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Health Insurance - Before you Insure

What is an endorsement?

An insurance endorsement is a formal update to your policy that changes its terms. It can expand or limit coverage based on new circumstances.

For example, if you are carrying out home renovations, an endorsement may temporarily adjust your cover during construction.

Endorsements can be added at the start of your policy or mid-term if your circumstances change.

For a full breakdown, check out our detailed guide here: What is an endorsement on my insurance policy?.

What is a Schedule of Insurance?

What is a Schedule of Insurance?

Your Schedule of Insurance is a handy document that summarises all the important details specific to your insurance policy. Think of it as a personalised snapshot—clearly laying out the key info such as:

  • Your personal details
  • Exactly what's covered
  • Policy start and end dates
  • Any specific terms or endorsements that apply to you

We always recommend double-checking your schedule carefully. Keep this document safe, along with your other policy documents, so you can refer to it whenever you need it.

Spotted a mistake, or something unclear? Give us a quick call on 01 524 6000 or send an email complaints@123.ie - we’ll happily clear things up.

What is a Statement of Fact?

A Statement of Fact is a clear summary of all the important details you've provided about yourself, your vehicle, and your insurance needs. It confirms the information we use to set up your policy.

Make sure it’s accurate—need changes? Let us know straight away.

What is a proposal form?

A proposal form gathers all the important details we need from you to set up your insurance, such as your claims history, car details, or your home’s rebuild cost. At 123.ie, it’s quick, easy, and paper-free—done online or over the phone. Simple!

What is Utmost Good Faith?

Utmost Good Faith is the obligation to voluntarily, accurately, and fully disclose all material facts related to the insurance risk, regardless of whether they are specifically requested.

Being transparent about all relevant details ensures your policy is valid and provides the right coverage. For more information, review our policy documents or contact us for assistance.

 

What does risk mean?

In insurance, ‘risk’ can mean two things:

  1. The insured item This is what is being covered, such as a car, home, or belongings.

  2. The insured event This is the situation you are protected against, like theft, fire, or accidental damage.

For example, if you insure your car, the car itself is the insured risk, while events like theft or a collision are the risks you’re covered against. Insurers assess both to determine policy coverage, terms, and premiums.

Need help to understand your cover? We’re here to help. Contact us for guidance or review your policy documents for full details.

What does non-disclosure mean?

Non-disclosure happens when you don’t share information that’s needed when you’re applying for, renewing, or changing your policy.

Insurers rely on the details you give to set up your cover and keep it right throughout the year. If important information is left out, your insurer may cancel your policy, reduce the amount they pay, or refuse to pay a claim.

Not sure what counts as relevant info? We can help. Contact us or read your policy documents to stay on the right track.

What is a peril?

A peril is an event or cause that leads to a loss covered by insurance. For example, fire is considered a peril under Home Insurance, as it can result in property damage and financial loss.

What is Premium?

An insurance premium is the amount you pay to an insurance company to cover a specific risk, such as your Car or Home, for a set period of time - typically one year. Terms and conditions apply, see our policy documents for more information.

What is an exclusion?

An exclusion is something your policy doesn’t cover. It’s a clearly listed situation, item, or event that isn’t included in your insurance.

For example, if your vehicle is stolen while left unlocked, you may not be covered. You’ll find all exclusions, terms, and conditions in our policy documents.

What does limit of liability mean?

The limit of liability refers to the maximum amount an insurance company will pay for a covered event or item. This cap may apply within a specific timeframe.

For instance, the personal accident benefit for Car Insurance has a yearly limit of €5,000. For more information on specific limits, see our policy documents.

Why is LCR Introduced at age 35?

As per the legislation, the age of 35 is deemed appropriate to afford young individuals ample time to complete their education and attain stable employment for a substantial period.

How Long is My Quote Valid?

When you request a Health Insurance quote from Irish Life Health, please note that the quote will remain valid for 30 days from the date it is generated.

