Open Enrolment and Lifetime Cover

Open enrolment and lifetime cover mean that, except in limited circumstances specified in legislation, health insurers must accept all applicants for health insurance and all consumers are guaranteed the right to renew their policies regardless of their age or health status.

An exception to these provisions is that they do not apply to certain “Restricted Membership Undertakings”. These undertakings mainly provide health insurance to certain vocational groups and their families. This cohort accounts for about 4% of the total health insurance market.

Health Insurance Act 1994 (Open Enrolment) Regulations 2015

In conjunction with the introduction of Lifetime Community Rating and on the basis of not disproportionately penalising older cohorts, amended Open Enrolment Regulations were signed by the Minister on 2 March 2015. The new Regulations apply standardised waiting periods for all new customers who take out health insurance from 1 May 2015. These maximum periods will be 26 weeks for illnesses that commence after joining, five years for pre-existing illnesses, and 2 years for upgrades in cover.

The Regulations were also amended to reflect market changes since they were originally drafted including (i) a definition of a pre-existing condition based on the onset of “signs and symptoms” rather than on the onset of the condition, (ii) to extend the definition of an insured person to include a reference to a ‘child adopted to a person’, where the child is under 18 years of age and (iii) some necessary technical amendments.