Health Insurance Cover

Dáil Éireann Debate, Tuesday - 14 October 2014

Tuesday, 14 October 2014

Ceisteanna (164)

Brendan Griffin

Ceist:

164. Deputy Brendan Griffin asked the Minister for Health his views on a proposal regarding private health insurance (details supplied); and if he will make a statement on the matter. [38958/14]

Freagraí scríofa

Minister for Health

The maximum waiting periods for eligibility for payment under a health insurance contract are set out in the Health Insurance Act, 2001 (Open Enrolment) Regulations 2005 and vary by age, whether medical conditions existed before the contract commenced and where the level of cover is upgraded.

Age on joining	Illnesses that commence after joining	Illnesses that commenced before joining	Accident and injuries	Maternity related claims
Under 55	26 weeks	5 years	None	52 weeks
55 – 59	52 weeks	7 years	None	52 weeks
60 – 64	52 weeks	10 years	None	52 weeks
65 and over	104 weeks	10 years	None	52 weeks

Waiting periods are applied so as to help avoid any incentive to take out health insurance immediately before treatment and to cancel it shortly afterwards. In the current system, all persons aged under 55 are covered after 26 weeks of joining for illnesses that commence after taking out health insurance. Those aged over 55 have longer waiting periods. The provisions on waiting periods help to support community rating. Under community rating, everybody is charged the same premium for a particular health insurance plan, irrespective of age, gender and the current or likely future state of their health. This system requires ‘intergenerational solidarity’, where younger people pay more for health insurance than the level of risk they present would demand, while older people pay less as a direct consequence.

The provision of waiting periods helps to encourage individuals to take out health insurance earlier in life, thus minimising the strain placed on the community rating system and ultimately benefitting the entire pool of insured persons in the community.

Question No. 165 answered with Question No. 154.