Health Insurance (Amendment) Act 2012

Health Insurance (Amendment) Act 2012 Skip to content Disclaimer Feedback Helpdesk Gaeilge Léim go dtí an t-ábhar Séanadh Aiseolas Deasc chabhrach English Gaeilge English Produced by the Office of the Attorney General Táirgthe ag Oifig an Ard-Aighne Home Legislation Acts of the Oireachtas Statutory Instruments Pre-1922 Legislation Constitution External Resources Bills (Houses of the Oireachtas) Iris Oifigiúil / Official Gazette Revised Acts (LRC) Classified List of Legislation (LRC) Translations (acts.ie) Translations (Houses of the Oireachtas) Government Publications for Sale EU Law (EUR-Lex) FAQ Disclaimer Feedback Helpdesk Search Baile Reachtaíocht Achtanna an Oireachtais Ionstraimí Reachtúla Reachtaíocht Réamh-1922 Bunreacht Acmhainní Seachtracha Billí (Tithe an Oireachtais) Iris Oifigiúil Achtanna Athbhreithnithe (CAD) (An Coimisiún um Athchóiriú an Dlí) Liosta Rangaithe Reachtaíochta Aistriúcháin (achtanna.ie) Aistriúcháin (Tithe an Oireachtais) Foilseacháin Rialtais ar Díol Dlí AE (EUR-Lex) CCanna (Ceisteanna Coitianta) Séanadh Aiseolas Deasc chabhrach Cuardach TitleTeideal Year(s) or rangeBliain nó blianta nó raon TypeCineál All Legislation Acts Statutory Instruments Advanced SearchCuardach Casta HomeBaile ActsAchtanna 2012 Health Insurance (Amendment) Act 2012 Health Insurance (Amendment) Act 2012 Permanent Page URL View by SectionAmharc de réir Ailt View Full ActAmharc ar an Acht Iomlán Bill History Stair Bille Commencement, Amendments, SIs made under the Act Tosach Feidhme, Leasuithe, IRí arna ndéanamh faoin Acht Open PDFOscail PDF Print Full ActPriontáil an tAcht Iomlán Number 45 of 2012 HEALTH INSURANCE (AMENDMENT) ACT 2012 ARRANGEMENT OF SECTIONS Section 1. Definition. 2. Amendment of section 1A of Principal Act. 3. Amendment of section 2 of Principal Act. 4. Amendment of section 3 of Principal Act. 5. Offences. 6. Interpretation of Part II. 7. Amendment of section 7 of Principal Act. 8. Amendment of section 7A of Principal Act. 9. Submission of new type of health insurance contract to Authority, etc. 10. Amendment of section 7AC of Principal Act. 11. Amendment of section 7C of Principal Act. 12. Amendment of section 7D of Principal Act. 13. Amendment of section 7E of Principal Act. 14. Amendment of section 7F of Principal Act. 15. Amendment of Principal Act. 16. Amendment of section 17 of Principal Act. 17. Appointment and powers of authorised officers. 18. Amendment of section 21 of Principal Act. 19. Amendment of section 32 of Principal Act. 20. Repeals. 21. Substitution of Schedule 2 to Principal Act. 22. Short title, collective citation and construction. Acts Referred to Companies Act 1963 1963, No. 33 Data Protection Acts 1988 and 2003 Health Insurance Act 1994 1994, No. 16 Health Insurance Acts 1994 to 2011 Health Insurance (Miscellaneous Provisions) Act 2009 2009, No. 24 Petty Sessions (Ireland) Act 1851 1851, (14 & 15) Vict. c.93 Stamp Duties Consolidation Act 1999 1999, No. 31 Taxes Consolidation Act 1997 1997, No. 13 Number 45 of 2012 HEALTH INSURANCE (AMENDMENT) ACT 2012 AN ACT TO AMEND THE HEALTH INSURANCE ACT 1994, IN PARTICULAR TO ENSURE THAT, IN THE INTERESTS OF SOCIETAL AND INTERGENERATIONAL SOLIDARITY, THE BURDEN OF THE COSTS OF HEALTH SERVICES BE SHARED BY INSURED PERSONS BY PROVIDING FOR A COST SUBSIDY BETWEEN THE MORE HEALTHY AND THE LESS HEALTHY, INCLUDING BETWEEN THE YOUNG AND THE OLD; TO PROVIDE, HAVING REGARD TO THE PRINCIPAL OBJECTIVE OF THE HEALTH INSURANCE ACT 1994, FOR RISK EQUALISATION CREDITS TO ENABLE THE LESS HEALTHY, INCLUDING THE OLD, TO HAVE ACCESS TO HEALTH INSURANCE COVER; TO PROVIDE FOR A MEANS WHEREBY ANY OVERCOMPENSATION TO REGISTERED UNDERTAKINGS OR FORMER REGISTERED UNDERTAKINGS ARISING FROM SUCH RISK EQUALISATION CREDITS SHALL BE REPAID; AND TO PROVIDE FOR RELATED MATTERS. [26th December, 2012] BE IT ENACTED BY THE OIREACHTAS AS FOLLOWS: Definition. 1.— In this Act “Principal Act” means the Health Insurance Act 1994 . Amendment of section 1A of Principal Act. 2.— Section 1A of the Principal Act is amended— (a) by substituting the following subsection for subsection (1): “(1) The principal objective of this Act is to ensure that, in the interests of the common good and across the health insurance market, access to health insurance cover is available to consumers of health services with no differentiation made between them (whether effected by risk equalisation credits or stamp duty measures or other measures, or any combination thereof), in particular as regards the costs of health services, based in whole or in part on the health risk status, age or sex of, or frequency of provision of health services to, any such consumers or any class of such consumers, and taking into particular account for the purposes of that objective— (a) the fact that the health needs of consumers of health services increase as they become less healthy, including as they approach and enter old age, (b) the desirability of ensuring, in the interests of societal and intergenerational solidarity, and regardless of the health risk status or age of, or frequency of provision of health services to, any particular generation (or part thereof), that the burden of the costs of health services be shared by insured persons by providing for a cost subsidy between the more healthy and the less healthy, including between the young and the old, and, without prejudice to the generality of that objective, in particular that the less healthy, including the old, have access to health insurance cover by means of risk equalisation credits, (c) the manner in which the health insurance market operates in respect of health insurance contracts, both in relation to individual registered undertakings and across the market, and (d) the importance of discouraging registered undertakings from engaging in practices, or offering health insurance contracts, whether by segmentation of the health insurance market (by whatever means) or otherwise, which have as their object or effect the favouring of the coverage by the undertakings of the health insurance risk of the more healthy, including the young, over the coverage of the health insurance risk of the less healthy, including the old.”, and (b) in subsection (2), by deleting “specified in subsection (1)”. Amendment of section 2 of Principal Act. 3.