Lifetime Community Rating and You.

Rules governing the price of private health insurance have come into effect from 1st May 2015. What this means is that from this date, anyone aged 35 and over who wants to buy private health insurance for the first time will have to pay an additional charge. This charge is based on your age at entry into health insurance.

How these new rules will affect you

Well if you already have health insurance, they won’t affect you at all.

However, from 1st May 2015 if you are aged 35 or over when you first take out private health insurance you will pay an additional charge of 2% for each year that you are aged 35 and over, up to a maximum of 70% for those joining at age 69 or over.

Also from 1st May 2015, changes to the rules around waiting periods and pre-existing conditions will come into effect for anyone buying private health insurance for the first time or anyone renewing or upgrading their cover from 1st May 2015.

The definition for pre-existing conditions has been amended and waiting periods applying to pre-existing conditions have been standardised for all age groups to 5 years for new joiners and 2 years for cover upgrades.

LCR loadings will apply for a maximum period of 10 years.

The good news is that…

If you take out a private health insurance plan before you are over 35, you will avoid the additional charge on your premium for as long as you remain a paid up private health insurance customer.

There’s also good news for young adults

From the 1st May 2015, student rates will be replaced by Young Adult Rates. So after the 1st May 2015 if you are aged between 18 and 25, the price you pay will be based on your age and not on whether or not you are in full time education.

But if you are aged 35 and over and don't have health insurance

There are some things which may reduce your additional charge.

  • Credit for breaks in the past when you had private health insurance as an adult.
  • Credit for breaks in private health insurance of at least 6 months duration, up to a cumulative total of 3 years credit. This credit may only be claimed if a person has had cumulative 3 years coverage in the PMI market before break in cover credit can be given.
  • Credit for periods while you were a member of Permanent Defence Forces, or the Joint Sickness Insurance Scheme of the European Union, provided you become an insured person on, or after, 1 September 2018 and within 9 months of ending your membership.
  • Credit for periods, where in certain specified circumstances, you gave up your private health insurance due to unemployment.
  • If you lived overseas on the 1st May 2015 and subsequently returned to Ireland, you will be entitled to a grace period of 9 months within which you can buy private health insurance without any age at entry loadings.
  • Credit for those who have resided outside the state provided they take up PMI within 9 months of ceasing to reside outside the state.

Find out more about how these special considerations may apply to you at