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1 Click here for Explanatory Memorandum AN BILLE ÁRACHAIS SLÁINTE (FORÁLACHA ILGHNÉITHEACHA), 2011 HEALTH INSURANCE (MISCELLANEOUS PROVISIONS) BILL 2011 Section 1. Definition. Mar a tionscnaíodh As initiated ARRANGEMENT OF SECTIONS 2. Amendment of section 6A of Act of Amendment of section 7D of Act of Amendment of section 7E of Act of Amendment of section 470B of Taxes Consolidation Act Amendment of section 125A of Stamp Duties Consolidation Act Short title, collective citation and construction. [No. 72 of 2011]

2 Acts Referred to Health Insurance Act , No. 16 Health Insurance Acts 1994 to 2009 Stamp Duties Consolidation Act , No. 31 Taxes Consolidation Act , No. 39 2

3 AN BILLE ÁRACHAIS SLÁINTE (FORÁLACHA ILGHNÉITHEACHA), 2011 HEALTH INSURANCE (MISCELLANEOUS PROVISIONS) BILL BILL entitled AN ACT TO AMEND THE HEALTH INSURANCE ACT 1994, THE TAXES CONSOLIDATION ACT 1997 AND THE STAMP DUTIES CONSOLIDATION ACT 1999, IN PART- ICULAR TO ENSURE THAT, IN THE INTERESTS OF SOCIETAL AND INTERGENERATIONAL SOLIDARITY, THE BURDEN OF THE COSTS OF HEALTH SERVICES BE SHARED BY INSURED PERSONS BY CONTINUING TO PROVIDE FOR A COST SUBSIDY BETWEEN THE YOUNG AND THE OLD; TO CONTINUE TO PROVIDE, HAVING REGARD TO THE PRINCIPAL OBJECTIVE OF THE MINISTER FOR HEALTH AND THE HEALTH INSURANCE AUTHORITY IN PERFORMING THEIR RESPECTIVE FUNCTIONS UNDER THE HEALTH INSURANCE ACT 1994, FOR TAX CREDITS TO ENABLE THE OLD TO HAVE ACCESS TO HEALTH INSURANCE COVER AND TO CONTINUE TO PROVIDE FOR A MEANS WHEREBY ANY OVERCOMPENSATION ARIS- ING FROM SUCH TAX CREDITS MAY BE REPAID; AND TO PROVIDE FOR RELATED MATTERS. BE IT ENACTED BY THE OIREACHTAS AS FOLLOWS: 1. In this Act Act of 1994 means the Health Insurance Act Definition Section 6A(1) of the Act of 1994 is amended (a) by substituting the following definition for the definition of age group : age group means age group as prescribed in regulations made under section 7D, and includes any age group, whether or not by reference to any one or more of the following: (a) being less than a specified age; 3 Amendment of section 6A of Act of 1994.

4 (b) being of a specified age or over such age but under another specified age; (c) being of a specified age or over such age;, (b) by substituting section 7D(1)(b); for section 7D(1)(b)., and 5 (c) by inserting the following definition after the definition of relevant period : type of cover means a specific health insurance contract which provides for the payment of prescribed benefits where either 10 (a) the particulars relating to the contract are contained in The Register of Health Insurance Contracts, or (b) the particulars relating to the contract were once contained in that Register but, notwith- 15 standing that such particulars are no longer contained in that Register, prescribed benefits are still payable under the contract.. Amendment of section 7D of Act of Section 7D of the Act of 1994 is amended (a) in subsection (2) 20 (i) by substituting subsections (5) and (6) for subsection (5), and (ii) by substituting the following paragraph for paragraph (b): (b) the total number of persons insured, or a 25 class thereof, in each age group, the gender profile of each age group, and the type of cover of each age group, in respect of the relevant period,, and 30 (b) by inserting the following subsection after subsection (5): (6) (a) Where the benefits payable under a type of cover to which an information return relates have materially changed, regulations made under this section may require a registered 35 undertaking or former registered undertaking to which subsection (1) applies to make separate information returns in respect of each material level of benefit. (b) Regulations made under this section may 40 require a registered undertaking or former registered undertaking to which subsection (1) applies to make separate information returns in respect of the sum of all types of cover to which an information return relates