— Section 2 of the Principal Act is amended— (a) in subsection (1)— (i) in the definition of “community rating”, by deleting “specified in section 1A(1)”, (ii) by substituting the following definition for the definition of “net premium”: “ ‘net premium’— (a) in relation to a health insurance contract effected for a period other than a period commencing on or after 1 January 2013, means the premium payable under the contract in respect of an individual in any year of assessment after— (i) the deduction made from the premium to which the individual is entitled, for that year of assessment, by virtue of section 470 of the Taxes Consolidation Act 1997 , and (ii) the deduction (if any) made from the premium to which the individual is entitled, for that year of assessment, by virtue of section 470B of the Taxes Consolidation Act 1997 , (b) in relation to a health insurance contract effected for a period commencing on or after 1 January 2013, means the premium payable under the contract in respect of an individual in any year of assessment after— (i) the deduction made from the premium to which the individual is entitled, for that year of assessment, by virtue of section 470 of the Taxes Consolidation Act 1997 , and (ii) taking into account the part (if any) of the premium which the individual is entitled not to have collected from the policy holder concerned, for that year of assessment, by virtue of section 11C(1);”, (iii) by deleting the definitions of “risk equalisation” and “scheme”, and (iv) by inserting the following definitions: “ ‘authorised officer’ means a person appointed under section 18E to be an authorised officer; ‘frequency of provision of health services’ includes history of health insurance claims; ‘health risk status’, in relation to any person (howsoever described), includes— (a) the present use of, or likely future use of, hospital services by the person, (b) the sexual orientation of the person, and (c) the suffering or prospective suffering of the person from a chronic illness or other medical condition or from an illness or medical condition of a particular kind; ‘principal objective’ means the principal objective specified in section 1A(1); ‘risk equalisation credits’ has the meaning assigned to it by section 6A(1); ‘Risk Equalisation Scheme’ shall be construed in accordance with section 11A;”, and (b) by adding the following subsection after subsection (2): “(3) In this Act a reference to— (a) a disease includes a reference to an illness, and (b) an illness includes a reference to a disease.”. Amendment of section 3 of Principal Act. 4.— Section 3 of the Principal Act is amended— (a) in subsection (2), by inserting “(or, in the case of regulations under section 11E, the Authority)” after “the Minister”, (b) in subsection (3), by deleting “(other than a regulation referred to in subsection (4))”, and (c) by deleting subsection (4). Offences. 5.— (1) The Principal Act is amended by substituting the following section for section 4: “Offences. 4.— (1) A person who contravenes a provision of this Act shall be guilty of an offence and shall be liable— (a) on summary conviction, to a class A fine or imprisonment for a term not exceeding 12 months or both, or (b) on conviction on indictment, to a fine or imprisonment for a term not exceeding 5 years or both. (2) 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 class A fine or imprisonment for a term not exceeding 12 months or both. (3) A person who, after conviction for an offence under subsection (1) or (2), 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 class E fine, or (b) on conviction on indictment, to a fine not exceeding €50,000. (4) Where an offence under this Act is committed by a body corporate and it is proved that the offence was committed with the consent or connivance, or was attributable to any wilful neglect, of a person who was a director, manager, secretary or other officer of the body corporate, or a person purporting to act in that capacity, that person, as well as the body corporate, shall be guilty of an offence and may be proceeded against and punished as if he or she were guilty of the first-mentioned offence. (5) Where the affairs of a body corporate are managed by its members, subsection (4) applies in relation to the acts and defaults of a member in connection with his or her functions of management as if he or she were a director or manager of the body corporate. (6) The Authority may bring and prosecute summary proceedings for an offence under this Act. (7) Notwithstanding section 10 (4) of the Petty Sessions (Ireland) Act 1851 , summary proceedings for an offence under this Act to which that provision applies may be instituted— (a) within 12 months from the date on which the offence was committed, or (b) within 6 months from the date on which evidence sufficient, in the opinion of the person instituting the proceedings, to justify proceedings comes to that person’s knowledge, whichever is the later, provided that no such proceedings shall be commenced later than 2 years from the date on which the offence concerned was committed. (8) For the purposes of subsection (7)(b), a certificate signed by or on behalf of the person initiating the proceedings as to the date on which evidence referred to in that subsection came to his or her knowledge shall be evidence of that date and, in any legal proceedings, a document purporting to be a certificate under this subsection and to be so signed shall be deemed to be so signed and admitted as evidence without proof of the signature of the person purporting to sign the certificate, unless the contrary is shown. (9) On convicting a person of an offence under this Act, the court shall unless satisfied that there are special and substantial reasons for not so doing, order the person to pay to the Authority the costs and expenses, measured by the court, incurred by the Authority in relation to the investigation, detection and prosecution of the offence.”. (2) Subsection (1), in so far as it relates to the amendment of the Principal Act, shall come into operation 30 days after the passing of this Act. Interpretation of Part II. 6.— The Principal Act is amended by substituting the following section for section 6A: “6A.— (1) In this Part and Schedules 3 and 4— ‘advanced cover’ shall be construed in accordance with section 11E(4); ‘age group’ means age group as prescribed in regulations made under section 7D, and includes any age group, whether or not by reference to any one or more of the following: (a) being less than a specified age; (b) being of a specified age or over such age but under another specified age; or (c) being of a specified age or over such age; ‘age-related tax credit’ has the same meaning as in section 470B(4) of the Taxes Consolidation Act 1997 ; ‘approved accounting standards’ means accounting standards which are in accordance with generally accepted accounting principles in the State; ‘changed existing contract’ has the meaning assigned to it by section 7AB(2)(a); ‘cumulative net financial impact’, in relation to a registered undertaking or former registered undertaking which has furnished the Authority with information under section 7F(1) in respect of a period, means the difference between— (a) the total amount of the age-related tax credits and risk equalisation credits recorded in accounts for that undertaking in respect of that period as extracted from that information by the undertaking in respect of that period, and (b) the total amount of the stamp duty referred to in section 125A of the Stamp Duties Consolidation Act 1999 recorded in accounts for that undertaking in respect of that period as extracted from that information by the undertaking in respect of that period; ‘draft report’ has the meaning assigned to it by section 7F(7); ‘Fund’ means the Risk Equalisation Fund established under section 11D; ‘hospital bed utilisation credit’ means the relevant amount payable from the Fund in respect of each hospital stay, on or after 31 March 2013, involving an overnight stay in a hospital bed in private hospital accommodation by an insured person where the insured person is such a person under a health insurance contract effected for any period commencing on or after 31 March 2013; ‘information return’ means an