Upon receiving the quote, whether obtained online or through our Call Centre, we will promptly send you an email containing a quote reference and a link. This link will allow you to conveniently view and review the details of your quote at your convenience.

What is your Tax Relief?

The Government offers a tax credit to alleviate the financial strain of private health insurance for individuals. As your health insurance provider, we handle the process of deducting your tax relief from your premium, eliminating the need for you to claim it back from the Revenue Commissioners. This ensures a seamless and hassle-free experience for you.

Does my age affect my health insurance premium?

In the Irish health insurance industry, Community Rating is a fundamental concept aimed at ensuring that a person's age does not dictate a different premium for their health insurance coverage. However, there are several exceptions to this principle:

• Age at Entry Loading: If an individual purchases health insurance for the first time at the age of 35 or older, there might be an additional loading applied to their premium.
• Children: Individuals under the age of 18 must be offered a premium that is no more than 50% of the adult rate.
• Young Adults: Those aged between 18 and 25 may qualify for a premium reduction.
• Group Schemes: Members of group insurance schemes may enjoy a premium reduction of up to 10%.
• Pensioners in Restricted Membership Insurers: Pensioners who are part of insurers with restricted memberships might be eligible for premium reductions.

These exceptions are essential components of the Community Rating system in Ireland and help regulate the health insurance market to ensure fair and equitable pricing for policyholders.

What is a Risk Equalisation Premium Credit?

The Risk Equalisation Fund, overseen by the Health Insurance Authority (HIA), provides a payment to health insurers known as the Risk Equalisation Premium Credit. This payment is intended to assist health insurance companies in covering the higher claims costs of individuals aged 65 and above.
The exact amount of the payment is determined based on factors such as the member's age, gender, and the level of coverage they have.

Do you need to contact your current insurer to cancel your policy?

If you need to contact your current insurer after setting up a policy with us, please see these handy links below. You simply need to fill in your details in the cancellation letter template and then send it on to your current insurer.

VHI Cancellation Letter: vhi-cancellation-letter.pdf (irishlifehealth.ie)
Laya Cancellation Letter: laya-cancellation-letter.pdf (irishlifehealth.ie)

What is a waiting period for Health Insurance?

The waiting period refers to the how long you must hold health insurance before being eligible to file a claim. There are three types of waiting periods:

  • Initial waiting period - This is relevant if you're obtaining health insurance for the first time or if your health coverage has been inactive for 13 weeks or longer before obtaining new insurance.
  • Pre-existing condition waiting period - this is relevant if your health insurance claim relates to a pre-existing condition.
  • Upgrade waiting period - this is relevant when you upgrade your health insurance, by purchasing a plan with more comprehensive cover than your previous plan.

Continuity of cover means holding a health insurance plan without any lapses in cover when you switch from one insurance provider to another.

  • Accident and Injuries: None
  • Illnesses that start after you join: 26 Weeks
  • Illnesses that existed in the 6 months before you join: 5 Years
  • Maternity related claims: 52 Weeks

What is the maximum Lifetime Community Rating (LCR) loading that applies?

Lifetime Community Rating is a mechanism that ties the health insurance premium to the age at which individuals acquire private health insurance. Late entry loadings are imposed on premiums for those who enter the health insurance market at 35 years or older.

If you are obtaining private health insurance for the first time at the age of 35 or above, you may face a 2% loading added to your premium for every year beyond 34, up to a maximum of 70%. This loading serves as an incentive for individuals to obtain health insurance earlier in life, promoting a fair and balanced insurance market.

What is a Group Discount?

Health Insurance Plans may include a discretionary discount ranging from 0% to 10%. Typically, this discount is applicable only to group schemes where multiple members are insured together. It's important to note that this discount might already be factored into your premium.

It's essential to adhere to the Community Rating legislation, which prohibits offering any other discounts to specific groups of people based on their age, sex, or health status. This ensures fairness and equal treatment for all policyholders.

