Mary Butler (Waterford, Fianna Fail) | Oireachtas source

Forcing cover for all model 2 hospitals would have unintended consequences. It would drive up the price of entry-level plans. A high-cost claim under this Bill will arise when a customer's health insurance claim or claims exceeds €50,000 in a 12-month period. The fund will then pay 40% of the portion of the claim that exceeds that amount. So, for a claim of €60,000, the fund would pay out €4,000. The types of activities conducted in model 2 hospitals are less likely to result in these high-cost claims as, typically, there are of lower complexity and do not result in long-term stays. In circumstances where a patient was being treated for such a long time on a private basis that it results in a high-cost claim, that would be a patient that was covered by their health insurance for that hospital. It is important that people who want to buy or already have health insurance - we know that is 46% of people in the country - need to be clear on what they are buying and what they are covered for. Health insurers generally issue statements to make sure the customer is aware of what they have. Unfortunately, I am not in a position to accept the amendment.

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