information return referred to in section 7D(1); ‘non-advanced cover’ shall be construed in accordance with section 11E(4); ‘positive’, in relation to the cumulative net financial impact on a registered undertaking or former registered undertaking which has submitted one or more information returns to the Authority in respect of a period, means that, for that period and that undertaking, the amount specified in paragraph (a) of the definition of ‘cumulative net financial impact’ in this subsection exceeds the amount specified in paragraph (b) of that definition; ‘private hospital accommodation’ means— (a) accommodation in a private hospital, whether or not in a bed, or (b) accommodation in a publicly funded hospital in a bed which is designated, pursuant to Article (8)(i) of the Health Services (In-Patient) Regulations 1991 ( S.I. No. 135 of 1991 ), as a designated private bed; ‘relevant amount’, in relation to the definition of ‘hospital bed utilisation credit’ in this section and an insured person referred to in that definition, means the lower of the following: (a) the amount specified in Schedule 3 for the purposes of that definition multiplied by the number of nights the insured person stayed in private hospital accommodation which fall within the hospital stay concerned referred to in that definition; (b) the sum of all benefits paid under the health insurance contract concerned referred to in that definition in respect of hospital in-patient services provided during the hospital stay concerned referred to in that definition of the insured person; ‘relevant contract’ has the meaning assigned to it by section 125A(1) of the Stamp Duties Consolidation Act 1999 ; ‘relevant contract (advanced cover)’ means a relevant contract which is not a relevant contract (non-advanced cover); ‘relevant contract (non-advanced cover)’ means a relevant contract which falls within a type of relevant contract specified in regulations under section 11E as a type of relevant contract in respect of which the Authority is satisfied under that section that it does not provide for advanced cover; ‘relevant financial provisions’ means— (a) the Risk Equalisation Scheme, (b) section 125A of the Stamp Duties Consolidation Act 1999 , or (c) section 470B of the Taxes Consolidation Act 1997 , or any combination of any of the Risk Equalisation Scheme (including any constituent provision of the Scheme) and any section referred to in paragraph (b) or (c); ‘relevant market sector’, in relation to information returns made to the Authority for any period of 6 months referred to in section 7D(1), means all the registered undertakings or former registered undertakings which have made those returns; ‘relevant period’ has the meaning assigned to it by section 7D(1)(b); ‘risk equalisation credits’— (a) in relation to an individual insured under a health insurance contract effected by a registered undertaking for any period commencing on or after 1 January 2013, means— (i) the payment from the Fund to the undertaking on behalf of the individual of any hospital bed utilisation credits which the individual is entitled to have so paid, and (ii) the payment from the Fund of the part (if any) of the premium payable under the contract which the individual is entitled to have so paid by virtue of section 11C(1), and (b) in relation to such undertaking and such contract, means— (i) the amount of the hospital bed utilisation credits (if any) referred to in paragraph (a)(i), and (ii) the amount of the part (if any) of the premium payable referred to in paragraph (a)(ii) that it has not collected from the policy holder by virtue of section 11C(1); ‘type of cover’ means a specific health insurance contract which provides for the payment of prescribed benefits where either— (a) the particulars relating to the contract are contained in The Register of Health Insurance Contracts, or (b) the particulars relating to the contract were once contained in that Register but, notwithstanding that such particulars are no longer contained in that Register, prescribed benefits are still payable under the contract. (2) Reasonable profit shall be determined under section 7F(4) in accordance with— (a) Article 33 of the European Union framework for State aid in the form of public service compensation (2011) (2012/C8/03) 1 (the text of which is set out for convenience of reference in Schedule 2), and (b) any factors that are prescribed as factors that may be taken into account for the purposes of so determining reasonable profit in accordance with the said Article.”. Amendment of section 7 of Principal Act. 7.— Section 7 of the Principal Act is amended— (a) in subsection (1)(a)— (i) in subparagraph (i)(I), by substituting “60” for “31”, and (ii) in subparagraph (ii)(II), by deleting “specified in section 1A(1)”, and (b) in subsection (3), by substituting the following paragraph for paragraphs (a) and (b): “(a) the health risk status, age or sex of, or frequency of provision of health services to, a person, or”. Amendment of section 7A of Principal Act. 8.— Section 7A of the Principal Act is amended, in subsection (4), by substituting the following paragraph for paragraph (b): “(b) the insured person has previously effected or been named in a health insurance contract with arestricted membership undertaking.”. Submission of new type of health insurance contract to Authority, etc. 9.— The Principal Act is amended by substituting the following section for section 7AB: “7AB.— (1) A registered undertaking shall not offer in the State a new type of health insurance contract (and regardless of whether the contract is already offered outside the State by the undertaking or any other person) unless it has submitted a sample of the contract to the Authority not later than 30 days before first making such offer. (2) Subject to subsection (3), a registered undertaking shall not change in any material particular the benefits payable under a type of health insurance contract that it offers in the State unless it has submitted a sample of the contract as so changed (in this Act referred to as a ‘changed existing contract’) to the Authority not later than 30 days before first making such change. (3) (a) A registered undertaking shall not in any calendar year change the benefits payable under a type of relevant contract (non-advanced cover) that it offers in the State such that it becomes a type of relevant contract (advanced cover) except— (i) in the case of the calendar year 2013, with effect from 31 March 2013, and (ii) in the case of any subsequent calendar year, with effect from 1 January of that subsequent calendar year. (b) A registered undertaking shall not in any calendar year change the benefits payable under a type of relevant contract (advanced cover) that it offers in the State such that it becomes a type of relevant contract (non-advanced cover) except— (i) in the case of the calendar year 2013, with effect from 31 March 2013, and (ii) in the case of any subsequent calendar year,with effect from 1 January of that subsequent calendar year. (4) Without prejudice to section 7(1)(a), a registered undertaking may vary the premium payable for effecting a type of health insurance contract if it gives notice in writing of the variation to the Authority not less than 30 days before the variation takes effect. (5) Notwithstanding subsection (1), a registered undertaking which has made an offer in the State to effect a health insurance contract of a particular type and which has maintained the offer for not less than the 60 consecutive days required by section 7(1)(a)(i)(I) may cease to make that offer in the State if it gives notice in writing of the cesser to the Authority not less than 30 days before the cesser takes effect. (6) Without prejudice to the operation of subsection (5), the notice in writing required to be given to the Authority under that subsection by a registered undertaking in respect of a cesser referred to in that subsection may be given before the expiration of the 60 consecutive days referred to in that subsection. (7) Nothing in subsections (2) to (6) shall be construed to prejudice a health insurance contract of the type referred to in subsection (5) effected before the cesser referred to in subsection (5) takes effect and, accordingly, the contract continues in being in accordance with the terms and conditions on which it was effected.”