5 4. Section 7E of the Act of 1994 is amended (a) in subsection (1) Amendment of section 7E of Act of (i) in paragraph (a), by inserting, together with such other information relevant to those purposes as it considers appropriate, after made to it, and (ii) in paragraph (b) (I) in subparagraph (i), by inserting and in respect of the other information referred to in paragraph (a) after specified period, and 10 (II) in subparagraph (iii), by inserting subject to subsection (1A), before the amounts, and (b) by inserting the following subsection after subsection (1): (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, on the basis of the age groups specified in the notice in addition to, or as an alternative to, on the basis of the age groups specified in the Table to subsection (4) of section 470B of the Taxes Consolidation Act Section 470B of the Taxes Consolidation Act 1997 is amended (a) in subsection (1), in the definition of relevant year of assessment Amendment of section 470B of Taxes Consolidation Act (i) in paragraph (a), by substituting, 2011 or 2012 for or 2011, and 30 (ii) in paragraph (b), by substituting 2013, the year of assessment 2013 for 2012, the year of assessment 2012, (b) in subsection (2), by substituting 1 January 2013 for 1 January 2012, 35 (c) in subsection (4)(a), by substituting 1 January 2013 for 1 January 2012, and (d) in subsection (5)(b) (i) by substituting 2013 for 2012, and (ii) by substituting 2012 for 2011 in both places where it appears Section 125A of the Stamp Duties Consolidation Act 1999 is amended (a) in subsection (1) 5 Amendment of section 125A of Stamp Duties Consolidation Act 1999.

6 (i) in the definition of accounting period, by substituting, the fourth accounting period or the fifth accounting period for or the fourth accounting period, (ii) in the definition of due date, by substituting the fol- 5 lowing paragraphs for paragraphs (c) and (d): (c) 21 September 2011 in the case of the third accounting period, (d) 21 September 2012 in the case of the fourth accounting period, and 10 (e) 21 January 2013 in the case of the fifth accounting period;, (iii) by inserting the following definition after the definition of excluded contract of insurance : fifth accounting period means the period of 5 15 months commencing on 1 August 2012 and ending 31 December 2012;, and (iv) in the definition of fourth accounting period, by substituting 12 months commencing on 1 August and ending 31 July 2012 for 5 months commencing on 1 August 2011 and ending 31 December 2011, and (b) in subsection (2) 25 (i) in paragraph (a), by substituting the following subparagraphs for subparagraphs (iii) and (iv): and (iii) on 1 January 2011 in the case of the third accounting period, (iv) on 1 January 2012 in the case of the 30 fourth accounting period, and (v) on 1 August 2012 in the case of the fifth accounting period,, (ii) in paragraph (b), by substituting the following subpar- 35 agraphs for subparagraphs (iii) and (iv): (iii) on 1 January 2011 in the case of the third accounting period, (iv) on 1 January 2012 in the case of the fourth accounting period, and 40 (v) on 1 August 2012 in the case of the fifth accounting period,. 6

7 5 7. (1) This Act may be cited as the Health Insurance (Miscellaneous Provisions) Act (2) The Health Insurance Acts 1994 to 2009 and sections 2, 3 and 4 may be cited as the Health Insurance Acts 1994 to 2011 and shall be construed together as one. Short title, collective citation and construction. 7

