Health Insurance Act 1994
F101[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
F102[(b) second—
(i) if the Authority is satisfied that that type of relevant contract does not provide for advanced cover where regulations do not presently specify 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,
(ii) if the Authority is not satisfied as referred to in paragraph (a) in respect of that type of relevant contract where regulations ("the relevant regulations") presently specify ("relevant specification") that the Authority is satisfied that that type of relevant contract does not provide for advanced cover—
(I) by regulations amend the relevant regulations to revoke the relevant specification with effect from the date on which the change concerned in a material particular of the benefits payable under that type of relevant contract is to be first made, and
(II) after making such regulations, amend, with effect from the date referred to in clause (I), the particulars entered in The Register of Health Insurance Contracts in respect of the relevant specification.]
F103[(3A) The Authority may at any time review any evaluation and analysis referred to in subsection (1), (2) or (3) that it has carried out and, if it is satisfied, after such review, that anything that resulted from such evaluation and analysis was not, or is no longer, correct, then the Authority may carry out a further evaluation and analysis referred to in subsection (1), (2) or (3), as the case may be, and its powers to make regulations referred to in this section and to enter particulars in, or amend particulars entered in, The Register of Health Insurance Contracts shall, with all necessary modifications, apply to any such further evaluation and analysis.]
(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.]
Annotations:
Amendments:
F101
Inserted (26.12.2012) by Health Insurance (Amendment) Act 2012 (45/2012), s. 15, commenced on enactment.
F102
Substituted (25.12.2013) by Health Insurance (Amendment) Act 2013 (48/2013), 8(a), commenced on enactment.
F103
Inserted (25.12.2013) by Health Insurance (Amendment) Act 2013 (48/2013), 8(b), commenced on enactment.
Editorial Notes:
E79
Power pursuant to subs. (2) exercised (29.09.2022) by Health Insurance Act 1994 (Section 11E(2)) Regulations 2022 (S.I. No. 553 of 2022), in effect as per reg. 1(2).
E80
Power pursuant to subs. (2) exercised (31.12.2021) by Health Insurance Act 1994 (Section 11E(2)) Regulations 2021 (S.I. No. 696 of 2021), in effect as per reg. 1(2).
E81
Power pursuant to subs. (2) exercised (1.12.2020) by Health Insurance Act 1994 (Section 11E(2)) Regulations 2020 (S.I. No. 538 of 2020), in effect as per reg. 1(2).
E82
Power pursuant to subs. (2) exercised (1.10.2020) by Health Insurance Act 1994 (Section 11E(2)) Regulations 2020 (S.I. No. 378 of 2020), in effect as per reg. 1(2).
E83
Power pursuant to subs. (3) exercised (1.04.2020) by Health Insurance Act 1994 (Section 11e(3)) Regulations 2013 (Amendment) Regulations 2020 (S.I. No. 90 of 2020), in effect as per reg. 1(2).
E84
Power pursuant to subs. (3) exercised (20.09.2019) by Health Insurance Act 1994 (Section 11E(3)) (No. 3) (Amendment) Regulations 2019 (S.I. No. 471 of 2019).
E85
Power pursuant to subs. (3) exercised (1.08.2019) by Health Insurance Act 1994 (Section 11E(3)) (No. 3) Regulations 2013 (S.I. No. 401 of 2019), in effect as per reg. 1(2).
E86
Power pursuant to subs. (2) exercised (25.11.2016) by Health Insurance Act 1994 (Section 11 E(2) (No. 2)) Regulations 2016 (S.I. No. 573 of 2016), in effect as per reg. 1(2).
E87
Power pursuant to subs. (2) exercised (1.03.2016) by Health Insurance Act 1994 (Section 11E(2)) Regulations 2016 (S.I. No. 120 of 2016), in effect as per reg. 1(2).
E88
Power pursuant to subs. (2) exercised (25.11.2015) by Health Insurance Act 1994 (Section 11E(2) (No. 3)) Regulations 2015 (S.I. No. 544 of 2015), in effect as per reg. 1(2).
E89
Power pursuant to subs. (2) exercised (13.04.2015) by Health Insurance Act 1994 (Section 11E(2) (No. 2)) Regulations 2015 (S.I. No. 151 of 2015), in effect as per reg. 1(2).
E90
Power pursuant to subs. (2) exercised (13.03.2015) by Health Insurance Act 1994 (Section 11E(2)) (Revocation) Regulations 2015 (S.I. No. 102 of 2015).
