Tuesday, 27 May 2014

Questions (766, 767)

Paudie Coffey

Question:

766. Deputy Paudie Coffey asked the Minister for Health if his attention has been drawn to the fact that health insurance companies are not covering the cost of drugs that are approved by the Health Service Executive on the NCCP (details supplied); if health insurance companies are allowed to act in this way; and if he will make a statement on the matter. [22487/14]

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Paudie Coffey

Question:

767. Deputy Paudie Coffey asked the Minister for Health if health insurance companies are required to cover the cost of all drugs and treatments that are available on the public health service; and if he will make a statement on the matter. [22488/14]

View answer

Written answers (Question to Health)

I propose to take Questions Nos. 766 and 767 together.

Minimum Benefit Regulations, made under the Health Insurance Acts, require insurers to offer a minimum benefit to every insured person. The regulations help to ensure that consumers obtain a minimum level of health insurance cover regardless of what plan they purchase. At present, the minimum benefits cover access to a semi-private room in a public hospital, including in-patient consultant fees, and a wide range of acute treatments. This represents the minimum level of cover that must be offered to every insured person. While I have sympathy for patients who find that certain drugs are not covered, it is not the role of the Minister for Health to direct private health insurers as to which services or facilities they cover. This is a commercial decision for the insurers themselves.

Cover for medical expenses under a customer's health insurance contract is a private contractual matter between the customer and the insurer. If the customer is not satisfied with any decision made by an insurer relating to the benefits payable under their contract, they should first discuss it with the insurer concerned. However, if the customer remains dissatisfied with the insurer's response, they may contact the Financial Services Ombudsman. The Financial Services Ombudsman is a statutory officer who deals independently with unresolved complaints from consumers about their individual dealings with all financial service providers, including health insurers. The service is provided free of charge to the complainant. The decision of the Financial Services Ombudsman is binding on all parties unless the decision is appealed to the High Court. Customers also have rights of access to the courts in disputes with insurers.