7F. —F73[(1) A registered undertaking or former registered undertaking shall, in respect of each year—

(a) maintain and furnish to the Authority (before F74[1 May] 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 F74[1 May] 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 F74[1 May] 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.]

(2) (a) A statement of profit and loss or balance sheet shall, prior to its being furnished to the Authority pursuant to subsection (1), be certified by an independent accountant in such form as may be specified by the Authority.

(b) The Minister may prescribe the bases for the calculation of costs, premia and other relevant financial data that are to be included in a statement of profit and loss or balance sheet to be furnished to the Authority pursuant to subsection (1).

(3) A registered undertaking or former registered undertaking which has furnished the Authority with information under subsection (1) shall provide the Authority with such assistance as is reasonably necessary for the due performance of the Authority’s functions under this section in relation to such information.

F73[(4)(a) F75[…]

F74[(b) The Authority shall take 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, as being a return on equity that does not exceed 12 per cent per annum in respect of that business for that period as calculated using approved accounting standards and having regard to 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).]

(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.]

F76[(4A) (a) The Authority shall take 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 2016 to the end of 2018, as being a return on sales, gross of reinsurance and excluding investment income, that does not exceed F77[6 per cent per annum] in respect of that business for that 3 year period taken as a whole and as calculated using approved accounting standards and having regard to the European Union framework for State aid in the form of public service compensation (2011) (2012/C8/03).

(b) F77[Subject to paragraph (c), paragraph (a) shall, with all necessary modifications, apply] to each applicable 3 year period as it applies to the 3 year period referred to in that paragraph.]

F78[(c) In respect of each of the following applicable 3 year periods—

(i) the 3 year period from 1 January 2020 to the end of 2022, and

(ii) the 3 year period from 1 January 2021 to the end of 2023,

the reference in paragraph (a) to 6 per cent per annum shall, as respects the applicable 3 year period referred to in subparagraph (i), be read as a reference to 4. 9 per cent per annum and, as respects the applicable 3 year period referred to in subparagraph (ii), be read as a reference to 5. 5 per cent per annum and paragraph (a) shall apply accordingly.]

(5) The Authority shall—

(a) F79[…]

F73[(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) F79[…]

(ii) if paragraph (b) of subsection (4) is applicable, the period from 1 January of 2011 to the end F80[of 2013,]

(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.]

F76[(iv) if paragraph (a) of subsection (4A) is applicable, the period from 1 January 2016 to the end of 2018, or

(v) if paragraph (b) of subsection (4A) is applicable, the period from 1 January of the first year of the applicable 3 year period to the end of the last year of the applicable 3 year period,]

(6) (a) Where the Authority determines under subsection (5)(b) that there is a positive cumulative net financial impact on a registered undertaking or former registered undertaking in respect of a period, it shall make a determination as to whether the undertaking has or has not, in respect of that period, made a profit which is in excess of the reasonable profit F79[…] in respect of that period.

(b) Where the Authority determines under paragraph (a) that a registered undertaking or former registered undertaking has made a profit which is in excess of a reasonable profit in respect of a period, it shall make a further determination as to the monetary equivalent amount of the profit which is in excess of the corresponding monetary equivalent amount of such reasonable profit in respect of that period.

(7) Where, in respect of a period, the Authority has determined under subsection (5)(b) that the cumulative net financial impact of the relevant financial provisions on a registered undertaking or former registered undertaking was positive, and determined under subsection (6)(a) that the undertaking has made a profit which is F74[in excess of the reasonable profit], it shall prepare a report (in this Part referred to as the "draft report") setting out—

(a) the reasonable profit, F79[…]

(b) the amount determined under subsection (5)(b) to be the positive cumulative net financial impact on the undertaking,

(c) the monetary equivalent amount determined under subsection (6)(b) to be the profit of the undertaking which is in excess of the corresponding monetary equivalent amount of F74[the reasonable profit],

(d) the cumulative amount of overcompensation, being the lower of the amounts referred to in paragraphs (b) and (c),

(e) the amount of overcompensation to be paid to F73[the Fund] by the undertaking, being the cumulative amount of overcompensation referred to in paragraph (d) reduced by the total amount of overcompensation paid or due to be paid to F73[the Fund] pursuant to the operation of subsection (10) in respect of all the periods prior to the first-mentioned period, and

(f) the bases on which it made the determinations, and calculated the amounts, referred to in paragraphs (a) to (e).

