Jennifer Whitmore (Wicklow, Social Democrats)
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756. To ask the Minister for Health if her Department or the HSE have considered implementing a standard procedure where GP practices and medical centres are in direct contact with health insurance providers so that there is no requirement for the patient to contact their health insurance provider to seek a reimbursement for the cost of their medical treatment; and if she will make a statement on the matter. [33600/25]

Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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I am responsible for the legal framework governing the health insurance market in Ireland. This is a voluntary market that operates under the principles of community rating, open enrolment, lifetime cover and minimum benefit.

Minimum benefit means that all health insurance contracts must provide a certain minimum level of cover for inpatient and outpatient hospital treatment. This approach is designed to be equitable and fair, by ensuring that all consumers obtain an appropriate minimum level of health insurance cover regardless of what plan they purchase. The Health Insurance Act, 1994 (Minimum Benefit) Regulations 1996, require insurers to offer a minimum benefit to customers in every insurance policy. A health insurer is free to provide additional benefits outside of the minimum benefits.

Insurers may exclude certain services and providers in their policies, provided they remain in compliance with the Minimum Benefit Regulations. Insurers are free to contract selectively with healthcare providers and are not required to cover treatment by any particular healthcare service provider, whether public or private, in line with Irish and EU competition law.

These decisions are taken by health insurers on the basis of commercial decision-making. It is important to note that I have no role in the commercial decisions or operational arrangements of private health insurance providers. These are matters for the insurers themselves, operating within the regulatory framework overseen by the Health Insurance Authority (HIA).

Patients are advised to check with their health insurance provider in advance of treatment to confirm the extent of their cover for the proposed treatment. This ensures clarity on any potential out-of-pocket expenses and helps avoid delays in claims processing.