404. Deputy Pearse Doherty asked the Minister for Health the actions she will take to assess the profits of the health insurance sector; and if she will make a statement on the matter. [39796/26]

405. Deputy Pearse Doherty asked the Minister for Health the actions she will take to assess the profits of the health insurance sector and reduce health insurance premiums. [48247/26]

I propose to take Questions Nos. 404 and 405 together.

As Minister for Health, I am responsible for the legal framework governing the private health insurance market, which operates on the principles of community rating, open enrolment, lifetime cover and

minimum benefit. These protections are designed to support fairness and keep health insurance as affordable as possible for all consumers. Community rating means that everyone can buy the same health insurance policy at the same price,

regardless of their age, gender or health status. In a risk-rated private health insurance market, older and sicker people seeking health insurance would pay much more than others. 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 which is payable by health insurance

providers in relation to each health insurance policy issued. The Health Insurance Authority maintains regulatory oversight of insurers and ensures compliance with community rating, open enrolment, and lifetime cover requirements, which helps to keep the health insurance market fair, accessible and sustainable for all consumers. The Health Insurance Authority also manages the Risk Equalisation Scheme which is approved by the European Commission under EC State aid rules as compatible aid under the Services of General Economic Interest Framework, reflecting its role in supporting community-rated health insurance in Ireland. Under State aid rules, any net beneficiary of the Risk Equalisation Scheme is allowed a maximum profit

of 6% before it is considered to have been overcompensated. Vhi has been the only net beneficiary of the scheme to-date i.e. Vhi receives more in credits than it pays into the Risk Equalisation Scheme Fund. This is because Vhi has older and sicker members. Vhi has not exceeded this 6% profit rate. The private health insurance market operates on a competitive, commercial basis. Insurers set their premiums in line with their own commercial decisions and strategies, within the framework of the

Health Insurance Act 1994, as amended. Health insurance companies generally base their premium prices on their expected claims experience for the next 12 months. They make predictions based on their customer base and what services they

will require in the coming year, and price their premiums accordingly. The cost of private health insurance is influenced by a number of factors, for example the number of persons in the market, the age profile of those holding private health insurance and rising healthcare costs. Healthcare costs rise annually due to medical inflation, increasing hospital charges, more expensive treatments and technologies, and higher wages and operating costs. Insurers factor all these costs into their pricing strategies. As Minister for Health, I have no role in the commercial decision-making of private health insurers, including decisions on premium prices.