Health Insurance (Amendment) Act 2012

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Amendment of section 7E of Principal Act.

13.— Section 7E of the Principal Act is amended—

(a) in subsection (1)—

(i) in paragraph (a), by deleting subparagraphs (i) to (v) and substituting the following:

“(i) the average insurance claim payment per insured person made by the relevant market sector during the relevant periods in respect of the total number of persons insured, or a class thereof, during the relevant periods,

(ii) the average insurance claim payment per insured person made by the relevant market sector during the relevant periods in respect of subgroups of the total number of persons insured, or a class thereof, during the relevant periods, where such subgroups include such combinations of the following groups of insured persons as the Authority determines to be relevant:

(I) those in different age groups;

(II) those of differing sex;

(III) those with differing types of cover,

(iii) the hospital bed utilisation in respect of each group and subgroup referred to in subparagraphs (i) and (ii), and

(iv) the net financial impact on each registered undertaking or former registered undertaking of the relevant financial provisions during the relevant periods, and”,

and

(ii) in paragraph (b)—

(I) by substituting the following subparagraph for subparagraph (iii):

“(iii) subject to subsection (1A), the amounts of the risk equalisation credits that the Authority considers, after having regard to such evaluation and analysis, would need to be afforded, under the Risk Equalisation Scheme, to persons insured by registered undertakings (other than restricted membership undertakings) having regard to the principal objective (in so far as the principal objective relates to relevant contracts), the aim of avoiding overcompensation being made to a registered undertaking or former registered undertaking under the operation of the relevant financial provisions (other than section 470B of the Taxes Consolidation Act 1997 ), the aim of maintaining the sustainability of the health insurance market and the aim of having fair and open competition in the health insurance market, and”,

and

(II) in subparagraph (iv)—

(A) by inserting “, after having regard to the aim of avoiding the Fund sustaining surpluses or deficits from year to year (as calculated using approved accounting standards),” after “the Authority considers”, and

(B) by deleting “Exchequer” and substituting “Fund”,

and

(b) by substituting the following subsections for subsections (1A) and (2):

“(1A) The Minister may, by notice in writing given to the Authority, require the Authority to prepare any report to be furnished to him or her pursuant to paragraph (b) of subsection (1), in so far as the report relates to subparagraph (iii) of that paragraph—

(a) in the case of hospital bed utilisation credits, on the basis of the amount specified in the notice or on the basis of the amount specified in Schedule 3 or both,

(b) on the basis of the classes of insured person specified in the notice or on the basis of the classes of insured person specified in column 1 of Table 2 set out in Schedule 4 or both.

(2) The Minister shall—

(a) first, after having regard to—

(i) the principal objective (in so far as theprincipal objective relates to relevant contracts),

(ii) any report furnished to him or her pursuant to subsection (1)(b),

(iii) the aim of avoiding overcompensation being made to a registered undertaking or former registered undertaking under the operation of the relevant financial provisions (other than section 470B of the Taxes Consolidation Act 1997 ),

(iv) the aim of maintaining the sustainability of the health insurance market,

(v) the aim of having fair and open competition in the health insurance market, and

(vi) the aim of avoiding the Fund sustaining surpluses or deficits from year to year (as calculated using approved accounting standards),

(b) second, after taking into account the amendments (if any) that he or she wishes to propose to the relevant financial provisions (other than section 470B of the Taxes Consolidation Act 1997 ) in view of the regard given the matters referred to in paragraph (a) (and whether or not those amendments accord with any matter set out in the report referred to in paragraph (a)(ii)), and

(c) third, after consultation with the Minister for Finance on the amendments (if any) referred to in paragraph (b),

make such recommendations to the Minister for Finance relating to section 125A of the Stamp Duties Consolidation Act 1999 as the Minister considers appropriate.”.