Health insurance and GP visits in Ireland

How health insurance works in Ireland

Health insurance in Ireland is voluntary and sits alongside the public health service. Plans are sold by a small number of insurers, including Vhi, Laya Healthcare, Irish Life Health and Level Health, and the market is overseen by the Health Insurance Authority (HIA).

Three principles protect you:

• Open enrolment: an insurer must accept anyone who applies, whatever their age or health.
• Community rating: everyone pays the same price for the same plan, apart from the Lifetime Community Rating loading explained below.
• Lifetime cover: an insurer cannot refuse to renew your policy.

Does it cover GP visits?

Every plan covers hospital care. GP visits are different: they come under outpatient or day-to-day benefits, which only some plans include. Where a plan does include them, it usually:

• refunds part of each GP visit, up to a set amount per visit
• limits the number of visits you can claim for each year
• may apply an excess, so you pay the first part of your costs yourself

Many plans also include the insurer’s own phone or video GP service. Look for the table of benefits for your plan, which sets out exactly what is covered. The HIA’s comparison tools are a good place to start if you are choosing a plan.

Claiming for a GP visit

• Pay the practice or online service, and keep the receipt.
• Claim through your insurer’s app or website. Some plans let you claim each visit as you go; others ask you to claim once a year.
• Check whether your plan sets conditions, for example about the type of practitioner, before you book.
• Keep copies of everything. You can claim tax relief on any part of the fee your insurer does not refund.

Tax relief

There are two kinds of relief, and they work differently:

• On your premium: relief at 20% is given at source, as a reduction in the price you pay, up to a limit per person. You do not need to claim it.
• On GP fees: you can claim relief at 20% on qualifying health expenses, including GP fees, that your insurer has not refunded. You claim through Revenue myAccount.

Our guide to private GP costs in Ireland explains health expenses relief in more detail.

Lifetime Community Rating

To encourage people to take out cover while they are younger, a loading is added if you first buy health insurance at age 35 or older. It is 2% of the premium for each year you are over 34, up to a maximum of 70%. Previous cover can reduce the loading, and the HIA explains how this works if you are moving to Ireland from abroad.

Waiting periods

When you first join, waiting periods usually apply before you can claim for some treatment, and they are longer for conditions you already had before joining. If you switch to a similar plan with another insurer, waiting periods you have already served usually count. Check the details with your insurer or the HIA before you switch or upgrade.

Questions to ask before you choose a plan

• Does it include GP visits, and how much is refunded per visit?
• How many visits a year can I claim for, and is there an excess?
• Can I claim for a private or online GP, or only certain practitioners?
• Does it cover private consultants, scans and tests, and do they need a GP referral?
• Does it include the insurer’s own digital GP service?

If you are likely to need a specialist, read our guide to private specialist referrals in Ireland. For how online appointments work, see how online GP consultations work in Ireland, and for medicine costs, how prescriptions work.

This guide is general information, not insurance or financial advice. Health insurance plans, benefits and rules vary and change over time, so always check the details of your own policy directly with your insurer before you book or claim.