The 1994 Act established a register of health insurance undertakings. It prohibited carrying on health insurance other than as a registered party. The 1994 Act prohibited non-community rated health insurance contracts. It provided that registered undertakers must provide health insurance contracts on the same terms and without discrimination in a range of circumstances. In particular, cover could not be varied by reference to
- age,
- sexual preference,
- prospective suffering from chronic diseases, illness,
- frequency of provision of health services,
- amounts of payment to which the person becomes entitled .
There was an exception for health insurance contracts which provides nursing care for persons over 65 or suffering from prescribed long-term illness or disability. There are certain reductions for persons under 18 and certain other categories.
A health insurance undertaker (other than a restricted membership insurer) is obliged to effect health insurance contract with a person under 65 and his / her dependents in that age, save only for circumstances and exceptions that might be prescribed. The Department may prescribe maximum waiting periods for eligibility for health insurance cover which may be imposed. In particular, the conditions may be prescribed in relation to
- persons over 55
- persons suffering from a medical condition
- persons who have not previously had a health insurance contract in the State.
Where there is a health insurance contract with a register insurer that insurer or another may not refuse to effect another health insurance contract irrespective of age, save in circumstances that might be prescribed. A restricted membership undertaking may refuse to effect a health insurance contract with certain persons.
A provider may not terminate or refuse to renew health insurance without consent of the insured except in cases as might be prescribed. Health insurance contract must meet minimum level of cover as may be prescribed
Health insurance providers may not provide inducements to terminate or effect the health insurance cover with it forego payment or offer inducements to avail of that person\’s rights to public health cover,
The Minister may make regulations regarding the advertising and promotion of health insurance.
The 2001 Act provided for payment of an adjusted health premium by persons over 35 who had not previously effected insurance. It restated the prohibition on non-community rated health insurance contracts. It re-enacted the provisions in relation to the obligation to provide health insurance cover.
A number of reviews between 1994 and 2006 recommended that there was no alternative to risk equalisation, if community rating was to be maintained. The initiation of risk equalisation was challenged by BUPA Ireland Limited.
Notwithstanding that risk equalisation had been legislated for 1990s it did not become operative until 2006.The Health Insurance Authority recommended to the Minister for Health in October 2005 the commencement of risk equalisation payments. In December 2005, the Minister for Health and Children decided that risk equalisation payments would commence from 1 January 2006.
The High Court upheld the risk equalisation scheme in 2006 and within three weeks BUPA Ireland announced that it was leaving the market. Quinn Group purchased its business. In July 2008, the Supreme Court found the risk equalisation scheme to be outside the powers of the legislation.
A stay on payments was imposed by the Courts until it ruled on a constitutional challenge to the Risk Equalisation Scheme. On the 16th of July 2008, the Supreme Court ruled that the Risk Equalisation Scheme was unconstitutional.
The Government announced, in November 2008, an initiative of an interim age related taxcredits and community rating health insurance levy to support the cost of health insurance forolder people. This interim system commenced in 2009 and was designed to be exchequer neutral.
The Health Insurance Amendment Act 2007 removed the three years period from risk equalisation for new health insurance providers. Risk equalisation payments were reduced by 20 percent.
The Voluntary Health Insurance Act 2008 conferred additional functions on the Voluntary Health Insurance Board. It was allowed to establish subsidiaries for performance and some of its functions. Its subsidiary will be permitted hold an authorisation from its financial regulator to provide non and life insurance business. This might include other levels of areas of insurance such as SwiftCare Clinics.
By 2006 VHI membership stood out 1.55 million. However, by 2011 the effect of the recession had caused a significant reduction in memberships. Legislation provided for variations in the normal solvency requirements on a temporary basis
The objective of the legislation and the Authority in performing their functions as provided in the 2009 Act was to ensure that in the interests of the common good, that access to health insurance cover is available to consumers of health service with no differentiation made between them as regards to cost based on age or general health status. A health insurer may not engaging a practice, the effect or objective of which is to frustrate the achievement of the principal objective as set out in the legislation.
The Health Insurance Miscellaneous Provisions Act 2009 sought to affirm the purpose of the existing legislation and provide access to health insurance without differentiation of age, and health status. It requires health insurers to act, offer contracts on these terms. Persons are to be charged the same net premium as defined. Insurers are to submit new contracts to the HIA for approval 20 days before offering them to the public.
A register of health insurance contracts is maintained. This is available for inspection. Insurers are obliged to make information returns to the authorities, six monthly. The authority must submit a report to the minister based on its undertaking and analysis.
There are new provisions for enhancing advertising and promotion of health insurance. It is designed to provide greater access, enhance the position of consumers relation to access to information. Prescribed information may be including in health insurance contracts. Certain information must accompany advertisements.
The legislation also enhanced provision for enforcement by way of enforcement notices.Where it is of the opinion that health insurance providers breaching its obligations under the legislation, the Authority may take a number of steps and ultimately apply to the High Court requiring compliance.
The Health Insurance (Miscellaneous Provisions) Act 2009 provided for tax credits to enable older persons of have access to health insurance cover and to provide mechanisms whereby overcompensation from such tax credits might be re paid.The legislation provided for age-related tax credits in relations to private health insurance. They are available to persons over 50. It is an addition to the income tax relief (available to the insurers directly) generally in respect of medical insurance premiums.
The Government, on 27th May 2010, announced a comprehensive strategy and set of actions for the health insurance market. These actions included the development of a full, robust, new risk equalisation scheme to start in 2013. The Health Insurance Authority published a consultation paper on risk equalisation on 21 June 2010 and submitted a report to the Minister for Health in December 2010.The Government announced details of the scheme in January 2012. Legislation was published in October 2012 and enacted in December 2012 to apply from January 2013.
The legislation creates a Risk Equalisation Fund administered by the Health Insurance Authority. The Risk Equalisation Fund supports the community rated market by providing age related health credits in respect of those over the age of 60 that help to meet their higher claims costs. The health credits vary by age, gender and by Level of Cover. Credits are also provided in respect of each overnight stay in a hospital bed in private or semi-private accommodation. These credits are funded by a community rating health insurance levy paid by health insurers which vary by Level of Cover.
The health credits and the community rating health insurance levy are administered by the health insurance companies and the Risk Equalisation Fund. Community rating health insurance levy payments for renewals from 1 January 2013 are paid by insurers to the Revenue Commissioners who in turn pass the money to the Risk Equalisation Fund. Health credits are paid out of the Fund to the insurers. Any surpluses or deficits in the Fund are carried forward and allowed for in setting future levy amounts.
The 2016 Risk Equalisation Scheme is similar to the 2013 Scheme except that risk equalisation payments would also be payable in respect of admissions to hospitals that did not involve an overnight stay in the hospital.