. Amendment of section 7AC of Principal Act. 10.— Section 7AC of the Principal Act is amended, in subsection (2), by substituting “Subject to section 11E, The Register” for “The Register”. Amendment of section 7C of Principal Act. 11.— Section 7C of the Principal Act is amended, in subsection (5)— (a) in paragraph (a), by substituting “Act 1997,” for “Act 1997, or”, and (b) by inserting the following paragraph after paragraph (a): “(aa) for the purposes of making a claim referred to in section 11C(2), or”. Amendment of section 7D of Principal Act. 12.— Section 7D of the Principal Act is amended, in subsection (2), by substituting the following paragraph for paragraph (b): “(b) the total number of persons insured, or a class thereof, in each age group, the gender profile of each age group, and the type of cover of each age group, in respect of the relevant period,”. Amendment of section 7E of Principal Act. 13.— Section 7E of the Principal Act is amended— (a) in subsection (1)— (i) in paragraph (a), by deleting subparagraphs (i) to (v) and substituting the following: “(i) the average insurance claim payment per insured person made by the relevant market sector during the relevant periods in respect of the total number of persons insured, or a class thereof, during the relevant periods, (ii) the average insurance claim payment per insured person made by the relevant market sector during the relevant periods in respect of subgroups of the total number of persons insured, or a class thereof, during the relevant periods, where such subgroups include such combinations of the following groups of insured persons as the Authority determines to be relevant: (I) those in different age groups; (II) those of differing sex; (III) those with differing types of cover, (iii) the hospital bed utilisation in respect of each group and subgroup referred to in subparagraphs (i) and (ii), and (iv) the net financial impact on each registered undertaking or former registered undertaking of the relevant financial provisions during the relevant periods, and”, and (ii) in paragraph (b)— (I) by substituting the following subparagraph for subparagraph (iii): “(iii) 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”, and (II) in subparagraph (iv)— (A) by inserting “, after having regard to the aim of avoiding the Fund sustaining surpluses or deficits from year to year (as calculated using approved accounting standards),” after “the Authority considers”, and (B) by deleting “Exchequer” and substituting “Fund”, and (b) by substituting the following subsections for subsections (1A) and (2): “(1A) The Minister may, by notice in writing given to the Authority, require the Authority to prepare any report to be furnished to him or her pursuant to paragraph (b) of subsection (1), in so far as the report relates to subparagraph (iii) of that paragraph— (a) in the case of hospital bed utilisation credits, on the basis of the amount specified in the notice or on the basis of the amount specified in Schedule 3 or both, (b) on the basis of the classes of insured person specified in the notice or on the basis of the classes of insured person specified in column 1 of Table 2 set out in Schedule 4 or both. (2) The Minister shall— (a) first, after having regard to— (i) the principal objective (in so far as theprincipal objective relates to relevant contracts), (ii) any report furnished to him or her pursuant to subsection (1)(b), (iii) 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 ), (iv) the aim of maintaining the sustainability of the health insurance market, (v) the aim of having fair and open competition in the health insurance market, and (vi) the aim of avoiding the Fund sustaining surpluses or deficits from year to year (as calculated using approved accounting standards), (b) second, after taking into account the amendments (if any) that he or she wishes to propose to the relevant financial provisions (other than section 470B of the Taxes Consolidation Act 1997 ) in view of the regard given the matters referred to in paragraph (a) (and whether or not those amendments accord with any matter set out in the report referred to in paragraph (a)(ii)), and (c) third, after consultation with the Minister for Finance on the amendments (if any) referred to in paragraph (b), make such recommendations to the Minister for Finance relating to section 125A of the Stamp Duties Consolidation Act 1999 as the Minister considers appropriate.”. Amendment of section 7F of Principal Act. 14.— Section 7F of the Principal Act is amended— (a) by substituting the following subsection for subsection (1): “(1) A registered undertaking or former registered undertaking shall, in respect of each year— (a) maintain and furnish to the Authority (before 1 April of the next succeeding year), in such form as may be specified by the Authority, a statement of profit and loss in respect of— (i) its relevant health insurance business in the State, and (ii) such other health insurance services, provided by the undertaking, as may be prescribed, (b) maintain and furnish to the Authority (before 1 April of the next succeeding year), in such form as may be specified by the Authority, a balance sheet in respect of— (i) its relevant health insurance business in the State, and (ii) such other health insurance services, provided by the undertaking, as may be prescribed, and (c) furnish to the Authority (before 1 April of the next succeeding year), such other information relating to the year as may be prescribed and, without limiting the generality of the foregoing, such information may include a statement of profit and loss and a balance sheet in respect of its relevant health insurance business in the State as it relates to those persons receiving age-related tax credits, in respect of health insurance contracts effected for any period before 1 January 2013, or receiving risk equalisation credits.”, (b) by substituting the following subsection for subsection (4): “(4) (a) The Authority shall, as soon as may be after the expiration of 2012, determine what would constitute a reasonable profit for a registered undertaking in respect of its relevant health insurance business in the State in respect of