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16 1994

HEALTH INSURANCE ACT, 1994

PART III

Registration of Health Insurance Undertakings

The Register.

14. —(1) The Minister shall cause a register of undertakings to be established which shall be known as The Register of Health Benefits Undertakings and is referred to in this Act as “the Register”.

(2) The Register shall be in such form and shall contain such particulars in relation to undertakings as may be prescribed.

(3) Upon the establishment of the Register, the following undertakings shall be entered in it:

(a) an undertaking duly authorised pursuant to the Council Directives to carry on health insurance business in the State, and

(b) the Voluntary Health Insurance Board.

(4) Upon application to the Minister or the Authority, as the case may be, in that behalf and upon furnishing to the Minister or the Authority, as the case may be, such information (if any) as the Minister or the Authority, as the case may be, may require, any other undertaking which was lawfully carrying on health insurance business in the State on the 30th day of June, 1994 and complies with the provisions of this Act shall be entered in the Register.

(5) The Minister may by regulations provide for the registration of undertakings (other than those specified in subsections (3) and (4)) of such classes as may be specified upon and subject to such terms and conditions as may be specified including (but without prejudice to the generality of the foregoing)—

(a) in the case of a restricted membership undertaking, terms and conditions requiring it to satisfy specified financial criteria and to effect not less than a specified number of health insurance contracts within a specified period, and

(b) in the case of any other undertaking, a term or condition requiring the undertaking to be the holder of an authorisation (within the meaning of the Insurance Act, 1989 ) for the time being in force to carry on non-life insurance business (within the meaning aforesaid).

(6) Upon the registration of an undertaking, the Minister or the Authority, as the case may be, shall cause a certificate containing such particulars of the registration as the Minister or the Authority, as the case may be, may determine and signed by an officer of the Minister or the Authority, as the case may be, authorised in that behalf by the Minister or the Authority, as the case may be, to be prepared and furnished to the undertaking and, if the undertaking is removed from the Register, it shall return the certificate to the Minister or the Authority, as the case may be.

(7) The Register may be established and maintained in a form that is not legible if it is capable of being converted into a legible form.

(8) A certificate issued by or on behalf of the Minister or the Authority, as the case may be, and stating that the undertaking specified in the certificate is or, as the case may be, is not registered shall, without proof of the signature of the person purporting to sign the certificate or that that person was the proper person so to sign, be evidence in any legal proceedings of the matters stated in the certificate, until the contrary is shown.

(9) On the establishment day, subsections (4), (6) and (8) shall cease to have effect in so far as they relate to the Minister.

Removal from Register.

15. —(1) Where the authorisation of a registered undertaking under the Council Directives is withdrawn, pursuant to the Council Directives, the undertaking shall be removed from the Register.

(2) (a) Where a registered undertaking—

(i) is convicted on indictment in the State for an offence or is convicted outside the State for an offence consisting of acts or omissions which would constitute an offence triable on indictment in the State if done or made in the State, or

(ii) contravenes a provision of this Act or of a regulation thereunder stated to be penal,

the undertaking shall be removed from the Register if the Minister or the Authority, as the case may be, so directs and the High Court so directs under subsection (3) or (4).

(b) Where the Minister or the Authority, as the case may be, proposes to give a direction under this subsection, the Minister or the Authority, as the case may be, shall send by registered post to the undertaking concerned, at the address of the undertaking specified in the Register, a notice stating the proposal and the reasons therefor and, before deciding whether to give the direction, shall take into account any representations made in relation to the proposal by the undertaking within the period of 21 days from the giving of the notice.

(3) (a) An undertaking to which a direction of the Minister or the Authority, as the case may be, under subsection (2) relates may, within the period of 21 days from the date of the direction, apply to the High Court for cancellation of the direction and on such an application—

(i) that Court may—

(I) cancel the direction, or

(II) confirm the direction and direct that the undertaking be removed from the Register, or

(III) give such other directions (if any) to the Minister or the Authority, as the case may be, as the Court thinks proper,

or

(ii) if the Minister or the Authority, as the case may be, satisfies that Court that the undertaking has, without reasonable cause, delayed unduly in proceeding with the application, that Court shall, unless it is satisfied that there are good reasons for not doing so, confirm the direction and direct that the undertaking be removed from the Register.

