Health Insurance Act 1994


Number 16 of 1994


HEALTH INSURANCE ACT 1994

REVISED

Updated to 1 January 2023


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 Local Government (Maternity Protection and Other Measures for Members of Local Authorities) Act 2022 (52/2022), enacted 21 December 2022, and all statutory instruments up to and including the Planning And Development And Foreshore (Amendment) Act 2022 (Commencement) Order 2023 (S.I. No. 1 of 2023), made 9 January, 2023, 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 2023


Introduction

This Revised Act presents the text of the Act as it has been amended since enactment, and preserves the format in which it was passed.

Related legislation

Health Insurance Acts 1994 to 2022: this Act is one of a group of Acts included in this collective citation, to be construed together as one (Health Insurance (Amendment) Act 2022 (49/2022), s. 8(3). The Acts in this group are:

Health Insurance Act 1994 (16/1994)

Health Insurance (Amendment) Act 2001 (17/2001)

Health Insurance (Amendment) Act 2003 (11/2003)

Health Insurance (Amendment) Act 2007 (3/2007)

Health Insurance (Miscellaneous Provisions) Act 2009 (24/2009), Part 2

Health Insurance (Miscellaneous Provisions) Act 2011 (34/2011), ss. 2, 3 and 4

Health Insurance (Amendment) Act 2012 (45/2012)

Health Insurance (Amendment) Act 2013 (48/2013), other than s. 12

Health Insurance (Amendment) Act 2014 (42/2014), other than s. 8

Health Insurance (Amendment) Act 2015 (54/2015), other than s. 6

Health Insurance (Amendment) Act 2016 (19/2016), other than s. 8

Health Insurance (Amendment) Act 2017 (37/2017), other than s. 6

Health Insurance (Amendment) Act 2018 (35/2018), other than ss. 5 to 7

Health Insurance (Amendment) Act 2019 (49/2019), other than s. 5

Health Insurance (Amendment) Act 2020 (24/0020), other than s. 5

Health Insurance (Amendment) Act 2021 (47/0021), other than s. 8

Health Insurance (Amendment) Act 2022 (49/0022), other than s. 7

Annotations

This Revised Act is annotated and includes textual and non-textual amendments, statutory instruments made pursuant to the Act and previous affecting provisions.

An explanation of how to read annotations is available at

www.lawreform.ie/annotations.

Material not updated in this revision

Where other legislation is amended by this Act, those amendments may have been superseded by other amendments in other legislation, or the amended legislation may have been repealed or revoked. This information is not represented in this revision but will be reflected in a revision of the amended legislation if one is available.

Where legislation or a fragment of legislation is referred to in annotations, changes to this legislation or fragment may not be reflected in this revision but will be reflected in a revision of the legislation referred to if one is available.

A list of legislative changes to any Act, and to statutory instruments from 1972, may be found linked from the page of the Act or statutory instrument at

www.irishstatutebook.ie.

Acts which affect or previously affected this revision

Health Insurance (Amendment) Act 2022 (49/2022)

Health Insurance (Amendment) Act 2021 (47/2021)

Health Insurance (Amendment) Act 2020 (24/2020)

Health Insurance (Amendment) Act 2019 (49/2019)

Data Protection Act 2018 (7/2018)

Health Insurance (Amendment) Act 2018 (35/2018)

Health Insurance (Amendment) Act 2017 (37/2017)

Health Insurance (Amendment) Act 2016 (19/2016)

Health Insurance (Amendment) Act 2015 (54/2015)

Health Insurance (Amendment) Act 2014 (42/2014)

Freedom of Information Act 2014 (30/2014)

Health Insurance (Amendment) Act 2013 (48/2013)

Health Insurance (Amendment) Act 2012 (45/2012)

Ministers and Secretaries (Amendment) Act 2011 (10/2011)

Health Insurance (Miscellaneous Provisions) Act 2011 (34/2011)

Health Insurance (Miscellaneous Provisions) Act 2009 (24/2009)

Voluntary Health Insurance (Amendment) Act 2008 (6/2008)

Health Insurance (Amendment) Act 2007 (3/2007)

Health Insurance (Amendment) Act 2003 (11/2003)

Health Insurance (Amendment) Act 2001 (17/2001)

All Acts up to and including Local Government (Maternity Protection and Other Measures for Members of Local Authorities) Act 2022 (52/2022), enacted 21 December 2022, were considered in the preparation of this revision.

