Health Insurance (Amendment) Act 2016

• Permanent Page URL

Amendment of section 7E of Principal Act

3. Section 7E of the Principal Act is amended—

(a) in subsection (1) —

(i) in paragraph (a)(iii), by the substitution of “hospital utilisation” for “hospital bed utilisation”, and

(ii) in paragraph (b) —

(I) in subparagraph (i), by the substitution of “specified period (taking into account the objective specified in subparagraph (iii)(II))” for “specified period”, and

(II) by the substitution of the following subparagraph for subparagraph (iii):

“(iii) (I) subject to subsection (1A), the amounts of the risk equalisation credits that the Authority considers, after having regard to such evaluation and analysis, would need to be afforded, under the Risk Equalisation Scheme, to persons insured by registered undertakings (other than restricted membership undertakings) having regard to the principal objective (in so far as the principal objective relates to relevant contracts), the aim of avoiding overcompensation being made to a registered undertaking or former registered undertaking under the operation of the relevant financial provisions (other than section 470B of the Taxes Consolidation Act 1997 ), the aim of maintaining the sustainability of the health insurance market and the aim of having fair and open competition in the health insurance market, and

(II) the objective that the projected net average insurance claim payment per insured person for a relevant age group of insured persons for any period of 12 consecutive months duration should be not less than 125 per cent of the projected net average insurance claim payment per insured person for all age groups of insured persons for that same period, and”,

(b) in subsection (2)(a) —

(i) in subparagraph (v), by the substitution of “market,” for “market, and”,

(ii) in subparagraph (vi), by the substitution of “standards), and” for “standards),”, and

(iii) by the insertion of the following subparagraph after subparagraph (vi):

“(vii) the objective specified in subsection (1)(b)(iii)(II),”,

and

(c) by the insertion of the following subsection after subsection (3):

“(4) In this section—

‘net’, in relation to the average insurance claim payment per insured person for—

(a) a relevant age group of insured persons, or

(b) all age groups of insured persons,

means after the application of the projected net financial impact of the relevant financial provisions for the 12 consecutive months concerned referred to in subsection (1)(b)(iii)(II);

‘relevant age group of insured persons’ means an age group of insured persons specified in column 1 of Table 2 set out in Schedule 4 in respect of which, in accordance with section 11C, part of the premium payable in respect of such insured person is, or is expected to be, payable from the Fund.”.