.
4. Does Health Insurance Cover Overseas Travel?
All health insurance plans cover medical emergencies abroad.
However, if you travel frequently, you should get a health plan that specifically covers your travel insurance needs.
All Irish Life Health 4D plans offered through Yonder have a travel add-on that could be perfect for most of your travelling needs.
5. What is a Restricted Membership Scheme?
A Restricted Membership Scheme is a health insurance plan only available to specific types of employees.
For example, this could be a plan open only to Gardaí or health workers.
6. Should I Insure Every Employee?
There are no legal obligations to provide health insurance to every employee. You can decide to cover employees based on their seniority or role.
However, many employers choose to offer private health insurance to all of their employees.
7. How Much Should I Spend on Private Health Insurance for Employees?
How much you spend on the insurance premium per employee depends on what you include in your package.
The average annual cost of Irish health insurance per adult was €1,412 in September 2022.
Depending on your package with Yonder, a monthly health insurance premium could cost as little as €52.25 for the Kick-Off Plan or as high as €164.77 for a comprehensive plan.
8. What Should My Employee Health Insurance Plan Include?
Depending on your budget, you can start with outpatient services coverage and increase it to cover inpatient hospital charges.
Optionally, you can add dental and vision benefits to the health insurance plan.
Ideally, you should focus on the benefits from which your team would derive the best value.
1. How Can I Save Money on a Private Health Insurance Plan?
One way to save money on your insurance plan is to look for quotes from various providers.
If employed, you could save money on health insurance by opting for cheaper corporate plans that offer similar benefits.
Since all plans offered by insurers are available to the public, you can directly contact the provider to inquire about corporate plans not advertised on their website.
You can also downgrade if you don’t need the full benefits listed in your current plan.
But remember: You will be subject to a waiting period if you decide to upgrade your plan again.
2. Does Private Health Insurance Cover Hearing Aids and Surgical Appliances?
Some plans cover this equipment, but it's always best to check with your provider.
Most providers will give you a list of covered appliances when requested.
3. Why Do People Change Health Insurance Plans?
People change their health insurance plans for many reasons.
Changes in plans for the future, like expecting children.
The need for better value cover.
As an extra precaution against unexpected illnesses.
When the existing plan doesn't provide enough coverage.
When the level of cover is too much, and downgrading helps save money.
4. How Can I Switch My Private Health Insurance Plan?
Yes, you can switch your insurance plan.
However, you need to be mindful of waiting periods that apply for new benefits, as well as any penalties you have to pay.
To minimise the risk of penalties and fees, switch the plan on your renewal date.
5. What Should I Do When Switching Health Insurance Providers?
Go through all the policy documents to understand your level of coverage.
You will also need to cancel the direct debit made to the old insurer.
If you find the new cover unsatisfactory, you can cancel it within 14 days and get a full refund.
6. Can Medical Card Holders Get Private Health Insurance?
Yes, you can hold a medical card and receive private health insurance.
When you visit your GP or get admitted to the hospital, you can decide whether to be considered a public or private patient.
7. Does Age Affect Insurance Premiums?
No. The health insurance industry in Ireland follows the lifetime community rating principle.
This means that everyone pays the same amount for health insurance.
A loading charge will apply to the premium for anyone first obtaining health insurance after 35 or for anyone whose insurance lapses for 13 weeks or more when they're over 35.
Group scheme members might have their premiums reduced by up to 10%.
Children's premiums are 50% of the adult premium.
Anyone aged 18-25 may receive a reduced premium.
Retired members of restricted membership schemes may pay a reduced premium.
8. What Happens if a Health Insurance Plan Lapses For More Than 13 Weeks?
You will have to serve initial waiting periods again if you plan lapses for over 13 weeks.
If you're over 35, a loading amount will also apply to your premium.
9. What Is The Difference Between Public and Private Patients?
Here are a few differences between public patients and private patients.
Don't have to pay a fee except for the public hospital inpatient charge (this amounts to €80 per day, up to a maximum amount of €800 per year).
Medical cardholders don't have to pay anything at public hospitals.
Don't have the right to choose their consultant.
Can receive treatment in a private or semi-private room at a public or private hospital.
The insurer or the patient has to bear the cost of hospital accommodation and treatment.
Have to pay all consultants' fees.
Private room charges can go up to thousands of euros per day since private hospitals can set their charges.
10. Should I Sign a Private Insurance Patient Form?
With the 2013 Health Amendment Act, private health insurance holders are charged a private rate for public treatment when they’re admitted through Accident and Emergency to public hospitals.
This happens when patients sign the Private Insurance Patient Form and waive their rights to public treatment in a public hospital.
If you ever face this issue, ensure you have a guarantee to receive a private or semi-private room or other additional benefits when you sign the waiver form.
If you're convinced that the treatment is the same regardless of whether you sign the form, you can refuse to sign.
While the private health insurance Ireland offers is comprehensive, it can be confusing to manage with all the other benefits you offer your employees.
But don't worry!
With Yonder, you can manage your private health insurance plan with just a few clicks.
Sign up for Yonder and discover easy health insurance management!
Global core benefits, simplified
👋 Zero commitments – get started in minutes