Statutory instruments which affect or previously affected this revision

Health Insurance Act 1994 (Section 11E(2)) Regulations 2022 (S.I. No. 553 of 2022)

Health Insurance Act 1994 (Information Returns) (Amendment) Regulations 2022 (S.I. No. 148 of 2022)

Health Insurance Act 1994 (Risk Equalisation Scheme) (Amendment) Regulations 2022 (S.I. No. 147 of 2022)

Health Insurance Act 1994 (Preparation of Financial Statements) Regulations 2022 (S.I. No. 146 of 2022)

Health Insurance Act 1994 (Section 11E(2)) Regulations 2021 (S.I. No. 696 of 2021)

Health Insurance Act 1994 (Section 11E(2)) Regulations 2020 (S.I. No. 538 of 2020)

Health Insurance Act 1994 (Section 11E(2)) Regulations 2020 (S.I. No. 378 of 2020)

Health Insurance Act 1994 (Section 11E(3)) Regulations 2013 (Amendment) Regulations 2020 (S.I. No. 90 of 2020)

Health Insurance Act 1994 (Section 11E(3)) (No. 3) (Amendment)Regulations 2019 (S.I. No. 471 of 2019)

Health Insurance Act 1994 (Section 11E(3)) (No. 3) Regulations 2013 (S.I. No. 401 of 2019)

Health Insurance Act 1994 (Determination of Relevant Increase under section 7A and Provision of Information under section 7B) (Amendment) Regulations 2018 (S.I. No. 224 of 2018)

Health Insurance Authority Superannuation Scheme 2016 (S.I. No. 637 of 2016)

Health Insurance Act 1994 (Lifetime Cover) (Revocation) Regulations 2016 (S.I. No. 627 of 2016)

Health Insurance Act 1994 (Section 11 E(2) (No. 2)) Regulations 2016 (S.I. No. 573 of 2016)

Health Insurance Act 1994 (Section 11E(2)) Regulations 2016 (S.I. No. 120 of 2016)

Health Insurance Act 1994 (Information Returns) (Amendment) Regulations 2015 (S.I. No. 608 of 2015)

Health Insurance Act 1994 (Section 11E(2) (No. 3)) Regulations 2015 (S.I. No. 544 of 2015)

Health Insurance Act 1994 (Section 11E(2) (No. 2)) Regulations 2015 (S.I. No. 151 of 2015)

Health Insurance Act 1994 (Section 11E(2)) (Revocation) Regulations 2015 (S.I. No. 102 of 2015)

Health Insurance Act 1994 (Section 11E(2)) Regulations 2015 (S.I. No. 101 of 2015)

Health Insurance Act 1994 (Minimum Benefit) (Amendment) Regulations 2015 (S.I. No. 96 of 2015)

Health Insurance Act 1994 (Open Enrolment) Regulations 2015 (S.I. No. 79 of 2015)

Health Insurance Act 1994 (Section 11E(2)) (No. 5) Regulations 2014 (S.I. No. 621 of 2014)

Health Insurance Act 1994 (Minimum Benefit) (Amendment) Regulations 2014 (S.I. No. 612 of 2014)

Health Insurance Act 1994 (Section 17) Levy Regulations 2014 (S.I. No. 528 of 2014)

Health Insurance Act 1994 (Section 11E(2)) (No. 4) Regulations 2014 (S.I. No. 496 of 2014)

Health Insurance Act 1994 (Section 11E(3)) Regulations 2014 (S.I. No. 438 of 2014)

Health Insurance Act 1994 (Section 11E(2)) (Revocation) Regulations 2014 (S.I. No. 437 of 2014)

Health Insurance Act 1994 (Section 11E(2)) (No. 3) Regulations 2014 (S.I. No. 389 of 2014)

Health Insurance Authority Employee Superannuation Scheme 2014 (S.I. No. 318 of 2014)

Health Insurance Act 1994 (Determination of Relevant Increase under section 7A and Provision of Information under section 7B) Regulations 2014 (S.I. No. 312 of 2014)

