Choosing Private Health Insurance in Ireland: What You Must Know

Ireland has a robust public healthcare system. 

However, many people turn to private health insurance for faster and better quality care. 

Most 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. 

What Is Private Health Insurance?

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. 

But do all health insurance plans offer the same benefits?

No.

Typically, you can obtain five 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 general practitioner (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.

• Dental and optical cover: Some health insurance plans offer additional coverage for dental and optical services, which may include routine check-ups, treatments, and surgeries.

• Overseas medical cover: This provides coverage for medical treatment needed while traveling abroad. It's important for employees who travel frequently.

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 Kota, 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.

Why Private Health Insurance Is Important

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 services Irish residents, European Union (EU)/European Economic Area (EEA), and Swiss nationals. 

According to the Health Service Executive (HSE), you can access many public health services with a valid European Health Insurance Card (EHIC).  

Most services are free, but sometimes you may incur a fee — like when visiting a GP or purchasing drugs and medicines. 

But a major problem with public healthcare?

The long waitlists. Additionally, patients often have limited options when choosing their healthcare providers. This includes a limited choice of consultants and hospitals. 

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. 

Who Offers Private Health Insurance in Ireland?

Ireland has four leading private health insurance providers:

• Irish Life Health

• VHI Healthcare

• Laya Healthcare

• HSF Health Plan (Only provides cash benefit plans)

You also 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. 

What’s more? 

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. 

What Are the Minimum Level of Benefits Provided?

That depends on the service provider. 

Suppose you subscribe to a plan that offers inpatient hospital services (like Kota’s Irish Life Health Plans). In that case, you get access to a minimum level of benefits for:

• Inpatient treatment: Every Kota plan (except the Kick-off Plan) covers all room and consultant charges at public hospitals. 

• Outpatient treatment: Kota fully covers benefits like a digital doctor, nurse on call, sexual health screening, and metabolic testing.

• Convalescence: Kota offers a minimum of €26 for 14 days as a convalescence benefit.

• Maternity benefits: The minimum benefit you get via Kota is €385 for public hospital charges.

• Psychiatric treatment: Kota supports a minimum cover of 100 days. 

• Substance abuse treatment: Minimum cover of 91 days per 5 years offered via Kota. 

What’s more?

Policyholders get a minimum level of accommodation — a semi-private room in a public hospital.

Is Tax Relief Applicable for Private Health Insurance Premiums?

Anyone with a private health insurance plan from an approved insurer can get tax relief on their premiums. 

People don't have to claim tax relief from The Irish Tax and Customs Authority (aka Revenue). 

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 is considered a child for health insurance tax relief purposes.

But look:

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. 

Who Gets Access to Private Health Insurance in Ireland?

Short answer: Everyone.

Insurance providers must follow three principles when offering health insurance plans in Ireland:  

• Open Enrolment

• Lifetime Cover

• Community Rating

Let's dig deeper into these principles:

1. Open Enrolment

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. 

2. Lifetime Cover

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. 

3. Community Rating

The community rating principle ensures that insurance companies charge the same rate for a service from everyone — regardless of age, sex, and health status. 

However, there may be 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%.

Another aspect of the community rating principle is the Lifetime Community Rating (LCR). 

What is Lifetime Community Rating?

LCR means your health insurance premium depends on your age when you first bought health insurance. The longer you wait, the higher the premium.

For example, if you first bought health insurance at 25, you'd still pay the premium of a 25-year-old when you turn 40. However, if you first bought health insurance at 40, you'd have to pay more than the premium of a 25-year-old.

Waiting Periods for Health Insurance Plans

As mentioned earlier, health insurance providers can't refuse coverage to anyone based on their health condition.

However, they can impose waiting periods and limit the level of cover based on policyholders’ health conditions. 

Here’s a quick look into three important waiting periods:

• Initial Waiting Periods: When an Irish resident first obtains a private medical insurance plan, the insurance provider can impose a maximum initial waiting period of 26 weeks. 

• Waiting Periods for People With Pre-existing Medical Conditions: The current maximum waiting period for pre-existing conditions is 5 years. 

• Waiting Periods for Upgrading Plans: 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.

Should You Provide Private Health Insurance to Employees?

Many employers in Ireland provide private health insurance plans for their teams.

Here’s why:

1. It Can Boost Job Satisfaction

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. 

2. It Could Help Improve Productivity

Sick employees severely impact your company's productivity. 

But 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.  

3. You Can Retain More Employees

Private health insurance helps 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.  

Private health insurance can increase employees' sense of security about their jobs. This can help you retain employees for longer and reduce employee turnover costs. 

4. It Could Help Overtake Your Competition

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 Kota comes in.

Get Easy Access to Private Health Insurance With Kota

Kota is a robust employee benefits platform that helps you manage private health insurance across global teams. 

You can pay and scale your benefits as needed and give employees complete flexibility over their health insurance packages. 

Kota supports:

• Access to insurance plans in 30+ countries.

• Easy integration with your payroll & HR software. 

• Access to reputed financial institutions and insurance providers. 

• Automated, scalable benefits with minimal paperwork. 

• Benchmarked data by comparing your benefits package to other local plans. 

• Flexibility for individual employees to control their options. 

How Does Kota Work?

First, you create plans for various contribution levels on Kota. 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!

Join Kota and enrol your team in minutes! 

18 FAQs About Private Health Insurance in Ireland

Here are some common questions employers and residents have about Irish health insurance:

A. For Employers in Ireland

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?

No. 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 greatly improve their maternity experience since they’ll get quicker access to better quality care. 

If you want to manage employees’ maternity benefits hassle-free, Kota 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 Kota 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 that is 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 offer private health insurance to all their employees.

7. How Much Should I Spend on Private Health Insurance for Employees?

How much you spend on life insurance 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 Kota, a monthly health insurance premium could start from as little as €59.17 for the Kick-Off Plan or as high as €184.19 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.

B. For Residents in Ireland

1. How Can I Save Money on a Private Health Insurance Plan?

Some ways you can save money on your insurance plan include:

• Look for quotes from various providers.

• Pay an excess on every claim.

• Cover your children under a different plan. 

If employed, you could save on health insurance by opting for cheaper corporate plans offering 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. 

For example:

• 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 and any penalties you have to pay. 

To minimise the risk of fines 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?

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?

The health insurance industry in Ireland follows the Lifetime Community Rating principle, which considers the age at which you first joined the private health insurance market — not your current age.  

Here’s an overview of its guidelines: 

• A loading charge will apply to the premium for anyone first obtaining health insurance after 34 or for anyone whose insurance lapses for 13 weeks or more when they're over 34.

• 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 your plan lapses for over 13 weeks. If you're over 34, 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. 

Public patients:

• Don't have to pay any fees or public hospital in-patient charges (which were €80 per day, up to a maximum of €800 per year) since they were abolished on 17 April 2023.

• Medical cardholders don't have to pay anything at public hospitals.

• Don't have the right to choose their consultant. 

Private patients:

• 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. 

Make Private Health Insurance Easy with Kota

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 Kota, you can manage your private health insurance plan with just a few clicks. 

Sign up for Kota and discover easy health insurance management!