Michael Cahill (Kerry, Fianna Fail)
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764. To ask the Minister for Health if she will ensure that the payment due for health scans such as CT, MRI, and so on are accepted from the patients' health insurance or medical card, which is not always the case at present, (details supplied); and if she will make a statement on the matter. [15400/25]

Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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Ireland operates a voluntary, community rated private health insurance market, meaning that individuals can choose whether or not to purchase private health insurance, and all policyholders pay the same premium for a given level of cover, regardless of their age, gender or health status.

A key feature of this system is minimum benefit, whereby insurers are required, under the Health Insurance Act 1994 (Minimum Benefit) Regulations 1996, to offer a minimum level of cover in every insurance policy. However, private health insurers have discretion over the specific treatments and procedures they choose to cover, provided they meet these minimum requirements.

I have no role in the commercial decisions of private health insurers, including decisions regarding the coverage of specific diagnostics such as CT, MRI, and so on.

If an individual is dissatisfied with their insurer’s decision regarding coverage, they can avail of their insurer’s internal complaints process. If they remain dissatisfied with the outcome, they may escalate their complaint to the Financial Services and Pensions Ombudsman (FSPO), which provides an independent dispute resolution service for consumers and financial service providers, including private health insurers.

Additional Information – Eligibility

Under the provisions of the Health Act 1970 (as amended) the Irish Public Health System provides for two categories of eligibility for persons ordinarily resident in the country, i.e. full eligibility (medical cards) and limited eligibility. Full eligibility is determined primarily by reference to income limits and determination of an individual's eligibility status is the responsibility of the HSE. Individuals with full eligibility can access a range of services including general practitioner services, prescribed drugs and medicines, all public hospital in-patient services including consultant services, all public hospital out-patient services including consultant services, dental, ophthalmic, and aural services and appliances, a termination of pregnancy service and a maternity and infant care service. Individuals with limited eligibility are eligible for in-patient and outpatient public hospital services including consultant services, subject to certain charges. Other services such as allied healthcare professional services may also be made available to persons with limited eligibility.

Separately, patients may opt for inpatient care in public hospitals under section 55 of the Health Act 1970 (as amended) which, provides that the HSE may make available in-patient services to persons who do not have or have waived their eligibility to public in-patient services. Statutory inpatient hospital charges apply for such an episode of care (as set out in the tables of charges specified in the Fourth Schedule to the 1970 Act) depending on the category of hospital and whether the accommodation was provided in a single or multi-occupancy room (as set out in the Fifth Schedule and the Sixth Schedule).