Health Insurance (Amendment) Act 2012
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Amendment of Principal Act. |
15.— The Principal Act is amended by inserting the following sections after section 11: | |
“Risk Equalisation Scheme. | ||
11A.— This section and sections 11B to 11G, the regulations under section 11E, the regulations under section 11F, and Schedules 3 and 4, shall comprise a scheme (to be known as the ‘Risk Equalisation Scheme’) for the purposes of assisting in the achievement of the principal objective. | ||
Application of Risk Equalisation Scheme. | ||
11B.— (1) Subject to subsection (2), the Risk Equalisation Scheme shall apply to— | ||
(a) each registered undertaking, and | ||
(b) each undertaking that has ceased to be a registered undertaking but was a registered undertaking at any time when the Scheme was in force. | ||
(2) The Risk Equalisation Scheme shall not apply to a restricted membership undertaking. | ||
(3) The Risk Equalisation Scheme shall not apply to so much of the activities of a registered undertaking as consist of effecting health insurance contracts where such a contract— | ||
(a) either of itself or as construed with any linked or related other health insurance contract, makes no provision for the making of in-patient indemnity payments, or | ||
(b) relates solely to the public hospital daily in-patient charges made under the Health (In-patient Charges) Regulations 1987 ( S.I. No. 116 of 1987 ). | ||
Payment from Fund of risk equalisation credits. | ||
11C.— (1) (a) Where a registered undertaking effects, before 31 March 2013, a relevant contract for any period commencing on or after 1 January 2013, it shall, in respect of each insured person who falls within a class of insured person specified in column 1 of Table 1 set out in Schedule 4, not collect from the policy holder such part of the premium payable (or, if that premium is payable by instalments, not so collect pro rata from the instalments) in respect of the provision of health insurance cover under that contract to that person— | ||
(i) as is equal to the amount (if any) specified in column 2 of that Table opposite that class of insured person, and | ||
(ii) on the basis that that part of the premium payable is payable from the Fund. | ||
(b) Where a registered undertaking effects, on or after 31 March 2013, a relevant contract for any period commencing on or after that date, it shall, in respect of each insured person who falls within a class of insured person specified in column 1 of Table 2 set out in Schedule 4, not collect from the policy holder such part of the premium payable (or, if that premium is payable by instalments, not so collect pro rata from the instalments) in respect of the provision of health insurance cover under that contract to that person— | ||
(i) as is equal to the amount (if any) specified in column 2 of that Table opposite that class of insured person, and | ||
(ii) on the basis that that part of the premium payable is payable from the Fund. | ||
(2) A registered undertaking or former registered undertaking may, in accordance with the regulations under section 11F, make a claim to the Authority to be paid an amount equal to its risk equalisation credits for the period to which the claim relates. | ||
(3) Where the Authority receives a claim referred to in subsection (2) from a registered undertaking or former registered undertaking, it shall, in accordance with the regulations under section 11F, pay out of the Fund to the undertaking that amount that the Authority is satisfied is so payable, in accordance with the Risk Equalisation Scheme, in respect of the risk equalisation credits to which the claim relates. | ||
(4) Information concerning the amounts of stamp duty paid by registered undertakings or former registered undertakings pursuant to section 125A of the Stamp Duties Consolidation Act 1999 shall, at the request of the Authority, be disclosed to the Authority by the Revenue Commissioners or a Revenue officer (within the meaning of section 851A of the Taxes Consolidation Act 1997 ) for the purposes of assisting the Authority in performing its functions under this Act. | ||
Risk Equalisation Fund. | ||
11D.— (1) The Authority shall establish, administer and maintain a fund to be known as the Risk Equalisation Fund (in this Act referred to as ‘the Fund’). | ||
(2) The Authority shall open and maintain— | ||
(a) subject to paragraph (b), an account (in this Act referred to as a ‘current account’) for all moneys paid into the Fund, and | ||
(b) an account (in this Act referred to as an ‘investment account’) for such moneys (if any) that are not immediately required for the purposes of the current account. | ||
(3) The National Treasury Management Agency may, at the request of the Authority and on the Authority’s behalf, invest moneys (if any) in the investment account of the Fund and any income, capital or other benefit received in respect of moneys invested under this subsection shall be paid into the investment account or invested under this subsection as directed by the Authority. | ||