8 Click here for Bill AN BILLE ÁRACHAIS SLÁINTE (FORÁLACHA ILGHNÉITHEACHA), 2011 HEALTH INSURANCE (MISCELLANEOUS PROVISIONS) BILL 2011 Background EXPLANATORY MEMORANDUM The Health Insurance Acts 1994 to 2009 provide the statutory basis for the regulation of the health insurance market in the interests of the common good. At the centre of the common good is intergenerational solidarity between all insured persons and community rated health insurance. Following the July 2008 Supreme Court judgement that found that the manner in which the risk equalisation scheme was introduced was ultra vires, people continued to have access to community rated health insurance plans and to benefit from other common good protections such as open enrolment (insurers must accept all applicants for insurance cover, regardless of their risk status, age or gender, subject to prescribed waiting periods) and lifetime cover (guarantees all consumers the right to renew their policies irrespective of age, risk status or claims history). However, the reality is that in the absence of a mechanism to support intergenerational solidarity there are incentives for insurers to design products that are attractive only to healthier lives, undermining intergenerational solidarity and the common good protections. In these circumstances the market can be subject to fragmentation and intergenerational solidarity weakened. In the absence of an appropriate response, it would be in the interests of all insurers to focus on products that would be particularly attractive to healthier lives and to minimise features in their products that would be attractive to older people and those who suffer ill-health. This course would conflict with the common good principles underlying regulation of the market. It was for these reasons that the Health Insurance (Miscellaneous Provisions) Act 2009 was enacted. Its main objects were: to affirm that the purposes of the Health Insurance Acts include, inter alia, ensuring that access to health insurance cover is available to all consumers without differentiation made in respect of age and health status; to strengthen the legislative provisions to achieve this purpose; to enhance intergenerational solidarity and community rated health insurance and to provide for the implementation of related measures to achieve these objects. 1

9 The key measure in this regard was the introduction, in respect of persons aged 50 years and over and for the period 1 January 2009 to 31 December 2011, of a new age-related tax credit in respect of payment due in that period of private health insurance premiums. This measure to be funded by the collection of an annual levy on health insurance companies based on the number of lives covered by policies underwritten by them. These measures provide that health insurers receive higher premiums in respect of insuring older people, but that older people receive tax credits equal to the amount of the additional premium so that all people continue to pay the same amount for a given health insurance product. In this way community rating is maintained but insurers receive higher premiums in respect of older people to partly compensate for the higher level of claims. This method of sharing costs is known as the Interim Scheme of Age-Related Tax Credits and Community Rating Levy. Objects of Bill The main object of the current Bill is to continue to ensure that, in the interests of societal and intergenerational solidarity, the burden of the costs of health services be shared by insured persons by providing that the cost subsidy (an age-related tax credit funded by the collection of a levy on all insured lives) between the young and the old, as provided for by the Health Insurance (Miscellaneous Provisions) Act 2009, be continued for a further year in Preliminary and general matters Section 1 and Section 7 provide for definition, short title, collective citation and construction. These are standard provisions. Amendment of Health Insurance Act 1994 Section 2 amends Section 6 of the Act by substituting a revised definition for age group and by inserting a new definition of type of cover. Section 3 amends Section 7 of the Act to provide for more detailed information returns to be submitted by health insurers to the Health Insurance Authority. The information returns will be broken down further by each year of age as required and also by type of health insurance cover. In addition, regulations made under Section 7 may require separate returns in situations where the benefits payable under a type of cover have materially changed. Section 4 amends Section 7 of the Act to provide broader scope to the Health Insurance Authority in terms of using additional relevant information alongside the formal information returns submitted by the health insurers. This will assist the Authority and the Minister in performing their respective functions under the Act. Amendment of Taxes Consolidation Act 1997 Section 5 amends Section 470B of the Taxes Consolidation Act 1997 to provide for an age-related tax credit in respect of payment of private health insurance premiums due during 2012, in respect of persons aged 50 years and over. This will extend the Scheme, which has been in operation since 2009, for a further year in

10 Amendment of Stamp Duties Consolidation Act 1999 Section 6 amends Section 125A of the Stamp Duties Consolidation Act 1999 to provide for the continuation in 2012 of the collection of an annual levy on heath insurance companies based on the number of lives covered by policies underwritten by them. An Roinn Sláinte, Samhain Wt /11. Clondalkin Pharma and Healthcare. (X58576). Gr