Private Health Insurance Decision Reference 2025-0221

• Case Outcome: Rejected
• Year: 2025
• Reference: 2025-0221
• Date: 23 December 2025
• Subject Matter: Private Health Insurance
• Finantial Sector: Insurance
• Conducts Complained Of: Mis-selling (insurance),Claim handling delays or issues, Disagreement regarding Settlement amount offered, Failure to advise on key product/service features

Decision Ref:

2025-0221

Sector:

Insurance

Product / Service:

Private Health Insurance

Conduct(s) complained of:

Mis-selling (insurance)

Claim handling delays or issues

Failure to advise on key product/service features

Disagreement regarding Settlement amount offered

Outcome:

Rejected

LEGALLY BINDING DECISION OF THE FINANCIAL SERVICES AND PENSIONS OMBUDSMAN

This complaint concerns a health insurance policy, held by the Complainants with the

Provider.

The Complainants’ Case

The Complainants state that their health insurance policy allows for an excess of €450.00

(four hundred and fifty euro) for the three family members on the policy. The

Complainants affirm that, if they had been set up as individual policy holders, a €150.00

(one hundred and fifty euro) excess would apply to each individual family member. The

Complainants state that as one member of the family incurred the majority of the medical

expenses on the policy, they would have to have three times the number of eligible claims

under the family excess compared to if they had an individual excess before being entitled

to any refund of expenses.

The Complainants state that the Provider did not advise them that individual policies

would have resulted in a lower individual excess, being more advantageous than a

collective family plan, which would have been in their best interests as customers.