Risk Equalisation (Amendment) Scheme, 2005

• Jurisdiction: Ireland
• Citation: IR SI 334/2005

STATUTORY INSTRUMENTS

S.I. No. 334 of 2005

RISK EQUALISATION (AMENDMENT) SCHEME, 2005

S.I. No 334 of 2005

RISK EQUALISATION (AMENDMENT) SCHEME, 2005

I, Mary Harney, Minister for Health and Children, in exercise of the powers conferred on me by sections 3 and 12 of the Health Insurance Act, 1994 (No. 16 of 1994) as amended and substituted by sections 9, 10 and 13 of the Health Insurance (Amendment) Act, 2001 (No. 17 of 2001) and section 5 of the Health Insurance (Amendment) Act, 2003 (No. 11 of 2003), hereby make the following Scheme- 1. This Scheme may be cited as the Risk Equalisation (Amendment) Scheme, 2005. 2. The Risk Equalisation Scheme, 2003 is hereby amended —

(a) by the substitution in Article 3:

(i) in the definition of “initial waiting period”, for “Health Insurance Act 1994 (Open Enrolment) Regulations, 1996, ( S.I. No. 81 of 1996 )” of “Health Insurance Act, 2001 (Open Enrolment) Regulations, 2005”,

(ii) for the definition of “settled claim” of the following:-

“ “settled claim” means a claim in respect of which payments due have been made but excluding any claim in respect of a person who, at the time of the hospital stay or stays to which the claim relates, had not completed an initial waiting period;”

(b) in Article 9(5)(d)-

by the deletion after “concerned,” of “and”,

(c) in Article 9(5)(e)-

by the deletion after “combined” of “.” and the insertion of “, and”,

(d) after Article 9(5)(e) by the addition of:-

“ (f) such other information as the Authority may from time to time specify.

Returns and details shall be submitted by returning undertakings in accordance with such guidance and/or directions as the Authority may from time to time specify to returning undertakings in respect of their form, details or content.”.

(e) by the substitution in Article 1 of the Second Schedule for the definition of “covered persons” of the following:-

“ “covered persons” means in relation to a scheme undertaking -

(a) insured persons who on the last day of a specified period were named in a health insurance contract effected by that scheme undertaking and who belonged on that day to a specified cell or combination of cells, or

(b) persons not already included under paragraph (a) of this definition who during the same specified period as in paragraph (a) above, were named in a health insurance contract effected by that scheme undertaking and who, but for the cessation of their health insurance contract...