Finian McGrath (Dublin North Central, Independent)
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To ask the Minister for Health if he will advise and assist citizens who have V.H.I membership, and have been refused cover for their medical expenses. [52287/12]

James Reilly (Dublin North, Fine Gael)
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The main legislative provisions for the regulation of the Irish private health insurance market are included in the Health Insurance Acts 1994 to 2011. Within that statutory framework, all private health insurers are free to design their own health insurance schemes and to enter into agreements with health service providers. As Minister for Health I do not have statutory powers to direct the VHI or any insurer as to what specific benefits are payable under any particular contract. However, the Health Insurance Act 1994 (Minimum Benefit) Regulations 1996 (S.I. 83/1996 as amended by S.I. 333/2005) set out a minimum level of cover which must be provided by insurers. In addition, the Health Insurance Act 1994 (Open Enrolment) Regulations 1996 (S.I. 81/1996 as amended by S.I. 332/2005) outline the waiting periods which insurers may require customers to serve in different circumstances, including in relation to pre-existing conditions.

Cover for medical expenses under a customer's health insurance contract is a private contractual matter between the customer and the insurer. If the customer is not satisfied with any decision made by an insurer relating to the benefits payable under their contract, they should first discuss it with the insurer concerned. However, if the customer remains dissatisfied with the insurer's response, they may contact the Financial Services Ombudsman. The Financial Services Ombudsman is a statutory officer who deals independently with unresolved complaints from consumers about their individual dealings with all financial service providers. is service is provided free of charge to the complainant. The decision of the Financial Services Ombudsman is binding on all parties unless the decision is appealed to the High Court. Customers also have rights of access to the courts in disputes with insurers.

Insurers provide a 14 day cooling off period where they will cancel a customer's contract and give a full premium refund. However, I would advise all private health insurance customers to consider carefully the full range of plans and levels of cover available within the market before taking out a contract, so that they can be sure that their own needs are fully met. It is important to note that once entered into, health insurance contracts are of one year duration. Even if the customer is paying the premium in instalments over the twelve month contract term, this does not alter the contract in that respect.

The Health Insurance Authority (HIA) is the independent regulator of the private health insurance market in Ireland. It provides information to policy holders in relation to rights and health insurance plans and the benefits provided. The HIA's web-site is www.hia.ie and has a very useful health insurance comparison tool which may assist the public in finding the most suitable and competitive health insurance plan to meet their needs. The HIA can also be contacted at Lo-Call 1850 929 166.