the period from 1 January 2010 to the end of 2012. (b) The Authority shall, as soon as may be after the expiration of 2013, determine what would constitute a reasonable profit for a registered undertaking in respect of its relevant health insurance business in the State in respect of the 3 year period from 1 January 2011 to the end of 2013. (c) Paragraph (b) shall, with all necessary modifications, apply to each relevant 3 year period as it applies to the 3 year period referred to in that paragraph.”, (c) in subsection (5), by substituting the following paragraph for paragraph (b): “(b) as soon as may be, make a determination as to whether or not the cumulative net financial impact of the relevant financial provisions on a registered undertaking or former registered undertaking is positive for— (i) if paragraph (a) of subsection (4) is applicable, the period from 1 January 2010 to the end of 2012, (ii) if paragraph (b) of subsection (4) is applicable, the period from 1 January of 2011 to the end of 2013, or (iii) if paragraph (c) of subsection (4) is applicable, the period from 1 January of the first year of the relevant 3 year period to the end of the last year of the relevant 3 year period, to which the information furnished to it under subsection (1) relates and, if so, the amount by which the cumulative net financial impact is positive.”, (d) in subsections (7)(e), (10) and (11), by substituting “the Fund” for “the Exchequer” wherever it appears, and (e) by inserting the following after subsection (13): “(14) In this section— ‘relevant health insurance business in the State’, in relation to a registered undertaking or former registered undertaking, means so much of the undertaking’s health insurance business as falls within paragraph (b) of subsection (1) of section 7D after taking into account subsection (5) of that section; ‘relevant 3 year period’ means— (a) the period from 1 January 2012 to the end of 2014, (b) the period from 1 January 2013 to the end of 2015, (c) the period from 1 January 2014 to the end of 2016, and so on for each succeeding 3 year period.”. Amendment of Principal Act. 15.— The Principal Act is amended by inserting the following sections after section 11: “Risk Equalisation Scheme. 11A.— This section and sections 11B to 11G, the regulations under section 11E, the regulations under section 11F, and Schedules 3 and 4, shall comprise a scheme (to be known as the ‘Risk Equalisation Scheme’) for the purposes of assisting in the achievement of the principal objective. Application of Risk Equalisation Scheme. 11B.— (1) Subject to subsection (2), the Risk Equalisation Scheme shall apply to— (a) each registered undertaking, and (b) each undertaking that has ceased to be a registered undertaking but was a registered undertaking at any time when the Scheme was in force. (2) The Risk Equalisation Scheme shall not apply to a restricted membership undertaking. (3) The Risk Equalisation Scheme shall not apply to so much of the activities of a registered undertaking as consist of effecting health insurance contracts where such a contract— (a) either of itself or as construed with any linked or related other health insurance contract, makes no provision for the making of in-patient indemnity payments, or (b) relates solely to the public hospital daily in-patient charges made under the Health (In-patient Charges) Regulations 1987 ( S.I. No. 116 of 1987 ). Payment from Fund of risk equalisation credits. 11C.— (1) (a) Where a registered undertaking effects, before 31 March 2013, a relevant contract for any period commencing on or after 1 January 2013, it shall, in respect of each insured person who falls within a class of insured person specified in column 1 of Table 1 set out in Schedule 4, not collect from the policy holder such part of the premium payable (or, if that premium is payable by instalments, not so collect pro rata from the instalments) in respect of the provision of health insurance cover under that contract to that person— (i) as is equal to the amount (if any) specified in column 2 of that Table opposite that class of insured person, and (ii) on the basis that that part of the premium payable is payable from the Fund. (b) Where a registered undertaking effects, on or after 31 March 2013, a relevant contract for any period commencing on or after that date, it shall, in respect of each insured person who falls within a class of insured person specified in column 1 of Table 2 set out in Schedule 4, not collect from the policy holder such part of the premium payable (or, if that premium is payable by instalments, not so collect pro rata from the instalments) in respect of the provision of health insurance cover under that contract to that person— (i) as is equal to the amount (if any) specified in column 2 of that Table opposite that class of insured person, and (ii) on the basis that that part of the premium payable is payable from the Fund. (2) A registered undertaking or former registered undertaking may, in accordance with the regulations under section 11F, make a claim to the Authority to be paid an amount equal to its risk equalisation credits for the period to which the claim relates. (3) Where the Authority receives a claim referred to in subsection (2) from a registered undertaking or former registered undertaking, it shall, in accordance with the regulations under section 11F, pay out of the Fund to the undertaking that amount that the Authority is satisfied is so payable, in accordance with the Risk Equalisation Scheme, in respect of the risk equalisation credits to which the claim relates. (4) Information concerning the amounts of stamp duty paid by registered undertakings or former registered undertakings pursuant to section 125A of the Stamp Duties Consolidation Act 1999 shall, at the request of the Authority, be disclosed to the Authority by the Revenue Commissioners or a Revenue officer (within the meaning of section 851A of the Taxes Consolidation Act 1997 ) for the purposes of assisting the Authority in performing its functions under this Act. Risk Equalisation Fund. 11D.— (1) The Authority shall establish, administer and maintain a fund to be known as the Risk Equalisation Fund (in this Act referred to as ‘the Fund’). (2) The Authority shall open and maintain— (a) subject to paragraph (b), an account (in this Act referred to as a ‘current account’) for all moneys paid into the Fund, and (b) an account (in this Act referred to as an ‘investment account’) for such moneys (if any) that are not immediately required for the purposes of the current account. (3) The National Treasury Management Agency may, at the request of the Authority and on the Authority’s behalf, invest moneys (if any) in the investment account of the Fund and any income, capital or other benefit received in respect of moneys invested under this subsection shall be paid into the investment account or invested under this subsection as directed by the Authority. (4) Subject to subsection (5), the following shall be paid into the Fund: (a) all stamp duty paid, in respect of health insurance contracts effected to provide health insurance cover for any period commencing on or after 1 January 2013, by virtue of section 125A of the Stamp Duties Consolidation Act 1999 ; and (b) any other moneys which may