(4) Subject to subsection (5), the following shall be paid into the Fund: | ||
(a) all stamp duty paid, in respect of health insurance contracts effected to provide health insurance cover for any period commencing on or after 1 January 2013, by virtue of section 125A of the Stamp Duties Consolidation Act 1999 ; and | ||
(b) any other moneys which may belong to or accrue to the Fund or be received by the Authority in respect of it (including any amount referred to in section 7F(10) or subsection (7)). | ||
(5) (a) In this section ‘special account’ means the account (if any) established under paragraph (d). | ||
(b) The Minister may, for the purpose of maintaining a sufficient amount of moneys in the current account of the Fund, having regard to the sums payable from the current account, request the Minister for Finance to advance moneys to the special account from the Central Fund. | ||
(c) A request under paragraph (b) shall be approved by the Minister for Finance, following consultation with the Minister for Public Expenditure and Reform, before any moneys are advanced to the special account pursuant to a request under that paragraph. | ||
(d) For the purposes of moneys advanced to the current account of the Fund pursuant to a request under paragraph (b), an account shall be established which shall be— | ||
(i) in the name of the Minister, and | ||
(ii) an account with the Paymaster General. | ||
(e) The Minister shall, subject to such conditions as the Minister for Finance considers appropriate, manage and control the special account for the purpose of maintaining an amount of moneys in the current account of the Fund that is sufficient to meet the sums payable from that current account. | ||
(f) Whenever the moneys in the current account of the Fund are insufficient to meet the sums payable from that account— | ||
(i) there shall be paid into that account from the investment account of the Fund the moneys necessary to meet those sums payable, and | ||
(ii) if there is still a shortfall in the current account of the Fund to meet those sums payable after the moneys in the investment account have been paid into it, there shall be paid into the current account from the special account the moneys necessary to meet the shortfall. | ||
(6) The following shall be paid out of the Fund: | ||
(a) amounts payable to registered undertakings by virtue of section 11C(3); | ||
(b) amounts payable to the Central Fund to repay moneys paid into the current account of the Fund from the special account; | ||
(c) costs, charges and expenses incurred in maintaining, protecting, administering and applying the Fund; and | ||
(d) other sums properly payable out of the Fund. | ||
(7) Where it comes to the knowledge of the Authority that, for whatever reason, there has been a payment (including any part thereof) from the Fund to a registered undertaking or former registered undertaking which is not in accordance with this Act, the Authority may recover the amount concerned— | ||
(a) as a simple contract debt in any court of competent jurisdiction from the registered undertaking or former registered undertaking concerned, or | ||
(b) by deducting that amount from any payment from the Fund otherwise due to the registered undertaking or former registered undertaking concerned. | ||
(8) The Authority shall keep all proper and usual accounts of all moneys paid into the Fund and disbursements from the Fund, including— | ||
(a) an income and expenditure account, | ||
(b) a cash-flow statement, and | ||
(c) a balance sheet. | ||
(9) As soon as may be after the end of each financial year of the Authority, the Authority shall submit— | ||
(a) the accounts of the Fund to the Comptroller and Auditor General for audit, and | ||
(b) a copy of an abstract of the accounts as so audited together with a copy of the report of the Comptroller and Auditor General thereon to the Minister. | ||
(10) The Minister shall cause copies of the 2 documents referred to in subsection (9)(b) to be laid before each House of the Oireachtas as soon as may be after the documents are submitted to him or her by the Authority. | ||
(11) There shall be included among the debts which, under section 285 of the Companies Act 1963 are, in the distribution of the assets of a registered undertaking or former registered undertaking which is a company being wound up, to be paid in priority to all other debts, all amounts payable to the Fund by virtue of section 7F(10) or subsection (7), and the Companies Act 1963 shall be construed accordingly. | ||
Specification by Authority of certain health insurance contracts as not providing for advanced cover. | ||
11E.— (1) The Authority shall, before 1 January 2013— | ||
(a) first, evaluate and analyse each type of relevant contract on offer in the State in order to ascertain, to the Authority’s satisfaction, whether that type of relevant contract does not provide for advanced cover, and | ||
(b) second, if the Authority is satisfied that that type of relevant contract does not provide for advanced cover— | ||
