Public vs Private Hospital Cover: What Does Your Health Insurance Actually Cover?

Having private health insurance can give you greater choice when it comes to accessing healthcare in Ireland. However, simply having a health insurance policy doesn't necessarily mean that every hospital, room type or treatment will be covered in the same way.

The level of hospital cover available can vary significantly from one health insurance plan to another. That's why it's important to understand exactly what your policy provides rather than assuming you're covered everywhere.

Public and Private Treatment

If you need hospital treatment, one of the important distinctions to understand is whether you are being treated as a public or private patient.

According to the Health Insurance Authority (HIA), if you are admitted to hospital and have private health insurance, you will need to tell the hospital whether you want to be admitted as a public or private patient.

One of the main benefits of private health insurance is that, depending on your policy, it can provide cover for treatment as a private patient, including inpatient consultant services and private or semi-private hospital accommodation.

However, the exact cover available depends on your individual plan.

Are You Covered in Every Private Hospital?

Not necessarily.

Health insurance policies can provide different levels of cover across different hospitals and medical facilities. A policy that provides good cover in one hospital may provide more limited cover in another.

This is why the hospital list associated with your policy is important.

If there are particular hospitals that you would prefer to have access to, it's worth checking whether your plan covers them and what level of cover applies.

Don't assume that the words "private hospital cover" mean you have the same level of cover in every private hospital.

Private and Semi-Private Rooms

Hospital accommodation is another area where policies can differ.

A private room is generally a hospital room containing a single bed, while a semi-private room can contain several beds.

Your policy documentation should tell you what type of accommodation your plan covers and where that cover applies.

This can be particularly important when comparing two policies. They may appear similar at first glance but provide different accommodation benefits.

What About Consultants and Treatments?

Hospital cover isn't just about the building you're treated in.

You should also consider the benefits available for consultants, procedures and other medical services.

The HIA identifies cover for inpatient consultant services as a private patient as one of the main potential benefits of private health insurance.

However, the benefits, limits and conditions attached to your particular policy matter.

Before undergoing planned treatment, it can be worthwhile confirming your cover with your insurer so that you understand what is covered and whether you could have anything to pay yourself.

Could You Still Have Something to Pay?

Yes.

Having private health insurance doesn't always mean your insurer will pay 100% of every eligible hospital bill.

Depending on your policy and treatment, an excess or shortfall may apply.

An excess is an amount specified under your policy that you have to pay yourself when making certain claims. A shortfall is an amount on a hospital bill that isn't covered by your policy and must be paid out of pocket. Read our other article Health Insurance Excesses and Shortfalls Explained: What Could You Have to Pay Yourself? to learn more about excesses and shortfalls.

Understanding these costs before treatment can help avoid an unexpected bill afterwards.

Don't Just Compare Policies on Price

When reviewing your health insurance, it's understandable to focus on the premium.

But price is only one part of the picture.

A cheaper policy isn't necessarily better value if it doesn't provide the hospital access or benefits that are important to you. Equally, paying more doesn't automatically mean that every additional benefit will be useful for your circumstances.

When comparing your options, consider questions such as:

• Which hospitals are covered?
• What level of cover applies in those hospitals?
• What accommodation am I covered for?
• What excesses or shortfalls could apply?
• What consultant and treatment benefits are included?
• Are there restrictions or exclusions I need to know about?

Know What You're Paying For

Health insurance can be complicated, particularly when you're comparing policies with different hospital lists, benefits and excesses.

Rather than waiting until you need treatment to find out what your policy provides, review your cover in advance.

Understanding where you can be treated, what level of cover you have and what you could potentially have to pay yourself can help you make a more informed decision about whether your current policy is still right for you.

At Health Insurance Ireland, we can help you understand your existing cover and compare the options available to you.

Get in touch with Health Insurance Ireland to review your health insurance and make sure you understand what you're paying for.

Enquiry Form: Click here

Email: info@healthinsuranceireland.ie