belong to or accrue to the Fund or be received by the Authority in respect of it (including any amount referred to in section 7F(10) or subsection (7)). (5) (a) In this section ‘special account’ means the account (if any) established under paragraph (d). (b) The Minister may, for the purpose of maintaining a sufficient amount of moneys in the current account of the Fund, having regard to the sums payable from the current account, request the Minister for Finance to advance moneys to the special account from the Central Fund. (c) A request under paragraph (b) shall be approved by the Minister for Finance, following consultation with the Minister for Public Expenditure and Reform, before any moneys are advanced to the special account pursuant to a request under that paragraph. (d) For the purposes of moneys advanced to the current account of the Fund pursuant to a request under paragraph (b), an account shall be established which shall be— (i) in the name of the Minister, and (ii) an account with the Paymaster General. (e) The Minister shall, subject to such conditions as the Minister for Finance considers appropriate, manage and control the special account for the purpose of maintaining an amount of moneys in the current account of the Fund that is sufficient to meet the sums payable from that current account. (f) Whenever the moneys in the current account of the Fund are insufficient to meet the sums payable from that account— (i) there shall be paid into that account from the investment account of the Fund the moneys necessary to meet those sums payable, and (ii) if there is still a shortfall in the current account of the Fund to meet those sums payable after the moneys in the investment account have been paid into it, there shall be paid into the current account from the special account the moneys necessary to meet the shortfall. (6) The following shall be paid out of the Fund: (a) amounts payable to registered undertakings by virtue of section 11C(3); (b) amounts payable to the Central Fund to repay moneys paid into the current account of the Fund from the special account; (c) costs, charges and expenses incurred in maintaining, protecting, administering and applying the Fund; and (d) other sums properly payable out of the Fund. (7) Where it comes to the knowledge of the Authority that, for whatever reason, there has been a payment (including any part thereof) from the Fund to a registered undertaking or former registered undertaking which is not in accordance with this Act, the Authority may recover the amount concerned— (a) as a simple contract debt in any court of competent jurisdiction from the registered undertaking or former registered undertaking concerned, or (b) by deducting that amount from any payment from the Fund otherwise due to the registered undertaking or former registered undertaking concerned. (8) The Authority shall keep all proper and usual accounts of all moneys paid into the Fund and disbursements from the Fund, including— (a) an income and expenditure account, (b) a cash-flow statement, and (c) a balance sheet. (9) As soon as may be after the end of each financial year of the Authority, the Authority shall submit— (a) the accounts of the Fund to the Comptroller and Auditor General for audit, and (b) a copy of an abstract of the accounts as so audited together with a copy of the report of the Comptroller and Auditor General thereon to the Minister. (10) The Minister shall cause copies of the 2 documents referred to in subsection (9)(b) to be laid before each House of the Oireachtas as soon as may be after the documents are submitted to him or her by the Authority. (11) There shall be included among the debts which, under section 285 of the Companies Act 1963 are, in the distribution of the assets of a registered undertaking or former registered undertaking which is a company being wound up, to be paid in priority to all other debts, all amounts payable to the Fund by virtue of section 7F(10) or subsection (7), and the Companies Act 1963 shall be construed accordingly. Specification by Authority of certain health insurance contracts as not providing for advanced cover. 11E.— (1) The Authority shall, before 1 January 2013— (a) first, evaluate and analyse each type of relevant contract on offer in the State in order to ascertain, to the Authority’s satisfaction, whether that type of relevant contract does not provide for advanced cover, and (b) second, if the Authority is satisfied that that type of relevant contract does not provide for advanced cover— (i) by regulations specify that the Authority is satisfied that that type of relevant contract does not provide for advanced cover, and (ii) after making such regulations, enter particulars in The Register of Health Insurance Contracts to indicate that that type of relevant contract has been so specified as not providing for advanced cover. (2) Where a sample of a new type of relevant contract is submitted to the Authority under section 7AB(1), the Authority shall, before the expiration of 30 days after the sample was so submitted— (a) first, evaluate and analyse the new type of relevant contract in order to ascertain, to the Authority’s satisfaction, whether that type of relevant contract does not provide for advanced cover, and (b) second, if the Authority is satisfied that that type of relevant contract does not provide for advanced cover— (i) by regulations specify that the Authority is satisfied that that type of relevant contract does not provide for advanced cover, and (ii) after making such regulations, enter particulars in The Register of Health Insurance Contracts to indicate that that type of relevant contract has been so specified as not providing for advanced cover. (3) Where a changed existing contract which is a relevant contract is submitted to the Authority under section 7AB(2), the Authority shall, before the expiration of 30 days after the changed existing contract was so submitted— (a) first, evaluate and analyse that type of relevant contract in order to ascertain, to the Authority’s satisfaction, whether that type of relevant contract does not provide for advanced cover, and (b) second, if the Authority is satisfied that that type of relevant contract does not provide for advanced cover— (i) by regulations specify that the Authority is satisfied that that type of relevant contract does not provide for advanced cover, and (ii) after making such regulations, enter particulars in The Register of Health Insurance Contracts to indicate that that type of relevant contract has been so specified as not providing for advanced cover. (4) For the purposes of this Act— (a) a relevant contract which provides health insurance cover for— (i) not more than 66 per cent of the full cost for hospital charges in a private hospital, or (ii) not more than the prescribed minimum payments within the meaning of the Health Insurance Act 1994 (Minimum Benefit) Regulations 1996 ( S.I. No. 83 of 1996 ), whichever is the greater, is a relevant contract which provides for non-advanced cover, and (b) any other relevant contract is a relevant contract which provides for advanced cover, and references in this Act to ‘non-advanced cover’ and ‘advanced cover’ shall be construed accordingly. Scheme regulations. 11F.