(i) by regulations specify that the Authority is satisfied that that type of relevant contract does not provide for advanced cover, and | ||
(ii) after making such regulations, enter particulars in The Register of Health Insurance Contracts to indicate that that type of relevant contract has been so specified as not providing for advanced cover. | ||
(2) Where a sample of a new type of relevant contract is submitted to the Authority under section 7AB(1), the Authority shall, before the expiration of 30 days after the sample was so submitted— | ||
(a) first, evaluate and analyse the new type of relevant contract in order to ascertain, to the Authority’s satisfaction, whether that type of relevant contract does not provide for advanced cover, and | ||
(b) second, if the Authority is satisfied that that type of relevant contract does not provide for advanced cover— | ||
(i) by regulations specify that the Authority is satisfied that that type of relevant contract does not provide for advanced cover, and | ||
(ii) after making such regulations, enter particulars in The Register of Health Insurance Contracts to indicate that that type of relevant contract has been so specified as not providing for advanced cover. | ||
(3) Where a changed existing contract which is a relevant contract is submitted to the Authority under section 7AB(2), the Authority shall, before the expiration of 30 days after the changed existing contract was so submitted— | ||
(a) first, evaluate and analyse that type of relevant contract in order to ascertain, to the Authority’s satisfaction, whether that type of relevant contract does not provide for advanced cover, and | ||
(b) second, if the Authority is satisfied that that type of relevant contract does not provide for advanced cover— | ||
(i) by regulations specify that the Authority is satisfied that that type of relevant contract does not provide for advanced cover, and | ||
(ii) after making such regulations, enter particulars in The Register of Health Insurance Contracts to indicate that that type of relevant contract has been so specified as not providing for advanced cover. | ||
(4) For the purposes of this Act— | ||
(a) a relevant contract which provides health insurance cover for— | ||
(i) not more than 66 per cent of the full cost for hospital charges in a private hospital, or | ||
(ii) not more than the prescribed minimum payments within the meaning of the Health Insurance Act 1994 (Minimum Benefit) Regulations 1996 ( S.I. No. 83 of 1996 ), | ||
whichever is the greater, is a relevant contract which provides for non-advanced cover, and | ||
(b) any other relevant contract is a relevant contract which provides for advanced cover, | ||
and references in this Act to ‘non-advanced cover’ and ‘advanced cover’ shall be construed accordingly. | ||
Scheme regulations. | ||
11F.— The Minister may make regulations relating to the making and determination of claims referred to in section 11C(2), including, without prejudice to the generality of the foregoing— | ||
(a) the minimum or maximum periods, or both, to which the claims, or a class of the claims, may relate, | ||
(b) the information returns to be made by registered undertakings or former registered undertakings to the Authority in respect of relevant contracts, or a class of relevant contracts, offered or entered into by them, | ||
(c) the provision of other information by a registered undertaking or former registered undertaking required by the Authority in respect of a particular claim or class of claims, and | ||
(d) the making of enquiries by the Authority and the keeping of records by registered undertakings or former registered undertakings, in respect of claims or a class of claims. | ||
Power to specify form of documents for purposes of Risk Equalisation Scheme. | ||
11G.— (1) The Authority may specify the form of documents (including the form of a claim referred to in section 11C(2)) required for the purposes of the Risk Equalisation Scheme as the Authority thinks appropriate. | ||
(2) The Authority’s power under subsection (1) may be exercised in such a way as to— | ||
(a) include in the specified form of any document referred to in that subsection a statutory declaration— | ||
(i) to be made by the person completing the form, and | ||
(ii) as to whether the particulars contained in the form are true and correct to the best of that person’s knowledge and belief, | ||
and | ||
(b) specify 2 or more forms of any document referred to in that subsection, whether as alternatives, or to provide for particular circumstances or particular cases, as the Authority thinks appropriate. | ||
(3) The form of a document specified under this section shall be— | ||
(a) completed in accordance with such directions and instructions as are specified in the document, | ||
(b) accompanied by such other documents as are specified in the document, and | ||
(c) if the completed document is required to be provided to— | ||
(i) the Authority, | ||
(ii) another person on behalf of the Authority, or | ||
(iii) any other person, | ||
so provided in the manner (if any) specified in the document.”. |