Health Insurance Act 1994

Number 16 of 1994

HEALTH INSURANCE ACT 1994

REVISED

Updated to 1 January 2025

This Revised Act is an administrative consolidation of the Health Insurance Act 1994. It is prepared by the Law Reform Commission in accordance with its function under the Law Reform Commission Act 1975 (3/1975) to keep the law under review and to undertake revision and consolidation of statute law.

All Acts up to and including the Family Courts Act 2024 (48/2024), enacted 13 November 2024, and all statutory instruments up to and including the Health Insurance Act 1994 (Section 11E(2)) (Amendment) Regulations 2025 (S.I. No. 15 of 2024), made 22 January 2025, were considered in the preparation of this Revised Act.

Disclaimer: While every care has been taken in the preparation of this Revised Act, the Law Reform Commission can assume no responsibility for and give no guarantees, undertakings or warranties concerning the accuracy, completeness or up to date nature of the information provided and does not accept any liability whatsoever arising from any errors or omissions. Please notify any errors, omissions and comments by email to

revisedacts@lawreform.ie.

Number 16 of 1994

HEALTH INSURANCE ACT 1994

REVISED

Updated to 1 January 2025

ARRANGEMENT OF SECTIONS

PART I

Preliminary and General

Section
1.	Short title and commencement.
1A.	Principal objective of Minister and Authority in performing respective functions under Act.
2.	Interpretation.
2A.	Certain arrangements by employers to constitute health insurance contracts.
3.	Regulations.
4.	Offences.
5.	Repeals.
6.	Expenses.

PART II

Health Insurance Contracts

6A.	Interpretation of Part II.
6B.	Duration of entrustment act.
7.	Prohibition of non-community rated health insurance contracts.
7A.	Premiums which may be charged under health insurance contracts in certain circumstances.
7AB.	Submission of new type of health insurance contract and furnishing of certain other types of health insurance contract to Authority.
7AC.	Register of Health Insurance Contracts.
7B.	Provision of information.
7C.	Registered insurers shall make all reasonable efforts to obtain certain information in respect of insured persons, etc.
7D.	Obligation to make information returns to Authority.
7E.	Evaluation and analysis of information returns, etc.
7F.	Overcompensated undertaking required to make payment to Exchequer if it has made more than reasonable profit.
7G.	Disclosure of contents of information returns.
7H.	Registered undertaking to provide certain premium information to policy holders or certain other persons.
8.	Obligation to provide health insurance.
9.	Prohibition of termination of, or refusal to renew, health insurance contracts.
10.	Minimum level of health insurance cover.
11.	Prohibition of inducements by registered undertakings.
11A.	Risk Equalisation Scheme.
11B.	Application of Risk Equalisation Scheme.
11C.	Payment from Fund of risk equalisation credits.
11D.	Risk Equalisation Fund.
11E.	Specification by Authority of certain health insurance contracts as not providing for advanced cover.
11F.	Scheme regulations.
11G.	Power to specify form of documents for purposes of Risk Equalisation Scheme.
12.	Risk equalisation schemes. (Repealed)
12A.	Risk equalisation schemes - further provisions. (Repealed)
12B.	Limited exemption from requirement to make returns and otherwise comply with risk equalisation scheme. (Repealed)
13.	Advertising and promotion of health insurance business.

PART III

Registration of Health Insurance Undertakings

14.	The Register.
15.	Removal from Register.
16.	Prohibition on carrying on of health insurance business by persons other than registered undertakings.
17.	Levy on registered undertakings.
18.	Records.

PART IIIA

Enforcement Notices

18A.	Interpretation of Part IIIA.
18B.	Issue of enforcement notices.
18C.	Application for cancellation of direction specified in enforcement notice.
18D.	Rules of Court.

PART IIIB

Appointment and Powers of Authorised Officers

18E.	Authorised officers of Authority.
18F.	Powers of authorised officers.
18G.	Privileged legal material.

PART IV

The Health Insurance Authority

19.	Establishment day.
20.	Establishment of Authority.
21.	Functions of Authority.
22.	Conferral of additional functions on Authority.
23.	Consultants and advisers.
24.	Power to borrow.
25.	Gifts.
26.	The Registrar.
27.	Staff of Authority.
28.	Superannuation of staff of Authority.
29.	Membership of either House of the Oireachtas or of European Parliament.
30.	Advances by Minister to Authority.
31.	Disclosure by member of Authority of interest in proposed contract.
32.	Accounts and audits of Authority.
33.	Reports and information to Minister.
33A.	Annual report with respect to the operation of a scheme. (Repealed)
33B.	Equality of treatment of undertakings. (Repealed)
34.	Disclosure of information.
35.	Liability of Authority for acts, omissions etc.

SCHEDULE 1

The Health Insurance Authority

SCHEDULE 2

European Union Framework for State Aid in the Form of Public Service Compensation (2011) (2012/C8/03)

SCHEDULE 3

Amount Specified for Purposes of Definition of "Hospital Bed Utilisation Credit"

SCHEDULE 4

Amount of Premium to be paid from Fund in Respect of Certain Classes of Insured Person Based on Age and Sex of Insured Persons and their Type of Insurance Cover on Date Contract is Effected

SCHEDULE 5

Amount And Percentage Specified For Purposes Of Definitions Relating To High Cost Claims

Number 16 of 1994

HEALTH INSURANCE ACT 1994

REVISED

Updated to 1 January 2025

AN ACT TO REGULATE FURTHER, IN THE INTERESTS OF THE COMMON GOOD, THE PROVISION OF VOLUNTARY HEALTH INSURANCE SO AS TO PROVIDE, INTER ALIA, FOR THE ESTABLISHMENT OF THE HEALTH INSURANCE AUTHORITY, FOR THE ESTABLISHMENT OF SCHEMES FOR THE EQUALISATION OF RISKS BETWEEN HEALTH BENEFITS UNDERTAKINGS, FOR A MINIMUM RANGE OF COVER UNDER SUCH INSURANCE, FOR UNIFORMITY OF THE PREMIUMS CHARGED BY EACH PARTICULAR SUCH UNDERTAKING IN RESPECT OF SPECIFIED RANGES OF SUCH COVER AND FOR THE ESTABLISHMENT OF A REGISTER OF SUCH UNDERTAKINGS AND TO PROVIDE FOR RELATED MATTERS. [30th June, 1994]

BE IT ENACTED BY THE OIREACHTAS AS FOLLOWS:

Revised Acts

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Health Insurance Act 1994