What is a waiting period for Health Insurance?
The waiting period refers to the how long you must hold health insurance before being eligible to file a claim. There are three types of waiting periods:
Initial waiting period - This is relevant if you're obtaining health insurance for the first time or if your health coverage has been inactive for 13 weeks or longer before obtaining new insurance.
Pre-existing condition waiting period - this is relevant if your health insurance claim relates to a pre-existing condition.
Upgrade waiting period - this is relevant when you upgrade your health insurance, by purchasing a plan with more comprehensive cover than your previous plan.
Continuity of cover means holding a health insurance plan without any lapses in cover when you switch from one insurance provider to another.
Accident and Injuries:
Illnesses that start after you join:
Illnesses that existed in the 6 months before you join:
Maternity related claims:
Irish Life Health Upgrade Waiting Periods
Outpatient Medical Expenses
Under 55 years: None
55+ years: None
Day To Day Medical Expenses:
Under 55 years: None
55+ years: 26 Weeks
Inpatient Pre-existing Conditions:
Under 55 years: 2 Years
55+ years: 2 Years
What is a Pre-existing Condition?
A pre-existing condition refers to any ailment, illness, or condition with signs or symptoms that have been present at any point since birth, before obtaining health insurance for the first time, or prior to reinstating health insurance after a lapse of more than 13 weeks.
What is a ‘Break in Cover’ period?
Once an individual has maintained a continuous private health insurance policy for at least 3 years and then decides to cancel it for a duration of 6 months or more, they become eligible to receive credit for any periods of non-cover that start on or after 1 February 2019. However, this credit is subject to a lifetime limit of 3 years. The credited periods can be comprised of non-consecutive time spans, each lasting a minimum of 6 months.
Were you covered under the Defense Forces Scheme or Members of the EU Joint Sickness Scheme?
If you were covered under either of these Schemes, please call us on 01 518 1400.
Does my age affect my health insurance premium?
In the Irish health insurance industry, Community Rating is a fundamental concept aimed at ensuring that a person's age does not dictate a different premium for their health insurance coverage. However, there are several exceptions to this principle:
- Age at Entry Loading: If an individual purchases health insurance for the first time at the age of 35 or older, there might be an additional loading applied to their premium.
- Children: Individuals under the age of 18 must be offered a premium that is no more than 50% of the adult rate.
- Young Adults: Those aged between 18 and 25 may qualify for a premium reduction.
- Group Schemes: Members of group insurance schemes may enjoy a premium reduction of up to 10%.
- Pensioners in Restricted Membership Insurers: Pensioners who are part of insurers with restricted memberships might be eligible for premium reductions.
These exceptions are essential components of the Community Rating system in Ireland and help regulate the health insurance market to ensure fair and equitable pricing for policyholders.
What is the maximum Lifetime Community Rating (LCR) loading that applies?
Lifetime Community Rating is a mechanism that ties the health insurance premium to the age at which individuals acquire private health insurance. Late entry loadings are imposed on premiums for those who enter the health insurance market at 35 years or older.
If you are obtaining private health insurance for the first time at the age of 35 or above, you may face a 2% loading added to your premium for every year beyond 34, up to a maximum of 70%. This loading serves as an incentive for individuals to obtain health insurance earlier in life, promoting a fair and balanced insurance market.
Why is LCR Introduced at age 35?
As per the legislation, the age of 35 is deemed appropriate to afford young individuals ample time to complete their education and attain stable employment for a substantial period.
What is a Health Insurance Levy?
The Irish Government imposes a Health Insurance Levy on health insurers for each policyholder. This levy is subject to potential annual changes in accordance with the Government's yearly budget.
The levy constitutes a fixed portion of your health insurance premium. For instance, if you are an adult with an annual premium of €1,200 on a Level 2 plan, €449 of that amount represents your Health Insurance Levy, approximately one-third of the total premium.
The funds generated from this levy are utilized to support the Risk Equalisation Premium Credit, which benefits insured individuals aged 65 and over.
What is a Risk Equalisation Premium Credit?
The Risk Equalisation Fund, overseen by the Health Insurance Authority (HIA), provides a payment to health insurers known as the Risk Equalisation Premium Credit. This payment is intended to assist health insurance companies in covering the higher claims costs of individuals aged 65 and above.
The exact amount of the payment is determined based on factors such as the member's age, gender, and the level of coverage they have.
What is a Group Discount?
Health Insurance Plans may include a discretionary discount ranging from 0% to 10%. Typically, this discount is applicable only to group schemes where multiple members are insured together. It's important to note that this discount might already be factored into your premium.
It's essential to adhere to the Community Rating legislation, which prohibits offering any other discounts to specific groups of people based on their age, sex, or health status. This ensures fairness and equal treatment for all policyholders.
What is your Tax Relief?