— The Minister may make regulations relating to the making and determination of claims referred to in section 11C(2), including, without prejudice to the generality of the foregoing— (a) the minimum or maximum periods, or both, to which the claims, or a class of the claims, may relate, (b) the information returns to be made by registered undertakings or former registered undertakings to the Authority in respect of relevant contracts, or a class of relevant contracts, offered or entered into by them, (c) the provision of other information by a registered undertaking or former registered undertaking required by the Authority in respect of a particular claim or class of claims, and (d) the making of enquiries by the Authority and the keeping of records by registered undertakings or former registered undertakings, in respect of claims or a class of claims. Power to specify form of documents for purposes of Risk Equalisation Scheme. 11G.— (1) The Authority may specify the form of documents (including the form of a claim referred to in section 11C(2)) required for the purposes of the Risk Equalisation Scheme as the Authority thinks appropriate. (2) The Authority’s power under subsection (1) may be exercised in such a way as to— (a) include in the specified form of any document referred to in that subsection a statutory declaration— (i) to be made by the person completing the form, and (ii) as to whether the particulars contained in the form are true and correct to the best of that person’s knowledge and belief, and (b) specify 2 or more forms of any document referred to in that subsection, whether as alternatives, or to provide for particular circumstances or particular cases, as the Authority thinks appropriate. (3) The form of a document specified under this section shall be— (a) completed in accordance with such directions and instructions as are specified in the document, (b) accompanied by such other documents as are specified in the document, and (c) if the completed document is required to be provided to— (i) the Authority, (ii) another person on behalf of the Authority, or (iii) any other person, so provided in the manner (if any) specified in the document.”. Amendment of section 17 of Principal Act. 16.— Section 17(4) of the Principal Act is amended by deleting “(but not including payments referred to in section 12(4)(a)(ii))”. Appointment and powers of authorised officers. 17.— The Principal Act is amended by inserting the following Part after Part IIIA: “PART IIIB Authorised officers of Authority. 18E.— (1) The Authority may appoint in writing such and so many persons to be authorised officers for the purposes of all or any of the provisions of this Act (including any regulations made under this Act) as it thinks appropriate and such appointment may be specified to be for a fixed period. (2) Every authorised officer appointed under this section shall be furnished with a warrant of appointment and shall, when exercising any power conferred on him or her by or under this Act, if requested by a person affected, produce the warrant of appointment or copy of it to that person. (3) An appointment under this section as an authorised officer shall cease— (a) if the Authority revokes the appointment, (b) if the appointment is for a fixed period, on the expiry of that period, or (c) if the person appointed ceases to be an employee or agent of the Authority. Powers of authorised officers. 18F.— (1) The powers conferred by this section may be exercised in respect of any registered undertaking or former registered undertaking for the purpose of— (a) securing the enforcement of the provisions of this Act (including regulations made under this Act), or (b) enabling or assisting the Minister or the Authority to perform any of their respective functions under this Act. (2) An authorised officer may do all or any of the following: (a) subject to subsection (3), at all reasonable times enter any premises, at which there are reasonable grounds for believing that any books, records or other documents in relation to the issue of any health insurance contract, or in relation to the acceptance of any premium in respect of a health insurance contract, are kept, and search and inspect the premises and such books, records or other documents on the premises; (b) secure for later inspection any premises or any part of a premises in which books, records or other documents are kept or there are reasonable grounds for believing that such books, records or other documents are kept; (c) require any person to whom this section applies or any person employed by such person to produce to the authorised officer such books, records or other documents and in the case of information in a non-legible form to reproduce it in a legible form or to give to the officer such information or explanation as the officer may reasonably require in relation to any entries in such books, records or other documents; (d) inspect and take copies of or extracts from, or remove for a reasonable period for further examination, any books, records, data (within the meaning of the Data Protection Acts 1988 and 2003) or other documents in whatever form kept (including, in the case of information in a non-legible form, a copy of or extract from such information in a permanent legible form) which the officer finds or which is produced to the officer in the course of inspection; (e) require any person to whom this section applies or any person employed by such person to give to the authorised officer such information as the officer may reasonably require in relation to any entries in such books, records or other documents; (f) require any person to whom this section applies to give to the authorised officer any information which the authorised officer may require in regard to the business or activity concerned or in regard to the persons carrying on such business or activity or employed in connection therewith; (g) require any person by whom or on whose behalf data equipment is or has been used or any person having charge of, or otherwise concerned with the operation of, the data equipment or any associated apparatus or material, to afford the authorised officer reasonable assistance in relation thereto; (h) summon, at any reasonable time, any other person employed in connection with the business or activity concerned to give to the authorised officer any information which the officer may reasonably require in regard to such business or activity and to produce to the authorised officer any books, records or other documents which are in that person’s power or control; (i) require any person employed in the premises concerned to prepare a report on aspects of the business specified by the authorised officer or activities of a person to whom this section applies or to explain entries in any books, records, documents or other materials furnished. (3) An authorised officer shall not, other than with the consent of the occupier, enter a private dwelling unless he or she has obtained a warrant issued by a judge of the District Court under subsection (8) authorising such entry. (4) A person who has in his or her power, possession or procurement any books, records or other documents referred to in subsection (2) shall— (a) produce them at the request of an authorised officer and permit the authorised