The HSE and the medical card

Public health services in Ireland come from the Health Service Executive. Anyone ordinarily resident can use them, meaning someone who has lived in Ireland for at least a year or intends to live there for at least a year. Entitlement does not hinge on paying tax or PRSI, Ireland’s social insurance, so it follows the person rather than the job.

The medical card is the widest form of public cover. It provides public health services at no charge, including GP visits and public in-patient and out-patient hospital care, and most applicants are means-tested on income. The HSE assesses everyone who applies for a GP visit card for a medical card first, and those who don’t qualify for the full card are considered for the GP visit card, which covers GP visits only.

Public patients without a medical card pay a daily charge for in-patient stays in public hospitals, capped over any 12 months. Private cover adds private hospital and private-room access, faster consultant access and day-to-day benefits on top of this public base.

Only registered insurers sell Irish health insurance

The Health Insurance Authority keeps a register of health insurers under the Health Insurance Act 1994, and only insurers on that register may carry on health insurance business in Ireland. Registered policies sit inside the Irish system of open enrolment, community rating, risk equalisation and minimum benefits.

International plans sit outside it. A 2017 answer in the Oireachtas, Ireland’s parliament, said an international plan is not a health insurance contract under Irish health insurance law, which places it outside community rating, risk equalisation and minimum benefits.

That makes the employer’s choice a question of plan type as much as plan design. An international plan can top up public care, while Irish-registered cover is what protects the employee’s position under Lifetime Community Rating. How the two compare in other countries is in our overview of international health insurance for remote employees.

Lifetime Community Rating and the late-entry loading

Since 1 May 2015, anyone aged 35 or older who first buys private health insurance pays a loading of 2% of the gross premium for each year over 34 that they went without cover. Earlier periods of Irish cover reduce the loading, and a gap of up to 13 weeks does not trigger it.

Years on an international plan may not be credited. The same 2017 parliamentary answer said time on an international plan does not count toward Lifetime Community Rating, so an employee who later moves to an Irish-registered policy can face the loading. Because that answer dates from 2017, check the current Lifetime Community Rating rules on the Health Insurance Authority’s site before relying on it.

The rule weighs most on employees already past 34 who expect to stay in Ireland long term, since each year treated as uninsured adds to the loading they would carry into a registered policy.

Open enrolment and waiting periods

Irish private health insurance is open enrolment and community rated. Anyone ordinarily resident can buy it whatever their age, sex, health or medical history, and the insurer charges the same price for the same cover.

Waiting periods still apply. The HIA’s maximums are 26 weeks for new illnesses, 52 weeks for maternity benefits and 5 years for pre-existing conditions, and a condition counts as pre-existing if signs or symptoms appeared in the 6 months before joining. Cover that starts early in the employment gives those periods time to run.

Benefit in kind and Tax Relief at Source

Revenue treats employer-paid medical insurance as a benefit in kind. The insurer applies Tax Relief at Source to the premium, the employer pays the reduced amount and returns the value of that relief to Revenue, and the employee is taxed, through income tax, PRSI and USC, on the gross premium.

The employee can then claim Medical Insurance Relief at the standard rate of 20% on the part of the policy that covers benefits qualifying for health expenses relief. Revenue notes that the Tax Relief at Source rules changed from 1 January 2026, so the steps above may not match how a policy renewed after that date is handled.

Running Irish payroll from the US

Payroll guides describe the usual setup: a US company with an employee in Ireland registers as an employer with Revenue, runs PAYE, PRSI and USC through real-time payroll reporting, and pays employer PRSI on top. The same guides note that a non-resident employer can register without forming an Irish company.

Employer-of-record providers describe the alternative, in which the EOR holds the Revenue registration and runs payroll and benefits as the legal employer. Who arranges health cover in each model is set out in our guide to health coverage for EOR staff and contractors abroad.

Treating an Irish worker as a contractor raises its own questions about status and tax. Have an Irish tax adviser look over the arrangement before you settle on one, and compare it with the US view in employees vs. independent contractors in California.

Getting an introduction for an Irish hire

Our part is the introduction. Use the quote form on this page to tell us how many people you have in Ireland, roughly how old they are if Lifetime Community Rating could matter, and whether anyone already holds an Irish policy. From there, the details go to a benefits partner used to arranging cover for staff spread across several countries.

The partner and the insurer then decide eligibility, plans and pricing for your Irish hire. If the hire also changes your US policies, our page on insurance changes for remote teams covers the commercial side we handle.

A few useful answers

Common questions

Can a US company give an Irish employee an international health plan?

Such a plan sits outside Irish health insurance law. Only HIA-registered insurers may carry on health insurance business in Ireland, and a 2017 parliamentary answer said time on an international plan does not count toward Lifetime Community Rating.

How does an employee in Ireland use public health services?

Through the HSE. Anyone ordinarily resident can use public health services, whether or not they pay PRSI. A means-tested medical card adds GP visits and public hospital care at no charge, and a GP visit card covers GP visits only.

How is employer-paid health insurance taxed in Ireland?

As a benefit in kind. The employer pays the premium net of Tax Relief at Source and returns that relief to Revenue, and the employee pays income tax, PRSI and USC on the gross premium, then claims Medical Insurance Relief at 20% on the qualifying part.

What is the Lifetime Community Rating loading?

A charge of 2% of the gross premium for each year over 34 without cover, paid by people aged 35 or older who first buy private health insurance. Earlier Irish cover reduces it, and a gap of up to 13 weeks does not trigger it.

Can Mithril1 set up health insurance for our Irish employee?

Not directly: for an employee based in Ireland, we can introduce you to a benefits partner that handles international and remote-team health coverage. Send the details through the quote form; plan options, eligibility and pricing come from the partner and the insurer.

International Health Insurance for Remote Employees in Ireland