Health Insurance (Amdment) Act 2001
Premiums which may be charged under health insurance contracts in certain circumstances.
6.—The following section is inserted after section 7 of the Principal Act:
“7A.—(1) In this section, ‘insured person’ means any person, other than the registered undertaking, who is party to or named in the health insurance contract concerned and is of or over the age of 35 years.
(2) Notwithstanding section 7, a registered undertaking may require, on account of any of the circumstances referred to in paragraph (a), (b), (c) or (d) of subsection (4), the payment under a health insurance contract of a premium the amount of which is greater than that of the premium (in this section referred to as the ‘unadjusted premium’) which could have been required to be paid if this section had not been enacted.
(3) Any requirement to pay such a greater amount is subject to regulations under subsection (6).
(4) The following are the circumstances mentioned in subsection (2)—
(a) the insured person has not previously effected or been named in a health insurance contract with the registered undertaking concerned or any other undertaking,
(b) the insured person had previously effected or been named in a health insurance contract with a restricted membership undertaking of the kind referred to in subsection (2)(b) of section 12 that has served on the Minister a notice under the provision of a scheme mentioned in that subsection before the date specified for the purposes of that subsection,
(c) in the period of the 12 months preceding the date on which the registered undertaking concerned was requested to effect the health insurance contract (not being a contract that falls within paragraph (b)) no health insurance contract was in force to which the insured person was a party or in which he or she was named,
(d) the following conditions are complied with in relation to the health insurance contract concerned—
(i) the contract provides more favourable terms to the insured person (whether in respect of the health services to which the contract relates or the nature or the amounts of the payments to be made by the registered undertaking concerned in respect of those services) than those provided to the insured person in the contract prior to its being renewed or, as the case may be, than those provided to the insured person in the health insurance contract lastly effected with another undertaking to which the insured person was a party or in which he or she was named,
(ii) the provision of those more favourable terms has been made at the request of the insured person.
(5) The difference between the amount of the premium which a registered undertaking requires to be paid by virtue of this section and the amount of the unadjusted premium is referred to in this section as the ‘relevant increase’.
(6) The Minister may by regulations provide that the amount of the relevant increase—
(a) shall be determined by the registered undertaking concerned in a manner specified in the regulations (in subsection (7) referred to as the ‘relevant method’),
(b) shall not, in any case, be greater than such percentage as is specified in the regulations of the amount of the unadjusted premium.
(7) Regulations under subsection (6) may—
(a) specify a different relevant method or a different percentage of the amount of the unadjusted premium by reference to—
(i) the different circumstances referred to in paragraphs (a) to (d) of subsection (4) on account of which the relevant increase is required to be paid,
(ii) different cases involving any of those circumstances that may occur,
(b) require that the registered undertaking concerned, in determining the amount of the relevant increase, take into account, to the extent and in the manner specified in the regulations, any previous period or periods during which the insured person was a party to or named in a health insurance contract effected with that or any other registered undertaking.”.