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HEALTH INSURANCE ACT, 1994
Preliminary and General
Short title and commencement.
1. —(1) This Act may be cited as the Health Insurance Act, 1994.
(2) Subject to section 12 (2) (b), this Act shall come into operation on such day or days as the Minister shall fix by order or orders either generally or with reference to any particular purpose or provision and different days may be so fixed for different purposes and different provisions.
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);
“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;
“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.
3. —(1) The Minister may—
(a) by regulations provide for any matter referred to in this Act as prescribed or to be prescribed, and
(b) make regulations generally for the purpose of giving effect to this Act and, if in any respect any difficulty arises during the period of two years after the commencement of this section in bringing into operation this Act, by regulations do anything which appears to be necessary or expedient for bringing this Act into operation.
(2) Regulations under this Act may contain such incidental, supplementary and consequential provisions as appear to the Minister to be necessary or expedient for the purposes of the regulations.
(3) Every regulation under this Act shall be laid before each House of the Oireachtas as soon as may be after it is made and, if a resolution annulling the regulation is passed by either such House within the next 21 days on which that House has sat after the regulation is laid before it, the regulation shall be annulled accordingly, but without prejudice to the validity of anything previously done there-under.
4. —(1) (a) A person who contravenes a provision of this Act shall be guilty of an offence and shall be liable—
(i) on summary conviction, to a fine not exceeding £1,000, or
(ii) on conviction on indictment, to a fine not exceeding £100,000.
(b) A person who contravenes a provision of a regulation under this Act stated to be a penal regulation shall be guilty of an offence and shall be liable on summary conviction to a fine not exceeding £1,000.
(2) A person who, after conviction for an offence under subsection (1), continues to contravene the provision concerned, shall be guilty of an offence on each day on which the contravention continues and for each such offence shall be liable—
(a) on summary conviction, to a fine not exceeding £100, or
(b) on conviction on indictment, to a fine not exceeding £10,000.
(3) Where an offence under this Act is committed by a body corporate and is proved to have been so committed with the consent or connivance of or to be attributable to any neglect on the part of any person, being a director, manager, secretary or other officer of the body corporate, or a person who was purporting to act in any such capacity, that person, as well as the body corporate, shall be guilty of an offence and shall be liable to be proceeded against and punished as if he or she were guilty of the first-mentioned offence.
6. —Any expenses incurred by the Minister in the administration of this Act shall, to such extent as may be approved by the Minister for Finance, be paid out of moneys provided by the Oireachtas.