S.I. No. 201/1950 - National Health Insurance (Rules For Insured Persons) Order, 1950.

S.I. No. 201 of 1950.

NATIONAL HEALTH INSURANCE (RULES FOR INSURED PERSONS) ORDER, 1950.

The Minister for Social Welfare in exercise of the powers conferred on him by Section 22 of the Social Welfare Act, 1948 (No. 17 of 1948) and by Section 5 and sub-section (2) of Section 20 of the Social Welfare Act, 1950 (No. 14 of 1950) and of every other power him in this behalf enabling by this his Order hereby makes the following Rules :—

1 Short title.

1. This Order may be cited for all purposes as the National Health Insurance (Rules for Insured Persons) Order, 1950.

2 Definitions.

2. In this Order unless the context otherwise requires the following words and expressions shall have the meanings hereinafter respectively assigned to them :—

Acts.

" the Acts " means the National Health Insurance Acts, 1911 to 1950 ;

Appeals Officer.

" appeals officer " means an appeals officer appointed under Article 7 of the National Health Insurance (Decisions and Appeals) Order, 1950 ( S.I. No. 189 of 1950 ) ;

Insurance Officer.

" insurance officer " means an insurance officer appointed under Article 8 of the National Health Insurance (Decisions and Appeals) Order, 1950, and includes two or more insurance officers acting together ;

Minister.

" the Minister " means the Minister for Social Welfare ;

Society.

" the Society " means Cumann an Árachais Náisiúnta ar Shláinte.

3 Commencement of Order.

3. This Order shall come into operation on the 1st August, 1950.

4 Application for contribution card.

4. Every person becoming an insured person under the Acts either for the first time or on re-entry into insurance shall in the appropriate form set out in the Schedule to these Rules apply for a contribution card. The obligation to complete such form of application may, however, be dispensed with by the Minister in particular cases.

5 Demand for particulars.

5. Every insured person shall furnish to the Minister on demand such particulars and evidence regarding age, marriage and his right to be insured, as may be required by the Minister.

6 Claims for benefit and payment thereof.

6.—(1) Every person claiming benefit shall furnish to the Minister such information regarding his claim and any other matter connected therewith as the Minister may require.

(2) Benefit payable to any insured person or to any person claiming through an insured person shall be payable at his residence by post or otherwise, provided, however, that the Minister may, in particular cases, arrange for benefit to be paid at such time and place as he may arrange and on such conditions as he may lay down.

7 Sickness and disablement benefits.

7.—(1) Where sickness or disablement benefit is payable for a period of less than six days (whether separately or coupled with a complete week or weeks), one-sixth of the weekly sum payable shall be paid for each such day.

(2) An insured person who is rendered incapable of work by some specific disease or by bodily or mental disablement, shall, whether or not he claims sickness or disablement benefit, forward to the Minister within seven days from the commencement of such incapacity notice of illness and shall furnish as soon as possible such evidence of the incapacity, by way of medical certificate or otherwise, as the Minister may require.

(3) During the continuance of incapacity, an insured person shall furnish weekly, or at such longer intervals as the Minister may decide, medical certificates or such other evidence as the Minister may require regarding the continuance of incapacity.

(4) An insured person who is incapable or who claims to be incapable of work, and is, or may become entitled to sickness or disablement benefit in respect of the incapacity—

(a) shall obey the instructions of the doctor in attendance, and shall answer any reasonable inquiries by the Minister regarding the instructions given by the doctor ;

(b) shall be present at his place of residence for the time being at all reasonable hours and shall not be absent at any time without leaving word where he may be found, provided that the Minister in a particular case may waive this obligation on such conditions as he may think fit ;

(c) shall not leave the locality where he resides without first notifying the Minister ;

(d) shall not be guilty of conduct which is likely to retard his recovery ;

(e) shall not do any kind of work, domestic or other, unless it be light work for which no remuneration is, or would ordinarily be, payable, or work undertaken primarily as a definite part of the insured person's medical treatment in a hospital, sanatorium, or other similar institution ;

(f) shall not unreasonably refuse to see the Minister's Sickness Visitor or other officer or to answer any reasonable inquiries relating to his claim ; provided, however, that women shall not be visited otherwise than by women.

(5) The Minister may exempt an insured person from the operation of paragraph (e) of sub-rule (4) of this Rule for such periodas he may think fit where the insured person has become incapable of following his usual occupation and is undergoing a course of training with a view to fitting himself to take up some other occupation.

(6) Where an insurance officer, in relation to an insured person claiming or in receipt of sickness or disablement benefit, is not, from the evidence furnished, satisfied with regard to the incapacity for work of such person, the continuance of such incapacity, or the cause of such incapacity, the Minister may, on giving not less than three days' notice, require the insured person to provide additional medical evidence, and for that purpose may require the insured person to submit himself for special examination, either at his own home or at some other place reasonably convenient to him, either by a Medical Referee appointed under the scheme established for the purpose of obtaining second medical opinions, or by some other medical practitioner. If the insured person refuses or fails to submit himself to such examination at his own home, or refuses or fails to submit himself elsewhere for the purpose, he shall, unless in the latter case he proves that he was physically unable to attend, be deemed to have failed to furnish satisfactory evidence of incapacity.

(7) Any reasonable travelling expenses incurred by the insured person in attending for special medical examination under the preceding sub-rule shall be paid by the Minister, who shall determine in any particular case what is a reasonable amount of expenses.

(8) In all cases where sub-rule (6) of this Rule is brought into operation and the requisite notice is issued to the insured person, there shall at the same time be sent to the doctor in attendance on the insured person notice of the time and place of the special medical examination.

8 Claims for Workmen's Compensation, etc.

8.—(1) An insured person who has met with an injury or is suffering from any disease in respect of which he is or may appear to be entitled to receive or recover compensation or damages, whether from his employer or any other person, under the Workmen's Compensation Acts, 1934 and 1948, or any scheme certified thereunder or under the Employers' Liability Act, 1880, or at common law, shall give notice of such injury or disease in writing to the Minister, quoting his correct insurance number and full postal address within seven days of meeting with the injury or becoming aware that he is suffering from the disease unless he is unavoidably prevented from doing so, in which case he shall give such notice as soon as possible.

(2) An insured person claiming or entitled to such compensation or damages shall furnish to the Minister weekly, or at such longer intervals as the Minister may require, medical certificates or such other evidence of incapacity as the Minister may require. Where the insured person obtains a medical certificate from a certifier under the Medical Certification Scheme established by the Minister, such certificate shall be deposited with the Minister, and shall not be surrendered to the insured person's employer or to any person acting on the employer's behalf in connection with a claim for such compensation or to any other person in connection with such a claim for damages.

9 Maternity benefit.

9. (1) For the purposes of payment of maternity benefit, " confinement " shall mean labour resulting in the issue of a living child or labour after 28 weeks of pregnancy resulting in the issue of a child whether alive or dead.

(2) An insured married woman to whom maternity benefit is payable in respect of her own insurance shall abstain from remunerative work during a period of four weeks after her confinement.

10 Breaches Rules and penalties therefor.

10.—(1) a) Where an insured person commits any breach of these Rules an insurance officer shall have power to impose a penalty by way of either a fine or suspension from sickness and disablement benefits.

(b) Any insured person who, for the purpose of obtaining or continuing benefit or for the purpose of obtaining or continuing benefit at a rate higher than that appropriate to the case, makes any statement or representation (whether written or oral) which is to his knowledge false or misleading in a material respect or knowingly conceals material facts, shall be deemed to have committed a breach of these Rules.

(c) Any person who, within three years of his admission to membership of the Society or of his applying for a contribution card under Rule 4 of these Rules (whichever is appropriate), is found to have made a wilful and material mis-statement or omission in his application for such membership or for such card, shall also be deemed to have committed a breach of these Rules.

