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Prohibition of termination of, or refusal to renew, health insurance contracts
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5. The Principal Act is amended by the substitution of the following section for section 9:
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“9. (1) A registered undertaking shall not terminate or (irrespective of whether or not the contract provides for its renewal) refuse to renew a health insurance contract without the consent of the other party to the contract except—
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(a) where there has been fraudulent misrepresentation to the undertaking in relation to the contract which has, or could have, resulted in financial loss to the undertaking,
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(b) where the undertaking ceases to carry on health insurance business in the State, or
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(c) subject to subsections (2) to (5), where the undertaking has ceased to offer, in the State, health insurance contracts of the type of that contract.
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(2) Where a registered undertaking refuses to renew a health insurance contract (‘non-renewed contract’) on the ground referred to in subsection (1)(c) and that contract provides for benefits in respect of hospital in-patient services, it shall, at the same time as such refusal, offer, to the other party to the non-renewed contract, a replacement health insurance contract (‘replacement contract’) where—
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(a) subject to subsection (3), the hospital in-patient services for which the benefits are payable under the replacement contract are the same as, or more than, such services for which benefits are payable under the non-renewed contract, and
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(b) subject to subsection (4), the benefits payable in respect of hospital in-patient services under the replacement contract are the same as, or more than, the level of such benefits payable under the non-renewed contract.
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(3) Subsection (2)(a) shall not apply in the case of a hospital in-patient service—
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(a) which is no longer available in the State at the time of the refusal referred to in subsection (2), or
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(b) in respect of which the registered undertaking has ceased to offer (whether before such refusal or with effect on or after the time of such refusal), in the State, any health insurance contract under which benefits are payable in respect of such service.
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(4) (a) Paragraph (b) applies if—
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(i) the replacement contract provides that the insured person who makes a claim under the contract for payment of benefits in respect of hospital in-patient services provided to the person is liable to pay an amount (‘excess amount’) towards the provision of such services, and
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(ii) the excess amount—
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(I) is not greater than €100 where the non-renewed contract did not provide for an equivalent to the excess amount, or
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(II) is not greater than €100 more than the equivalent to the excess amount provided in the non-renewed contract.
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(b) The provision in the replacement contract for the payment of the excess amount shall be disregarded for the purposes of subsection (2)(b).
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(5) Without prejudice to the generality of section 8(5), where the second-mentioned contract referred to in that section is the replacement contract, it shall be presumed for the purposes of this section that the services or payment provided for in the replacement contract are the same as those provided for in the first-mentioned contract referred to in section 8(5).”.
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