Dáil Éireann debate -
Tuesday, 2 Nov 1999

Vol. 509 No. 6

Written Answers. - Health Insurance.

Liz McManus

Question:

356 Ms McManus asked the Minister for Health and Children if he will ensure that a person (details supplied) in County Wicklow is reinstated immediately as a fully insured member of the VHI in view of the serious mental illness suffered by him and the decision by the VHI to subject him to a long waiting period and a three year restriction; and if he will make a statement on the matter. [21468/99]

Minister for Health and Children (Mr. Cowen)

Regulations made pursuant to the Health Insurance Act, 1994, allow insurers discretion to impose waiting periods on the payment of benefit in respect of persons taking out insurance cover. This is a normal feature of health insurance business and is of particular relevance to insurers in circumstances where they are obliged to operate on the basis of community rating and open enrolment.

In the consumer interest, the regulations set down maximum waiting periods which must not be exceeded by insurers. In the normal course, insurers have discretion to apply maximum initial waiting periods of relatively short duration, 26 weeks and 52 weeks, depending on whether the person is under or over 55 years at the time of joining, respectively. However, in relation to any person with a pre-existing medical condition taking out health insurance for the first time, or after a break in membership of 13 weeks or more, insurers are entitled to apply specified waiting periods in relation to claims arising from that particular condition. The maximum waiting periods are five years under age 55, seven years from age 55 to under age 60 and ten years from age 60 to under age 65. My Department has ascertained from the VHI that when a member breaks his or her cover for a significant period, he or she is subject to the standard waiting periods on rejoining. It is understood that the VHI does, however, look at each case on an individual basis and that a number of factors are taken into consideration when decisions are made to alter the standard waiting periods. In the case raised by the Deputy the VHI decided to impose a three year waiting period rather than the permitted maximum of five years.

It is entirely up to individual insurers as to the waiting periods, if any, they decide to impose, subject to the maximum periods set out in the regulations. These regulations apply to all health insurers operating here and it would not be appropriate for me to dictate to any particular insurer either the rules they should make generally in this area of activity or the waiting periods that should apply in the case of any individual.

All persons ordinarily resident in Ireland are entitled to avail of health services as public patients. It is therefore open to the person referred to by the Deputy to obtain treatment as a public patient.