E91
Power pursuant to subs. (2) exercised (13.03.2015) by Health Insurance Act 1994 (Section 11E(2)) Regulations 2015 (S.I. No. 101 of 2015), in effect as per reg. 1(2).
E92
Power pursuant to subs. (2) exercised (22.12.2014) by Health Insurance Act 1994 (Section 11E(2)) (No. 5) Regulations 2014 (S.I. No. 621 of 2014), in effect as per reg. 1(2).
E93
Power pursuant to subs. (2) exercised (30.10.2014) by Health Insurance Act 1994 (Section 11E(2)) (No. 4) Regulations 2014 (S.I. No. 496 of 2014), in effect as per reg. 1(2).
E94
Power pursuant to subs. (3) exercised (2.10.2014) by Health Insurance Act 1994 (Section 11E(3)) Regulations 2014 (S.I. No. 438 of 2014), in effect as per reg. 1(2).
E95
Power pursuant to subs. (2) exercised (2.10.2014) by Health Insurance Act 1994 (Section 11E(2)) (Revocation) Regulations 2014 (S.I. No. 437 of 2014).
E96
Power pursuant to subs. (2) exercised (29.08.2014) by Health Insurance Act 1994 (Section 11E(2)) (No. 3) Regulations 2014 (S.I. No. 389 of 2014), in effect as per reg. 1(2).
E97
Power pursuant to subs. (2) exercised (9.05.2014) by Health Insurance Act 1994 (Section 11E(2)) (No. 2) Regulations 2014 (S.I. No. 202 of 2014), in effect as per reg. 1(2).
E98
Power pursuant to subs. (2) exercised (18.03.2014) by Health Insurance Act 1994 (Section 11E(2)) Regulations 2014 (S.I. No. 148 of 2014), in effect as per reg. 1(2).
E99
Power pursuant to subs. (3) exercised (19.12.2013) by Health Insurance Act 1994 (Section11E(2)) (No. 3) Regulations 2013 (S.I. No. 568 of 2013), in effect as per reg. 1(2).
E100
Power pursuant to subs. (3) exercised (19.12.2013) by Health Insurance Act 1994 (Section11E(3)) (No. 4) Regulations 2013 (S.I. No. 567 of 2013), in effect as per reg. 1(2).
E101
Power pursuant to subs. (3) exercised (26.09.2013) by Health Insurance Act 1994 (Section11E(3)) (No. 3) Regulations 2013 (S.I. No. 364 of 2013), in effect as per reg. 1(2).
E102
Power pursuant to subs. (3) exercised (20.06.2013) by Health Insurance Act 1994 (Section 11E(3)) (No. 2) Regulations 2013 (S.I. No. 204 of 2013), in effect as per reg. 1(2).
E103
Power pursuant to subsection exercised (20.06.2013) by Health Insurance Act 1994 (Section 11E(2)) (No. 2) Regulations 2013 (S.I. No. 203 of 2013), in effect as per reg. 1(2).
E104
Power pursuant to subs. (3) exercised (20.03.2013) by Health Insurance Act 1994 (Section11E(3)) Regulations 2013 (S.I. No. 92 of 2013), in effect as per reg. 1(2).
E105
Previous affecting provision: power pursuant to subs. (2) exercised (20.03.2013) by Health Insurance Act 1994 (Section 11E(2)) Regulations 2013 (S.I. No. 93 of 2013), in effect as per reg. 1(2); revoked (13.03.2015) by Health Insurance Act 1994 (Section 11E(2)) (Revocation) Regulations 2015 (S.I. No. 102 of 2015), reg. 2(a).
E106
Previous affecting provision: power pursuant to subs. (2) exercised (4.04.2014) by Health Insurance Act 1994 (Section 11E(2)) (Amendment) Regulations 2014 (S.I. No. 167 of 2014); revoked (2.10.2014) by Health Insurance Act 1994 (Section 11E(2)) (Revocation) Regulations 2014 (S.I. No. 437 of 2014), reg. 2(b).
E107
Previous affecting provision: power pursuant to subs. (2) exercised (18.03.2014) by Health Insurance Act 1994 (Section 11E(2)) Regulations 2014 (S.I. No. 148 of 2014), in effect as per reg. 1(2); revoked (2.10.2014) by Health Insurance Act 1994 (Section 11E(2)) (Revocation) Regulations 2014 (S.I. No. 437 of 2014), reg. 2(b).