Health Insurance Act 1994 (Section 11E(2)) (No. 2) Regulations 2014 (S.I. No. 202 of 2014)

Health Insurance Act 1994 (Section 11E(2)) (Amendment) Regulations 2014 (S.I. No. 167 of 2014)

Health Insurance Act 1994 (Section 11E(2)) Regulations 2014 (S.I. No. 148 of 2014)

Health Insurance Act 1994 (Section11E(2)) (No. 3) Regulations 2013 (S.I. No. 568 of 2013)

Health Insurance Act 1994 (Section11E(3)) (No. 4) Regulations 2013 (S.I. No. 567 of 2013)

Health Insurance Act 1994 (Information Returns) (Amendment) Regulations 2013 (S.I. No. 522 of 2013)

Health Insurance Act 1994 (Section11E(3)) (No. 3) Regulations 2013 (S.I. No. 364 of 2013)

Health Insurance Act 1994 (Section 11E(3)) (No. 2) Regulations 2013 (S.I. No. 204 of 2013)

Health Insurance Act 1994 (Section 11E(2)) (No. 2) Regulations 2013 (S.I. No. 203 of 2013)

Health Insurance Act 1994 (Section11E(2)) Regulations 2013 (S.I. No. 93 of 2013)

Health Insurance Act 1994 (Section11E(3)) Regulations 2013 (S.I. No. 92 of 2013)

Health Insurance Act 1994 (Risk Equalisation Scheme) Regulations 2013 (S.I. No. 70 of 2013)

Health Insurance Act 1994 (Information Returns) (Amendment) Regulations 2011 (S.I. No. 690 of 2011)

Finance (Transfer of Departmental Administration and Ministerial Functions) Order 2011 (S.I. No. 418 of 2011)

Health Insurance Act 1994 (Information Returns) Regulations 2009 (S.I. No. 294 of 2009)

Health Insurance Act 1994 (Registration) (Amendment) Regulations 2009 (S.I. No. 72 of 2009)

Risk Equalisation (Amendment) Scheme 2008 (S.I. No. 228 of 2008)

Risk Equalisation (Amendment) Scheme 2007 (S.I. No. 220 of 2007)

Health Insurance Act 1994 (Registration) (Amendment) Regulations 2005 (S.I. No. 335 of 2005)

Risk Equalisation (Amendment) Scheme 2005 (S.I. No. 334 of 2005)

Health Insurance Act 1994 (Minimum Benefit) (Amendment) Regulations 2005 (S.I. No. 333 of 2005)

Health Insurance Act 2001 (Open Enrolment) Regulations 2005 (S.I. No. 332 of 2005)

Risk Equalisation (Amendment) Scheme 2003 (S.I. No. 710 of 2003)

Risk Equalisation Scheme 2003 (S.I. No. 261 of 2003)

Health Insurance Act 1994 (Section 17) Levy Regulations 2001 (S.I. No. 255 of 2001)

Health Insurance Act, 1994 (Establishment Day) Order 2001 (S.I. No. 40 of 2001)

Health Insurance Act 1994 (Risk Equalisation) (Revocation) Regulations 1999 (S.I. No. 32 of 1999)

Health Insurance Act 1994 (Commencement) Order 1999 (S.I. No. 28 of 1999)

Health Insurance Act (Risk Equalisation Scheme) 1996 (S.I. No. 84 of 1996)

Health Insurance Act 1994 (Minimum Benefit) Regulations 1996 (S.I. No. 83 of 1996)

Health Insurance Act 1994 (Lifetime Cover) Regulations 1996 (S.I. No. 82 of 1996)

Health Insurance Act 1994 (Open Enrolment) Regulations 1996 (S.I. No. 81 of 1996)

Health Insurance Act 1994 (Registration) Regulations 1996 (S.I. No. 80 of 1996)

Health Insurance Act 1994 (Commencement) Order 1994 (S.I. No. 191 of 1994)

All statutory instruments up to and including Planning And Development And Foreshore (Amendment) Act 2022 (Commencement) Order 2023 (S.I. No. 1 of 2023), made 9 January 2023, were considered in the preparation of this revision.

Number 16 of 1994


HEALTH INSURANCE ACT 1994

REVISED

Updated to 1 January 2023


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 2023


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: