STATUTORY INSTRUMENTS

S.I. No. 332 of 2005

HEALTH INSURANCE ACT, 2001 (OPEN ENROLMENT) REGULATIONS, 2005

S.I. No 332 of 2005

HEALTH INSURANCE ACT, 2001 (OPEN ENROLMENT) REGULATIONS, 2005

I, Mary Harney, Minister for Health and Children, in exercise of the powers conferred on me by section 3 of the Health Insurance Act, 1994 ( section 13 of the Health Insurance (Amendment) Act, 2001 ( section 4 of the Health Insurance Act, 1994 and section 8 of the Health Insurance Act, 1994 ( section 8 of the Health Insurance (Amendment) Act, 2001 ( No. 17 of 2001 )), hereby make the following regulations-

PART I

GENERAL

1.               These Regulations may be cited as the Health Insurance Act, 2001 (Open Enrolment) Regulations, 2005.

2.               These Regulations shall come into operation on the 1^st day of July, 2005.

3.               In these Regulations-

“insured person” means a person named in a health insurance contract as an insured person or an infant born to a person named in a health insurance contract as an insured person provided that in the case of an infant the person who effected the health insurance contract requests that the health insurance contract be altered to name such infant as an insured person, and pays the appropriate premium in respect of such infant, within 13 weeks of the date of birth of the infant.

4.               The age of a person for the purposes of these Regulations is the age attained at the contract start date.

PART II

ENTRY

5.               For the purposes of section 8(1) of the Health Insurance Act, 1994 , a restricted membership undertaking shall not refuse to effect a health insurance contract, with or for a person of whatever age or such a person and his or her dependants except where such person is not qualified for membership of the undertaking.

PART III

MAXIMUM WAITING PERIODS

6.               (1)    The maximum waiting period for eligibility for payment under a health insurance contract which a registered undertaking may impose in respect of an insured person shall be-

(i)     26 weeks, in respect of a person who is under the age of 55 years provided that no maternity benefit shall be payable for the period of 52 weeks next following a person being named as an insured person;

(ii)    52 weeks, in respect of a person who is of or over the age of 55 years and under the age of 65 years;

(iii)   104 weeks, in respect of a person who is of or over the age of 65 years.

(2)    An infant shall be eligible to receive payments under a health insurance contract immediately from his or her date of birth where the infant has been named as an insured person within 13 weeks of his or her date of birth.

(3)    An insured person shall be eligible for minimum payments immediately in respect of health services prescribed pursuant to section 10 of the Health Insurance Act, 1994 where such health services are provided as a result of an accident or injury which occurred while that person was named as an insured person.

(4)    The maximum waiting periods prescribed in this article shall be known as the “initial waiting periods”.

7.               (1)    The maximum waiting period for eligibility for payments under a health insurance contract in respect of an insured person's medical condition, the date of onset of which is determined on the basis of medical advice to have been prior to the date he or she is first so named, other than where the insured person is an infant and has been so named within 13 weeks of his or her date of birth, shall be-

(i)       5 years, for a person who is under the age of 55 years;

(ii)      7 years, for a person who is of or over the age of 55 years and under the age of 60 years;

(iii)     10 years for a person who is of or over the age of 60 years.

(2)    The maximum waiting periods prescribed in this article shall be known as the “pre-existing condition waiting periods”.

8.               Subject to article 7, where a person is named in a contract of health insurance, herein referred to as the “higher contract”, in respect of the increase in the level of hospital in-patient or relevant health services or a more expensive type of hospital accommodation having previously been named as an insured person under a health insurance contract with the undertaking, the maximum waiting period for eligibility for payments in respect of the increased level of hospital in-patient services or relevant health services or the more expensive type of hospital accommodation, shall be-

(i)         2 years for a person under the age of 65 when first named under the higher contract; or

(ii)        5 years for a person of or over the age of 65 years when first named under the higher contract.

9.               For the purposes of section 8(4)(a) of the Health Insurance Act, 1994 the following case is hereby prescribed as the exception to the requirement to effect a health insurance contract that is where such a person has had a previous contract terminated or not renewed under article 4(a) of the Health Insurance Act, 1994 (Lifetime Cover) Regulations, 1996 ( S.I. No. 82 of 1996 ).

10.             For the purposes of section 8(5) of the Health Insurance Act, 1994 the period of thirteen weeks after the cesser of a health insurance contract is hereby prescribed.

11.             Articles 5 to 10 of these Regulations are hereby declared to be penal Regulations for the purposes of section 4 of the Health Insurance Act, 1994 .

12.              The Health Insurance Act, 1994 (Open Enrolment) Regulations, 1996 ( S.I. No. 81 of 1996 ) are hereby revoked.

EXPLANATORY NOTE

(This note is not part of the Instrument and does not purport to be a legal interpretation).

These Regulations replace the Health Insurance Act, 1994 (Open Enrolment) Regulations, 1996. In doing so it they provide for persons aged 65 and over, who do not already have cover, to avail of health insurance.