Dáil Éireann Debate, Thursday - 4 December 2025
524. Deputy Ken O'Flynn asked the Minister for Health to publish the underlying actuarial modelling, market projections, and equality assessment used by the Health Insurance Authority in recommending the 2026 stamp-duty increases; and to detail the Department’s own evaluation of affordability risks for policyholders with low or modest incomes. [68918/25]
View answer525. Deputy Ken O'Flynn asked the Minister for Health whether her Department has conducted an impact study on the effect of increased stamp duty on private health insurance on hospitals that rely on privately insured patients for elective activity, including expected reductions in private-patient throughput. [68919/25]
View answer532. Deputy Ken O'Flynn asked the Minister for Health the projected total revenue in 2026 from the stamp-duty increase on health-insurance policies, as approved under the Risk Equalisation Scheme; and to provide the Department’s modelling of the expected impact on the Risk Equalisation Fund balance. [68927/25]
View answer533. Deputy Ken O'Flynn asked the Minister for Health whether her Department prepared any distributional analysis of the levy increase on households earning between €30,000 and €70,000, including the estimated annual cost per policyholder for adults and children used in internal decision-making. [68928/25]
View answer534. Deputy Ken O'Flynn asked the Minister for Health whether the Department conducted any assessment of the potential impact of higher levies on private hospital activity levels, including projected changes in insured patient volumes for 2026 and the expected financial effect on hospitals. [68929/25]
View answer535. Deputy Ken O'Flynn asked the Minister for Health to publish the Health Insurance Authority’s underlying modelling for the 2026 levy recommendation, including the sensitivity tests relating to premium increases and policyholder retention. [68930/25]
View answer536. Deputy Ken O'Flynn asked the Minister for Health whether any options were considered to mitigate the effect of the levy increase on policyholders, including phased introduction, reduced levies for child policies, or offsetting measures through tax relief adjustments. [68931/25]
View answerI propose to take Questions Nos. 524, 525, 532, 533, 534, 535 and 536 together.
As Minister for Health, I am responsible for the legal framework governing the health insurance market in Ireland. This is a voluntary market operating under the principles of community rating, open enrolment, lifetime cover and minimum benefit. Community rating ensures that everyone can buy the same policy at the same price, regardless of age, gender or health status. In a risk-rated market, older and sicker people would pay much more for health insurance than they do in a community-rated market.
Community rating is enabled through the Risk Equalisation Scheme. Under the Scheme, funds are redistributed in the form of credits to compensate insurers for the additional cost of insuring older and sicker members. The credits are funded by a stamp duty levy paid into the Scheme by health insurance providers for each policy issued.
Each year, the Health Insurance Authority analyses the market and makes recommendations on the credit and stamp duty amounts to the Minister for Health. I approve the updated risk equalisation credits and request the Minister for Finance to approve the corresponding stamp duties required to fund the credits. The risk equalisation credits and stamp duty levies are carefully calibrated to ensure that the Risk Equalisation Fund is self-funding and does not require funds from the Exchequer. The stamp duty levy relates solely to the operation of the Risk Equalisation Scheme.
The Health Insurance Authority’s recommendation for the 2026 stamp duty was based on the actuarial modelling and market analysis contained in its Autumn RES Report (Report of the Authority to the Minister for Health on an evaluation and analysis of returns from 1 July 2024 to 30 June 2025). This report includes an evaluation and analysis of information collected by the HIA from 1 July 2024 to 30 June 2025. The Health Insurance Authority considered various approaches in making its recommendation to the Minister for Health. This report will be published on the Health Insurance Authority website shortly, subject to the redaction of commercially sensitive information.
In respect of policies to be written between 1 April 2026 and 31 March 2027, it is projected that €1,020 million in credits will be paid out of the Risk Equalisation Scheme. The level of credits and stamp duty was deemed necessary to ensure the continued sustainability of community rating and adequate support for insurers with higher-risk customers.
Premium setting is a matter for insurers, who consider multiple factors including claims experience, benefit changes, and operating costs. While increases to stamp duties may affect insurance premium costs, stamp duty is a ring-fenced contribution to the Risk Equalisation Fund and supports the credits needed to enable fairness and sustainability in the voluntary private health insurance market. Stamp duty is not automatically applied to each health insurance premium. Insurers decide how to build it into their pricing structures across their portfolio of policy types.
There are currently 1,769,340 adults and 496,140 children on advanced plans, as well as 133,176 adults and 37,344 children on non-advanced plans. Non-advanced contracts mainly cover treatment in public hospitals. They provide a more basic level of cover and are generally less expensive. Advanced contracts offer a higher level of cover, including access to private hospitals and additional benefits. There are 4 different rates of stamp duty depending on whether the policy is advanced or non-advanced and whether the customer is an adult or a child. The rates for non-advanced policies and children are lower, reflecting lower levels of claims.
To support policyholders, tax relief at source is also available on medical or dental insurance policies under section 470 of the Taxes Consolidation Act 1997. Income tax relief is granted at the standard rate of tax (currently 20%), subject to certain limitations.
The Department monitors market trends and coverage levels through quarterly data published by the Health Insurance Authority. As of Quarter 3 2025, 2.54 million people hold private health insurance in Ireland, representing an increase of 13,166 from Quarter 2. Year-on-year growth stands at 1.2%. These figures indicate continued stability in the insured population.
The Health Insurance Authority does not collect household earnings data on people with private health insurance, and is not in a position to conduct any distributional analysis of the levy increase or assess affordability risks for policyholders/households with specific incomes.
