I propose to take Questions Nos. 298 to 302, inclusive, together.
VHI's private health insurance premiums are primarily determined by the level of claims it is obliged to meet. It represents good commercial and insurance practice for VHI Healthcare, or indeed any other health insurer, to have regard to the possibility of members seeking third party recovery for fees or charges, where such recovery is in order, and a claim against the relevant third party is justified. VHI would be failing in its responsibilities to its members generally were it not to pursue policies that minimise its claims experiences, and consequently the levels of its premiums, where it is reasonable to do so. This is established practice in the area of health insurance, with BUPA (Ireland) having a similar rule regarding the payment of benefits for treatment which was due to the fault of a third party.
Insurance practice in this regard is reflected under the Health Insurance Act 1994 (Minimum Benefit) Regulations 1996 which were made in March of that year. These regulations include specific provision in respect of circumstances involving third party recovery relating to healthcare costs incurred by an insured person.
VHI has been contacted concerning the Deputy's questions and has advised that its rules in respect of third party claims are as set out in the rules, terms and conditions of membership. In that context, rule 8 (s) states that it will not pay benefits for expenses which a claimant is entitled to recover from a third party. Furthermore, rule 9 (f) states:
If you (the policy holder) claim benefits for treatment which is needed because a member was injured through the fault of some other person or body, you and the member (if the member is over 18) must complete the relevant section of the claim form. We (VHI Healthcare) will pay the benefits if a policy holder or member completes a written undertaking to:
(i) Include those benefits in any claim being made or to be made against the person who caused the injury: and
(ii) do everything we (VHI Healthcare) ask to recover those benefits and repay them to VHI Healthcare.