The Government offers a tax credit to alleviate the financial strain of private health insurance for individuals. As your health insurance provider, we handle the process of deducting your tax relief from your premium, eliminating the need for you to claim it back from the Revenue Commissioners. This ensures a seamless and hassle-free experience for you.
How Long is My Quote Valid?
When you request a Health Insurance quote from Irish Life Health, please note that the quote will remain valid for 30 days from the date it is generated.
Upon receiving the quote, whether obtained online or through our Call Centre, we will promptly send you an email containing a quote reference and a link. This link will allow you to conveniently view and review the details of your quote at your convenience.
Day to Day Medical Expenses
Day-to-day medical expenses encompass the benefits offered by your policy to cover routine health expenditures, including visits to GPs, dentists, or physiotherapists. To understand the specific coverage you have, it's essential to review your Table of Cover, which outlines the services and expenses included in your policy.
What are Personalised Packages?
In addition to the core benefits we offer; Irish Life Health provides the flexibility to customize your health insurance according to your specific requirements. You can select one or more additional packages of benefits from our range of Personalised Packages. We have three distinct ranges of Personalised Packages available, and the options you can choose from will depend on the plan you have.
Your chosen Personalised Packages are detailed in your Table of Cover, which also outlines the extent of coverage available for each benefit within the selected package. This way, you can easily tailor your health insurance to suit your individual needs with the added benefits that matter most to you.
What is Inpatient Excess?
The inpatient excess is a predetermined amount that you contribute towards the expenses incurred during your stay in a Private or High-Tech hospital. By having an inpatient excess on your policy, you can reduce costs while retaining access to Private and High-Tech hospital facilities. It's important to note that the inpatient excess is exclusively applicable to the Private and High-Tech hospital coverage on your plan; it is never applied to Public Hospital cover.
The specific inpatient excess amounts will vary depending on your chosen plan, so it's crucial to refer to the correct Table of Cover. To access this information, simply log into our Member Area. It's important to mention that all inpatient excess payments are made directly to the hospital, and you cannot seek reimbursement for this expense. The inpatient excess feature is designed to provide you with cost-effective access to private medical facilities while maintaining the quality of care you need.
What is an Excess?
An excess represents the initial portion of any insurance claim that you are responsible for paying. In the case of health insurance, there are two types of excess: inpatient excess and out-patient excess.
For inpatient excess, this is the amount you might need to pay when making private hospital claims. On the other hand, out-patient excess refers to the deduction made from the amount payable to you for certain covered expenses.
Paying excess can play a crucial role in managing the cost of your private health insurance. By agreeing to contribute more upfront as part of your coverage, you can potentially lower your health insurance premiums. It's important to emphasize that you will only be required to pay an excess if you actually go to the hospital. In other words, you won't be paying for services you might not use, providing a cost-effective approach to your insurance coverage.
How does the Outpatient Excess work?
The outpatient excess is the threshold amount per person that must be reached in benefits before a member becomes eligible to claim money back.
It's essential to understand that it is the benefit offered by the policy that contributes towards the outpatient excess, not the actual amount the member has personally paid for the treatment. In other words, once the cumulative benefits for outpatient services reach the specified excess amount, the member becomes eligible to claim money back for further eligible expenses.
Do you need to contact your current insurer to cancel your policy?
If you need to contact your current insurer after setting up a policy with us, please see these handy links below. You simply need to fill in your details in the cancellation letter template and then send it on to your current insurer.
• VHI Cancellation Letter: vhi-cancellation-letter.pdf (irishlifehealth.ie)
• Laya Cancellation Letter: laya-cancellation-letter.pdf (irishlifehealth.ie)
How to make a claim?
If you would like to make a claim, you can simply make a claim via your online account or contact Irish Life Health directly on 01 562 5100.
Claiming for Everyday Health Expenses?
You can claim for the everyday health expenses covered on your plan via your online account or contact Irish Life Health directly on 01 562 5100.
Am I covered for A&E Abroad?
You are indeed covered for accidents and emergencies while abroad. Your plan provides hospital (in-patient) accident and emergency cover ranging from €55,000 to €100,000 for temporary stays abroad (up to 31 consecutive days outside of Ireland). Our plans are tailored for members residing in Ireland for at least 180 days of the policy year.
If you require information or hospitalization while overseas, please contact our 24-hour international assistance helpline at 00 353 148 17840. It's important to reach out to this helpline before receiving treatment, whenever reasonably possible. Failing to do so may result in not being able to claim for treatment under this benefit.
For your convenience, please log into your Online Account to check your Table of Cover and confirm the extent of A&E cover on your policy. While health insurance covers accidents and emergencies abroad, we emphasize that it is not a substitute for travel insurance. Thus, we recommend purchasing travel insurance before your departure.
Furthermore, it's advisable to obtain a European Health Insurance Card before traveling. You can find information on how to apply for this card on www.ehic.ie.