Health Insurance Act, 1994
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Interpretation. |
2.—(1) In this Act, save where the context otherwise requires— | |
“ancillary health services” means— | ||
(a) out-patient services and general medical practitioner services, | ||
(b) dental services, other than those involving surgical procedures carried out in a hospital on an in-patient basis, | ||
(c) services consisting of the supply, alteration, maintenance or repair of hearing aids, spectacles, contact lenses, artificial teeth, eyes or limbs (including parts of teeth or limbs) or other medical, surgical, prosthetic or dental aids, equipment or appliances, | ||
(d) services consisting of the supply of drugs or medicinal preparations, | ||
(e) ambulance services, | ||
(f) services by an attendant of a person who is sick or disabled (other than as part of a hospital in-patient service), and | ||
(g) any other health service, or any health service included in a class of health service, prescribed for the purposes of this paragraph, | ||
but does not include— | ||
(i) hospital in-patient (including day patient) services, or | ||
(ii) any health service (including a health service specified in paragraphs (a) to (g)), or any health service included in a class of health service, prescribed for the purposes of this paragraph; | ||
“the Authority” means the Health Insurance Authority established by section 20 ; | ||
“community rating” shall be construed in accordance with section 7 (1) (c); | ||
“the Council Directives” means Council Directive 73/239/EEC of 24 July, 1973(1) , Council Directive 88/357/EEC of 22 June, 1988(2) and Council Directive 92/49/EEC of 18 June, 1992(3) ; | ||
“establishment day” means the day appointed under section 19 ; | ||
“health benefits undertaking” means a person (including a body established under the laws of a place outside the State) carrying on health insurance business; | ||
“health insurance business” means the business of effecting health insurance contracts; | ||
“health insurance contract” means a contract of insurance, or any other insurance arrangement, the sole or principal purpose of which is to provide for the making of payments by undertakings, whether or not in conjunction with other payments, specifically for the reimbursement or discharge in whole or in part of fees or charges in respect of the provision of hospital in-patient services or ancillary health services, but does not include a contract of insurance, or any other insurance arrangement, the sole purpose of which is to provide for the making of payments by undertakings in respect of sickness, injury or disease of amounts calculated by reference only to the duration of the sickness, injury or disease; | ||
“health services” means medical, surgical, diagnostic, nursing, dental, chiropody, chiropractic, eye therapy, occupational therapy, physiotherapy or speech therapy services or treatment or services or treatment provided in connection therewith, or similar services or treatment; | ||
“hospital in-patient services” means in-patient services within the meaning of the Health Act, 1970 ; | ||
“the Minister” means the Minister for Health; | ||
“out-patient services” has the meaning assigned to it by section 56 of the Health Act, 1970 ; | ||
“premium” has the meaning assigned to it by the Insurance Act, 1936 , and, in relation to a health insurance contract, includes any payment made to the undertaking concerned under the contract; | ||
“prescribed” means prescribed by regulations made by the Minister; | ||
“quarter” means a period of three months ending on the 31st day of March, 30th day of June, 30th day of September or 31st day of December; | ||
“registered”, in relation to an undertaking, means registered in the Register and cognate words shall be construed accordingly; | ||
“the Register” means the Register of Health Benefits Undertakings established under section 14 ; | ||
“the Registrar” means the Registrar and Chief Executive of the Authority; | ||
“restricted membership undertaking” means an undertaking which effects health insurance contracts with its members and the membership of which is restricted to persons and their dependants of a common vocational, occupational or other group or class; | ||
“risk equalisation” means the sharing of prescribed costs of registered undertakings between the undertakings (being costs incurred in respect of payments under health insurance contracts to or in relation to the persons with whom the contracts have been effected) by means of payments made by or to such undertakings in accordance with the terms and conditions of a scheme; | ||
“scheme” means a scheme of risk equalisation under section 12 ; | ||
“undertaking” means a health benefits undertaking. | ||
(2) (a) In this Act a reference to a section or a Schedule is a reference to a section of, or a Schedule to, this Act unless it is indicated that reference to some other enactment is intended. | ||
(b) In this Act a reference to a subsection, paragraph or subparagraph is a reference to a subsection, paragraph or subparagraph of the provision in which the reference occurs unless it is indicated that reference to some other provision is intended. | ||
(c) References in this Act to any enactment or to regulations are to any such enactment or regulations as amended. | ||