Health Insurance Act 1994

Obligation to provide health insurance.

8

F86[8. (1) A registered undertaking, other than a restricted membership undertaking, shall not refuse to effect a health insurance contract with or for a person of whatever age or such a person and his or her dependants except in such cases (if any) or in such circumstances (if any) as may be prescribed.

(2) A restricted membership undertaking shall not—

(a) impose as a condition of qualification for membership of the undertaking a requirement as to age,

(b) refuse to admit to membership of the undertaking a person who is qualified for such membership and requests to be so admitted, or

(c) refuse to effect a health insurance contract with or for such a person as aforesaid or with or for such a person and his or her dependants,

except in such cases (if any) or in such circumstances (if any) as may be prescribed.

F87[(3) For the purposes of this Act, the Minister may prescribe the maximum waiting periods for eligibility for services or payments, or both, under a health insurance contract which a registered undertaking may impose in respect of the person effecting the contract or his or her dependents including, but without prejudice to the generality of the foregoing, in respect of a person who—

(a) is of or under a prescribed age,

(b) is of or over a prescribed age,

(c) is suffering from a medical condition when the contract is effected,

(d) effects a health insurance contract in the State without previously having effected a health insurance contract in the State,

(e) effects a health insurance contract with the undertaking having previously effected a health insurance contract with that undertaking whether in respect of the same or different services or payments, or both, or

(f) effects a health insurance contract with the undertaking having previously effected a health insurance contract with another registered undertaking whether in respect of the same or different services or payments, or both.]

(4)(a) Subject to paragraph (b), where a health insurance contract effected by a person with a registered undertaking ceases to be in force for any reason, that or any other registered undertaking shall not refuse to effect another health insurance contract with the person, irrespective of his or her age, in respect of the same services except in such cases (if any) or in such circumstances (if any) as may be prescribed.

(b) A restricted membership undertaking may refuse to effect a health insurance contract with a person referred to in paragraph (a) if the person is not entitled to membership of the undertaking.

F87[(5) Where a health insurance contract ("the first-mentioned contract") effected with a registered undertaking (including such undertaking which is a restricted membership undertaking) ceases to be in force and a person who was a party to or named in that contract effects, within such period after that cesser as may be prescribed, another health insurance contract with a registered undertaking ("the second-mentioned contract"), then insofar as the second-mentioned contract is in respect of such services or payments, or both, as would have been provided or payable, as appropriate, under the first-mentioned contract—

(a) the waiting period for eligibility for the service or the payment, or both, under the second-mentioned contract to—

(i) the person, or

(ii) any other person who is named in the contract and was also a party to or named in the first-mentioned contract,

shall not be any longer than it would have been if the second-mentioned contract had been effected at the time the first-mentioned contract had been effected, and

(b) there shall be deemed to be expired so much of that waiting period as is equal to so much of the like period under the first-mentioned contract as had expired at the time of the cesser aforesaid.]

(6) F88[]]

Annotations:

Amendments:

F86

Substituted (29.06.2005) by Health Insurance (Amendment) Act 2001 (17/2001), s. 8, S.I. No. 322 of 2005.

F87

Substituted (25.12.2014) by Health Insurance (Amendment) Act 2014 (42/2014), s. 4(a), (b), commenced on enactment.

F88

Deleted (25.12.2014) by Health Insurance (Amendment) Act 2014 (42/2014), s. 4(c), commenced on enactment.

Editorial Notes:

E61

Power pursuant to section exercised (1.05.2015) by Health Insurance Act 1994 (Open Enrolment) Regulations 2015 (S.I. No. 79 of 2015), in effect as per reg. 1(2).

E62

Previous affecting provision: power pursuant to section exercised (1.07.2005) by Health Insurance Act 2001 (Open Enrolment) Regulations 2005 (S.I. No. 332 of 2005), in effect as per reg. 2; revoked (1.05.2015) by Health Insurance Act 1994 (Open Enrolment) Regulations 2015 (S.I. No. 79 of 2015, reg. 9, in effect as per reg. 1(2).

E63

Previous affecting provision: power pursuant to section exercised (28.03.1996) by Health Insurance Act 1994 (Open Enrolment) Regulations 1996 (S.I. No. 81 of 1996); revoked (1.07.2005) by Health Insurance Act, 2001 (Open Enrolment) Regulations 2005 (S.I. No. 332 of 2005), reg. 12, in effect as per reg. 2.