officer to inspect and take copies of, or extracts from, them, (b) at the request of an authorised officer, give any information which may be reasonably required with regard to them, and (c) give such other assistance and information to an authorised officer as is reasonable in the circumstances. (5) Where any person from whom production of a book, record or other document is required claims a lien thereon the production of it shall be without prejudice to the lien. (6) The duty to produce or provide any information, document, material or explanation extends to an examiner, liquidator, receiver, official assignee or any person who is or has been an officer or employee or agent of a person to whom this section applies, or who appears to the Minister, the Authority or the authorised officer to have the information, document, material or explanation in his or her possession or under his or her control. (7) An authorised officer, where he or she considers it necessary, may be accompanied by a member of the Garda Síochána when performing any powers conferred on an authorised officer by this Act. (8) If a judge of the District Court is satisfied on the sworn information of an authorised officer that there are reasonable grounds for suspecting that there is information required by an authorised officer under this section held on any premises or any part of any premises, the judge may issue a warrant authorising an authorised officer, accompanied by other authorised officers or by a member of the Garda Síochána, at any time or times within one month from the date of issue of the warrant, on production of the warrant if so requested, to enter the premises, if need be by reasonable force, and exercise all or any of the powers conferred on an authorised officer under this section. (9) A person shall not— (a) obstruct or impede an authorised officer in the exercise of a power under this section, (b) give to an authorised officer information which the person knows is false or misleading, or (c) without reasonable excuse, fail to comply with a request or requirement made by an authorised officer under this section. (10) (a) If any officer, employee, shareholder or agent of a person to whom this section applies refuses to produce to an authorised officer when requested to do so any book or document which it is his or her duty under this section to produce, or refuses to cooperate with an authorised officer when required to do so, or refuses to answer any question put to him or her by an authorised officer with respect to the affairs of the person to whom this section applies, the authorised officer may certify the refusal under his or her hand to the High Court. (b) Where a refusal is certified to the High Court, the High Court may enquire into the case and, after hearing any witnesses who may be produced against or on behalf of the officer, employee, shareholder or agent of the person to whom this section applies and any statement which may be offered in defence, make any order or direction as it thinks fit. (c) An order or direction made under paragraph (b) may include a direction to the person concerned to attend or re-attend before the authorised officer or produce particular books or documents or answer a particular question put to him or her by the authorised officer, or a direction that the person concerned need not produce a particular book or document or answer a particular question put to him or her by the authorised officer. (11) A person shall not falsely represent himself or herself as an authorised officer. (12) In this section— ‘agent’, in relation to a person to whom this section applies, includes past as well as present agents, and includes its bankers, accountants, solicitors, auditors and its financial and other advisers, whether or not those persons are officers or persons to whom this section applies; ‘person to whom this section applies’ means an undertaking referred to in subsection (1). Privileged legal material. 18G.— (1) Subject to subsection (2), nothing in this Part shall compel the disclosure by any person of privileged legal material or authorise the taking of privileged legal material. (2) The disclosure of information may be compelled, or possession of it taken, pursuant to the powers of this Part, notwithstanding that it is apprehended that the information is privileged legal material provided the compelling of its disclosure or the taking of its possession is done by means whereby the confidentiality of the information can be maintained (as against the person compelling such disclosure or taking such possession) pending the determination by the court of the issue as to whether the information is privileged legal material. (3) Without prejudice to subsection (4), where, in the circumstances referred to in subsection (2), information has been disclosed or taken possession of pursuant to the powers in this Part, the person— (a) to whom such information has been so disclosed, and (b) who has taken possession of it, shall (unless the person has, within the period subsequently mentioned in this subsection, been served with notice of an application under subsection (4) in relation to the matter concerned) apply to the court for a determination as to whether the information is privileged legal material and an application under this subsection shall be made within 7 days after the disclosure or the taking of possession. (4) A person who, in the circumstances referred to in subsection (2), is compelled to disclose information, or from whose possession information is taken, pursuant to the powers in this Part, may apply to the court for a determination as to whether the information is privileged legal material. (5) Pending the making of a final determination of an application under subsection (3) or (4), the court may give such interim or interlocutory directions as the court considers appropriate including, without prejudice to the generality of the foregoing, directions as to— (a) the preservation of the information, in whole or in part, in a safe and secure place in any manner specified by the court, (b) the appointment of a person with suitable legal qualifications possessing the level of experience, and the independence from any interest falling to be determined between the parties concerned, that the court considers to be appropriate for the purpose of— (i) examining the information, and (ii) preparing a report for the court with a view to assisting or facilitating the court in the making by the court of its determination as to whether the information is privileged legal material. (6) An application under subsection (3), (4) or (5) shall be by motion and may, if the court directs, be heard otherwise than in public. (7) In this section— ‘court’ means the High Court; ‘information’ means information contained in a document, a computer (including a personal organiser or any other electronic means of information storage or retrieval) or otherwise; ‘privileged legal material’ means information which, in the opinion of the court, a person is entitled to refuse to produce on the grounds of legal professional privilege.”. Amendment of section 21 of Principal Act. 18.— Section 21 of the Principal Act is amended, in subsection (1)— (a) by substituting “sections 4(6), 7AC, 7D, 7E, 7F, 7G, 14, 15, 17 …