(8) (a) The Authority shall, as soon as may be after the preparation of the draft report—

(i) furnish a copy of the draft report to the registered undertaking or former registered undertaking the subject of the report,

(ii) invite the undertaking to make representations to the Authority in relation to the draft report before the expiration of 21 days (or such longer period as the Authority may permit in its discretion) from the day on which the undertaking received the report, and

(iii) take into account any such representations made to it within that period before preparing the final report as soon as is practicable after the expiration of that period of 21 days (or, if applicable, the expiration of the longer period permitted pursuant to subparagraph (ii)).

(b) The determinations of the Authority contained in its final report shall be final and conclusive (including for the purposes of any proceedings concerning the recovery of an amount referred to in subsection (11)).

(c) The Authority shall furnish the final report to the Minister as soon as may be after it has been prepared.

(9) Where the Minister is furnished with a report under subsection (8), the Minister shall, as soon as may be, furnish a copy of the report to the registered undertaking or former registered undertaking the subject of the report together with a copy of this section.

(10) Where a registered undertaking or former registered undertaking is furnished with a copy of a report under subsection (9), it shall, not later than 2 months from the date on which it is given the report, pay to F73[the Fund] the amount set out in the report pursuant to paragraph (e) of subsection (7).

(11) The Minister on behalf of the Minister for Finance may recover, as a simple contract debt in any court of competent jurisdiction, from the registered undertaking or former registered undertaking by which it is payable, any amount due and owing to F73[the Fund] pursuant to the operation of subsection (10).

(12) Notwithstanding that the Authority may not, in respect of a particular year, or in respect of a particular registered undertaking or former registered undertaking, be required under subsection (8) to furnish a report to the Minister, the Minister may make a request in writing to the Authority to be furnished, within the period specified in the request (being a period reasonable in the circumstances), with such information relating to any determination it has made under subsection (5) or (6) in respect of a particular registered undertaking or former registered undertaking (including information relating to the basis on which such determination was made) as the Minister specifies in the request.

(13) The Authority shall comply with a request made under subsection (12) by the Minister.]

F81[(13A) For the purposes of this Act, a registered undertaking has not made a profit in excess of the reasonable profit in respect of its health insurance business in the State in respect of the 3 year period referred to in subsection (4)(b), or in respect of a relevant 3 year period, if its return on equity exceeds 12 per cent per annum in respect of that business for part of that period but not for all of that period.]

F82[(14) In this section—

F76["applicable 3 year period" means—

(a) the 3 year period from 1 January 2017 to the end of 2019, and

(b) the 3 year period from 1 January 2018 to the end of 2020,

and so on for each succeeding 3 year period;]

F80["reasonable profit"—

(a) shall be construed in accordance with subsection (4) in respect of a 3 year period referred to in paragraph (b) of that subsection and in respect of a relevant 3 year period, and

(b) shall be construed in accordance with subsection (4A) in respect of a 3 year period referred to in paragraph (a) of that subsection and in respect of an applicable 3 year period;]

F74["relevant health insurance business in the State", in relation to a registered undertaking or former registered undertaking, means all of the undertaking’s health insurance business in the State;]

F80["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.]]

F81["return on equity", in relation to a registered undertaking or former registered undertaking, not being a company established under the Companies Acts, and its relevant health insurance business in the State, includes the equivalent, as calculated using approved accounting standards, for such an undertaking, of a return on equity for a registered undertaking that is such a company.]