What is a ‘Break in Cover’ period?

Once an individual has maintained a continuous private health insurance policy for at least 3 years and then decides to cancel it for a duration of 6 months or more, they become eligible to receive credit for any periods of non-cover that start on or after 1 February 2019. However, this credit is subject to a lifetime limit of 3 years. The credited periods can be comprised of non-consecutive time spans, each lasting a minimum of 6 months.

What is Inpatient Excess?

The inpatient excess is a predetermined amount that you contribute towards the expenses incurred during your stay in a Private or High-Tech hospital. By having an inpatient excess on your policy, you can reduce costs while retaining access to Private and High-Tech hospital facilities. It's important to note that the inpatient excess is exclusively applicable to the Private and High-Tech hospital coverage on your plan; it is never applied to Public Hospital cover.

The specific inpatient excess amounts will vary depending on your chosen plan, so it's crucial to refer to the correct Table of Cover. To access this information, simply log into our Member Area. It's important to mention that all inpatient excess payments are made directly to the hospital, and you cannot seek reimbursement for this expense. The inpatient excess feature is designed to provide you with cost-effective access to private medical facilities while maintaining the quality of care you need.

How does the Outpatient Excess work?

The outpatient excess is the threshold amount per person that must be reached in benefits before a member becomes eligible to claim money back.

It's essential to understand that it is the benefit offered by the policy that contributes towards the outpatient excess, not the actual amount the member has personally paid for the treatment. In other words, once the cumulative benefits for outpatient services reach the specified excess amount, the member becomes eligible to claim money back for further eligible expenses.

What are Personalised Packages?

In addition to the core benefits we offer; Irish Life Health provides the flexibility to customize your health insurance according to your specific requirements. You can select one or more additional packages of benefits from our range of Personalised Packages. We have three distinct ranges of Personalised Packages available, and the options you can choose from will depend on the plan you have.

Your chosen Personalised Packages are detailed in your Table of Cover, which also outlines the extent of coverage available for each benefit within the selected package. This way, you can easily tailor your health insurance to suit your individual needs with the added benefits that matter most to you.

What is a Health Insurance Levy?

The Irish Government imposes a Health Insurance Levy on health insurers for each policyholder. This levy is subject to potential annual changes in accordance with the Government's yearly budget.

The levy constitutes a fixed portion of your health insurance premium. For instance, if you are an adult with an annual premium of €1,200 on a Level 2 plan, €449 of that amount represents your Health Insurance Levy, approximately one-third of the total premium.

The funds generated from this levy are utilized to support the Risk Equalisation Premium Credit, which benefits insured individuals aged 65 and over.

What is a Pre-existing Condition?

A pre-existing condition refers to any ailment, illness, or condition with signs or symptoms that have been present at any point since birth, before obtaining health insurance for the first time, or prior to reinstating health insurance after a lapse of more than 13 weeks.

Am I covered for A&E Abroad?

You are indeed covered for accidents and emergencies while abroad. Your plan provides hospital (in-patient) accident and emergency cover ranging from €55,000 to €100,000 for temporary stays abroad (up to 31 consecutive days outside of Ireland). Our plans are tailored for members residing in Ireland for at least 180 days of the policy year.

If you require information or hospitalization while overseas, please contact our 24-hour international assistance helpline at 00 353 148 17840. It's important to reach out to this helpline before receiving treatment, whenever reasonably possible. Failing to do so may result in not being able to claim for treatment under this benefit.

For your convenience, please log into your Online Account to check your Table of Cover and confirm the extent of A\&E cover on your policy. While health insurance covers accidents and emergencies abroad, we emphasize that it is not a substitute for travel insurance. Thus, we recommend purchasing travel insurance before your departure.

Furthermore, it's advisable to obtain a European Health Insurance Card before traveling. You can find information on how to apply for this card on www.ehic.ie.

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