(b) The High Court may direct how, as between the parties to an application under paragraph (a), the costs of the application are to be borne.

(4) Where an undertaking to whom a direction of the Minister or the Authority, as the case may be, under subsection (2) relates does not, within the period of 21 days beginning on the date of the direction, apply to the High Court for cancellation of the direction, that Court shall, on application to it ex parte in that behalf by the Minister or the Authority, as the case may be, unless it is satisfied that there are good reasons for not doing so, confirm the direction and direct that the undertaking be removed from the Register.

(5) The decision of the High Court on an application under this section shall be final, save that, by leave of that Court or of the Supreme Court, an appeal, by the Minister or the Authority, as the case may be, or the undertaking concerned, from the decision shall lie to the Supreme Court on a question of law.

(6) On the giving of a direction by the Minister or the Authority under subsection (2) in relation to an undertaking or upon the removal of an undertaking from the Register, the Minister or the Authority, as the case may be, shall forthwith send by registered post to the undertaking at the address of the undertaking specified in the Register a notice in writing stating, as may be appropriate—

(a) that the direction has been given, the reasons for it and its date, or

(b) that the undertaking has been removed from the Register.

(7) (a) Upon application to the Minister or the Authority, as the case may be, in that behalf and upon furnishing to the Minister or the Authority, as the case may be, such information (if any) as the Minister or the Authority, as the case may be, may require, an undertaking that has been removed from the Register shall, if the Minister or the Authority, as the case may be, so thinks fit and so directs in writing, be entered in the Register and such entry shall be subject to such terms and conditions (if any) as the Minister or the Authority, as the case may be, determines and specifies in the direction.

(b) A copy of a direction under this subsection shall be furnished to the undertaking concerned and it shall comply with any terms or conditions contained in it.

(8) On the establishment day, subsections (2) to (7) shall cease to have effect in so far as they relate to the Minister.

Prohibition on carrying on of health insurance business by persons other than registered undertakings.

16. —A person other than a registered undertaking shall not carry on health insurance business.

Levy on registered undertakings.

17. —(1) In this section “assessable amount”, in relation to a quarter, means the gross amount received by a registered undertaking by way of premiums in that quarter in respect of health insurance business of the undertaking in the State on or after the establishment day but excluding any amount so received in the course or by way of reinsurance.

(2) A registered undertaking shall, within 30 days from the end of the quarter following the establishment day and within 30 days from the end of each quarter thereafter, deliver to the Authority a statement in writing showing the assessable amount for that undertaking in respect of that quarter.

(3) There shall be charged on every statement delivered in pursuance of subsection (2) a levy of an amount equal to such percentage of the assessable amount shown therein as may be prescribed having regard to the costs and expenses referred to in subsection (4).

(4) The levy charged under subsection (3) on a statement delivered in pursuance of subsection (2) shall be paid by the undertaking concerned to the Authority upon delivery of the statement and the amount so paid shall be used by the Authority to defray the costs and expenses (but not including payments referred to in section 12 (3) (b)) incurred by it in the performance of its functions.

(5) There shall be furnished to the Authority by a registered undertaking such particulars as the Authority may deem necessary in relation to a statement under this section delivered by it to the Authority.

(6) In the case of failure by a registered undertaking to deliver a statement required under subsection (2) within the time specified in that subsection or of failure by a registered undertaking to pay any levy chargeable on such a statement on the delivery thereof, the undertaking shall be liable to pay, in addition to the levy, interest thereon at the rate of 15 per cent. per annum from the expiration of the quarter to which the statement relates until the day on which the levy is paid.

(7) An amount payable to the Authority under subsection (4) or (6) may be recovered by the Authority from the registered undertaking concerned as a simple contract debt in any court of competent jurisdiction.

Records.

18. —(1) A registered undertaking—

(a) shall maintain such records relating to its health insurance business as may be prescribed, and

(b) shall furnish to the Minister or the Authority, as the case may be, such information regarding the health insurance business aforesaid carried on by it as the Minister or the Authority may require for the purposes of his or her or, as the case may be, its functions under this Act.

(2) Upon the establishment day, subsection (1) shall cease to have effect in so far as it relates to the Minister.