Health Insurance Act, 1994
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Risk equalisation schemes. |
12.—(1) The Minister may, if he or she so thinks fit, having regard to the effects or likely effects of the operation of sections 7 to 11 , prescribe a scheme or schemes of risk equalisation (which or each of which shall be known as a risk equalisation scheme and is referred to in this Act as “a scheme”). | |
(2) (a) A scheme shall apply to each registered undertaking and each such undertaking shall comply with the terms and conditions of the scheme. | ||
(b) Paragraph (a) shall not come into operation as respects a restricted membership undertaking lawfully carrying on health insurance business in the State on the 30th day of June, 1994, before the 30th day of June, 1999. | ||
(3) A scheme may contain such terms and conditions as the Minister considers necessary or expedient and may, without prejudice to the generality of the foregoing, provide for— | ||
(a) the making of payments by registered undertakings to the Authority of such amounts as may be determined by the Authority, | ||
(b) the making of payments by the Authority of such amounts as may be determined by the Authority to such registered undertakings as may be so determined in such manner and by reference to such matters as may be specified in the scheme, | ||
(c) the establishment and maintenance by the Authority of a fund into which all moneys paid to the Authority under the scheme shall be paid and out of which all moneys paid by the Authority under the scheme shall be paid, and | ||
(d) the keeping by the Authority of specified accounts in relation to the scheme and the furnishing of copies of those accounts, as audited by the Comptroller and Auditor General, and copies of the reports of the Comptroller and Auditor General thereon to the Minister at specified times. | ||
(4) (a) A registered undertaking shall, in respect of each quarter or such other period as may be prescribed, make a return to the Authority and, in respect of such periods as aforesaid before the establishment day, to the person engaged under subsection (5) in relation to such matters concerning its health insurance business as may be prescribed. | ||
(b) The first return under paragraph (a) shall be made in respect of such period as may be prescribed. | ||
(c) Returns under paragraph (a) shall be made not later than 60 days after the end of the period to which they relate. | ||
(d) The contents of returns under paragraph (a) shall, in so far as they can be related to individual undertakings, be disclosed only where necessary for the purpose of the functions of the Authority or the person engaged under subsection (5). | ||
(5) (a) The Minister shall engage a person whom he or she considers to be competent and qualified to do so to advise him or her and consult with him or her in relation to the functions of the Minister under this section. | ||
(b) It shall be a function of a person engaged under paragraph (a) to evaluate and analyse returns made to him or her under subsection (4) for the purpose of advising the Minister in relation to the functions of the Minister under this section, including the determination of the question whether regulations should be made under subsection (7). | ||
(6) A payment due by a registered undertaking to the Authority under a scheme may be recovered by it from the undertaking as a simple contract debt in any court of competent jurisdiction. | ||
(7) (a) A scheme under this section shall come into operation on such day (if any) as may be prescribed. | ||
(b) The Minister shall make regulations under paragraph (a) if, but only if, he or she is satisfied that it is necessary to do so having regard to the effects or likely effects of the operation of sections 7 to 11 . |