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Health Insurance Act, 1994 (No. 16)Introductory TextActs Referred toPart I Preliminary and General (ss. 1-6)1. Short title and commencement.1A. Principal objective of Minister and Authority in performing respective functions under Act.2. Interpretation.2A. Certain arrangements by employers to constitute health insurance contracts.3. Regulations.4. Offences.5. Repeals.6. Expenses.Part II Health Insurance Contracts (ss. 6A-13)6A. Interpretation of Part II.6B. Duration of entrustment act7. Prohibition of non-community rated health insurance contracts.7A. Premiums which may be charged under health insurance contracts in certain circumstances.7AB. Submission of new type of health insurance contract and furnishing of certain other types of health insurance contract to Authority.7AC. Register of Health Insurance Contracts.7B. Provision of information.7C. Registered insurers shall make all reasonable efforts to obtain certain information in respect of insured persons, etc.7D. Obligation to make information returns to Authority.7E. Evaluation and analysis of information returns, etc.7F. Overcompensated undertaking required to make payment to Exchequer if it has made more than reasonable profit.7G. Disclosure of contents of information returns.7H. Registered undertaking to provide certain premium information to policy holders or certain other persons.8. Obligation to provide health insurance.9. Prohibition of termination of, or refusal to renew, health insurance contracts.10. Minimum level of health insurance cover.11. Prohibition of inducements by registered undertakings.11A. Risk Equalisation Scheme.11B. Application of Risk Equalisation Scheme.11C. Payment from Fund of risk equalisation credits.11D. Risk Equalisation Fund.11E. Specification by Authority of certain health insurance contracts as not providing for advanced cover.11F. Scheme regulations.11G. Power to specify form of documents for purposes of Risk Equalisation Scheme.12. Risk equalisation schemes.12A.12B. Limited exemption from requirement to make returns and otherwise comply with risk equalisation scheme.13. Advertising and promotion of health insurance business.Part III Registration of Health Insurance Undertakings (ss. 14-18)14. The Register.15. Removal from Register.16. Prohibition on carrying on of health insurance business by persons other than registered undertakings.17. Levy on registered undertakings.18. Records.Part IIIA Enforcement Notices (ss. 18A-18D)18A. Interpretation of Part IIIA.18B. Issue of enforcement notices.18C. Application for cancellation of direction specified in enforcement notice.18D. Rules of Court.Part IIIB (ss. 18E-18G)18E. Authorised officers of Authority.18F. Powers of authorised officers.18G. Privileged legal material.Part IV The Health Insurance Authority (ss. 19-35)19. Establishment day.20. Establishment of Authority.21. Functions of Authority.22. Conferral of additional functions on Authority.23. Consultants and advisers.24. Power to borrow.25. Gifts.26. The Registrar.27. Staff of Authority.28. Superannuation of staff of Authority.29. Membership of either House of the Oireachtas or of European Parliament.30. Advances by Minister to Authority.31. Disclosure by member of Authority of interest in proposed contract.32. Accounts and audits of Authority.33. Reports and information to Minister.33A. Annual report with respect to the operation of a scheme.33B. Performance of functions under Principal Act - equality of treatment of undertakings.34. Disclosure of information.35. Liability of Authority for acts, omissions etc.Schedule 1 The Health Insurance AuthoritySchedule 2 European Union Framework for state aid in the form of Public Service Compensation (2011) (2012/C8/03)Schedule 3 Amount Specified for Purposes of Definition of 'Hospital Utilisation Credit'Schedule 4 Amount of Premium to be Paid From fund in Respect of Certain Classes of Insured Person Based on Age and Sex of Insured Persons and Their Type of Insurance Cover on Date Contract is EffectedSchedule 5 Amount and Percentage Specified for Purposes of Definitions Relating to High Cost Claims
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Version status: In force | Document consolidation status: Updated to reflect all known changes
Version date: 1 April 2024 - onwards
Version 2 of 2

Schedule 5 Amount and Percentage Specified for Purposes of Definitions Relating to High Cost Claims

Section 6A.

1. Amount specified for the purposes of paragraph (a) of the definition of 'high cost claim threshold' - €50,000.

2. Percentage specified as the high cost claim quota share - 45 per cent.

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