(2) No fine imposed under these Rules shall exceed ten shillings, or in the case of repeated breaches of the Rules twenty shillings.

(3) Where the penalty of suspension from benefit is imposed, such suspension shall run from the date on which notice of the alleged breach of Rule is sent to the insured person, or from such other date as the insurance officer may determine, not being earlier than the commission of the alleged offence.

(4) An insured person who, at the date from which suspension runs, would, but for the suspension, be actually in receipt of benefit, shall not be suspended for a period exceeding four weeks or in the case of repeated branches of the Rules eight weeks. An insured person not in receipt of or applying for benefit shall not be suspended for a period exceeding six months, or in the case of repeated breaches of the Rules one year.

(5) Where the imposition of a penalty upon an insured person for a breach of these Rules is under consideration, the Minister shall cause to be sent to such person a statement in writing, giving full particulars of the charge against him, together with a copy of the Rule under which it is brought. The insured person shall be givenan opportunity of submitting his defence to an insurance officer. The insured person may attend before the insurance officer in person or he may be represented by some other person ; if he attends in person he may be accompanied by one other person, but shall, whether present or not, be permitted to submit such evidence in his defence as seems proper to him in the circumstances and as may be admissible.

(6) An insured person who has been fined and has failed to pay the fine within four weeks, may be suspended without further notice from sickness and disablement benefits, subject to the limits laid down in sub-rules (3) and (4) of this Rule.

(7) Any person who by way of penalty for breach of these Rules has been fined or suspended from sickness or disablement benefit shall have the right to appeal to an appeals officer and the procedure for dealing with such an appeal shall, with the necessary modifications, be the same as if such appeal were made under sub-article (2) of Article 9 of the National Health Insurance (Decisions and Appeals) Order, 1950.

11 Mode of sending notices.

11. Any notice or other document required or authorised under these Rules to be sent to any person may be sent by post addressed to that person at his last known place of residence.

12 Revocations.

12. All the existing Rules of the Society are hereby revoked.

SCHEDULE.

DEPARTMENT OF SOCIAL WELFARE.

(NATIONAL HEALTH AND WIDOWS' AND ORPHANS' PENSIONS INSURANCE)

(MAN)

APPLICATION FOR CONTRIBUTION CARD.

4. Home Address (if different from above)............................................

5. Occupation .................................

6. DATE OF BIRTH:

Note: Evidence of your are must be given to the Department. A Birth Certificatre can be obtained at a cost of 6d. from the Registrar of Births for the District in which you were born. A Baptismal Certicate may be furnished to the Department instead.

I, the undersigned, hereby apply for a contribution card and certify that the particulars given on this form are correct to the best of my knowledge and belief.

Signature : ............................................................ .

Date : ..................................................

Exd................................................ Entd........................................ Checked.............................

DEPARTMENT OF SOCIAL WELFARE.

(NATIONAL HEALTH AND WINDOWS' AND ORPHANS' PENSIONS INSURANCE)

(WOMAN)

APPLICATION FOR CONTRIBUTION CARD.

4. Home Address (if different from above)............................................................ .......................................................

5. Occupation ............................................................ ............................................................ ..........................................

6. DATE OF BIRTH:

If you husbang is living, state

Note : Evidence of your age must be given to the Department. A Birth Certificate can be obtained at a cost of 6d. from the Registrar of Births for the District in which you were born. A Baptismal Certificate may be furnished to the Department instead.

I, the undersigned, hereby apply for a contribution card and certify that the particulars given on this form are correct to the best of my knowledge and belief.

Signature : ............................................................ .......

Date : ..............................................

Exd......................................... Entd.......................................... Checked......................................

GIVEN under the Official Seal of the Minister for Social Welfare this 28th day of July. One Thousand Nine Hundred and Fifty.

WILLIAM NORTON,

Minister for Social Welfare.