Health Insurance (Amendment) Bill 2019: Committee Stage

The purpose of the Bill is to amend the Health Insurance Act 1994 to specify the amount of premiums to be paid from the Risk Equalisation Fund in respect of certain classes of insured persons from 1 April 2020, to amend the Act to specify the amount of hospital utilisation credit applicable from 1 April 2020 and to make consequential amendment to the Stamp Duties Consolidation Act 1999 and to provide for related matters. I welcome the Minister to the committee.

I am pleased to have the opportunity to address the committee on the Health Insurance (Amendment) Bill 2019. The Bill was published on 21 November and, as Deputies are aware, concluded its passage through Second Stage in the Dáil last week. I welcome the support received in the House for the core principle of community rating, which is a long established and well-supported Government policy for the health insurance market. This is a short and technical Bill comprising six sections, all focused on the specific issue of health insurance regulation. The provisions outlined in the Bill will ensure the ongoing sustainability of the private health insurance market, as well as health insurance policies at an affordable price for all citizens, young or old and sick or healthy.

To support community rating, which is one of the fundamental principles of Irish health insurance, legislation is needed each year to update and revise the scheme that enables the sharing of risk across the insured population. As part of the process, the Health Insurance Authority, which is the independent market regulator, carries out an annual evaluation of the market focused on the claims cost that every insurer has paid over the year. Based on this analysis, the authority recommends the level of credits and stamp duties that should apply the following year in order that risk may be shared across the market and the principle of community rating is maintained. The rates for next year recommended by the authority have been considered and accepted by the Minister for Health and the Minister for Finance. This year's Bill will provide for a general decrease in the credits across genders and age groups and there will be some changes in the stamp duty levies on contracts.

The stamp duty in respect of products providing advanced cover will be slightly increased by €5 to €449 per adult and by €2 to €150 per child. The stamp duty in respect of products providing non-advanced cover will be reduced by €20 to €157 per adult and by €7 to €52 per child.

It is important to note there has been no increase in stamp duty on health insurance contracts for the past two years so this 1% increase for policyholders with advanced contracts is not only necessary to support more affordable policies for older and less healthy people but is also extremely modest as the first increase in three years, bearing in mind much more significant increases in years gone by.

As I have said, the Bill allows us to maintain our support for the core principle of community rating, which is a long-established and well-supported Government policy for the health insurance market. I commend the Bill to the House.

Section 1 agreed to.

Amendment No. 1 has been ruled out of order.

Amendment No. 1 not moved.
Section 2 agreed to.
Sections 3 to 6, inclusive, agreed to.

I do not have a copy of the Bill in front of me. I want to raise a specific issue and I will be guided by the Chairman as to under which section is appropriate to raise it. It is with regard to discrimination against level 2 hospitals with regard to insurance cover. I will be guided by the Chairman as to when to intervene. It is relevant to the Bill before us.

The Deputy can make his comments now.

The specific issue I want to raise with the Minister of State is something that has come to my attention recently. People who take out private health insurance go through a checklist with the insurance company and are asked which tertiary hospital they are most likely to attend. People like me from Roscommon will be asked whether we want to go to Galway or Dublin and a number of private hospitals are listed. It has recently come to my attention that the insurance companies do not provide cover in all of the model 2 hospitals. I can understand with regard to a model 4 hospital if people want expert care for a heart attack they are asked whether they would go to the Mater Hospital, the Beacon Hospital, the Galway Clinic or the Blackrock Clinic but the insurance companies should not refuse cover in small hospitals such as those in Ennis, Roscommon, Mallow or Bantry. People should automatically get cover in these hospitals.

I presume the reason the insurance companies are selective is because there are expensive fees in some of the big private hospitals but there are standard charges for level 2 hospitals in the country. We should be actively encouraging people to go into our level 2 hospitals because if they go to hospital in Bantry, Ennis, Nenagh or Roscommon it takes pressure off the model 3 and 4 hospitals throughout the country and takes pressure off our accident and emergency departments. Admission charges for urgent care centres should be reduced to incentivise people to go to them rather than accident and emergency departments. Every insurance company should be obliged to provide cover to the smaller local hospitals.

The reason this has come to my attention is a private patient who attended Roscommon hospital found out when the insurance claim went in that the policy did not cover the local hospital. That person ended up having to pay. This causes two problems. People must pay out of their own pockets because they do not have the cover and they are discouraged from supporting their local hospital. There is an anomaly that is being exploited by the insurance industry at present. I am giving notice that I intend to table an amendment on Report Stage. I hope that in advance of Report Stage this anomaly can be addressed in the short term.

I appreciate the point the Deputy is making. I wish to seek clarification from the Deputy. Is his issue that it is prescribed in the policy that people do not have cover in a level 2 hospital or is it that it is not obvious in the policy?

It is not obvious and it is with regard to named level 2 hospitals. People have cover in some level 2 hospitals. Why, for argument's sake, would people living in Roscommon have cover in Bantry hospital but not Roscommon hospital? I cannot understand it. There does not seem to be justification for it with regard to level 2 hospitals. I fully understand why insurance companies would ask people whether they want cover in all of the more expensive high-level hospitals and what level of cover they want but local people are sometimes not being made aware of the fact that their own local hospital is not covered by the insurance policy. It should not come down to people having to specifically name a hospital. For example, if I am on holidays in west Cork, why should I not go to Bantry hospital rather than go to Cork where there will be problems in the accident and emergency department? We should encourage people to use our level 2 hospitals as a policy decision by the Government.

Insurance companies should not discriminate against any level 2 hospital. If we can get increased volumes of elective surgery in our small hospitals everyone benefits. It makes no sense from a policy point of view and the insurance industry should not be allowed to exclude any level 2 hospital in terms of cover. There is no justification for it. The charges in the level 2 hospitals in Nenagh, Bantry and Roscommon are the same as in any other level 2 hospital because they are all HSE owned hospitals, not private hospitals.

We are guided by the minimum benefit regulations that insurers have to meet but I will have my officials examine the issue. This is the first I have heard of it but I will have my officials examine it between now and Report Stage, at which time I will have more extensive response for the Deputy.

I thank the Minister of State. It is an issue that is close to the heart of the Chairman and, I am sure, the Minister of State as well.

Likewise, it is an issue close to my heart. I strongly support the views expressed by Deputy Naughten. There should be no situation where the patient finds out after the event that he or she is not covered because the treatment was provided in a particular hospital. The insurance companies need to make up their minds. The patient is entitled to full information prior to treatment. It should be clearly stated in the policy document that the patient is not covered for X, Y and Z if treated in a particular area. The policy should also include a written explanation for that decision.

Is Deputy Naughten saying that a person whose health insurance does not cover them for treatment in a level 2 hospital is liable to a charge of €80 per day for a maximum of ten days?

Ten days is the maximum period for which the person would be liable-----

-----but he or she should not be liable because the insurance should cover it.

Exactly. If the person's private insurance covers the charge in another level 2 hospital or a level 3 public hospital, why then should he or she be liable for the charge in a smaller hospital? There should be no exclusions. I can understand the differentiation in regard to the more expensive hospitals but I am speaking about small, local, public hospitals with a small number of private single rooms. We should be encouraging people to use their local hospitals. There should be across the board blanket cover on all of the level 2 hospitals because they are all public hospitals and that benefits our health service.

Does that also apply to a patient in a level 4 hospital who is stepped down to a level 2 hospital?

A patient could potentially end up in that situation. That may be a grey area. This does not make sense. We should be encouraging more throughput in our level 2 hospitals, not less. The insurance industry should support Government policy, not undermine it.

Title agreed to.
Bill reported without amendment.