Source document: https://docs-lawep.s3.us-east-2.amazonaws.com/1697804516057.pdf (Ireland)
Post-Enactment Report Health Insurance (Amendment) Act 2017 (Act 37 of 2017) (Dáil Éireann – Standing Order 164A) (Seanad Éireann – Standing Order 168) October 2019 Introduction The purpose of the Health Insurance (Amendment) Act 2017 is to reinforce the legislation and regulations underpinning the private health insurance market in Ireland.
The annual Act sets out the credits to be paid out under the Risk Equalisation Scheme (RES) as well as implementing any necessary adjustments to the level of Stamp Duty included in health insurance policies.

Risk equalisation is a mechanism designed to support the objective of a community rated health insurance market, whereby customers pay the same net premium for the same health insurance product, irrespective of age, gender or health status.
The Health Insurance Acts 1994 to 2017 provide for a Risk Equalisation Scheme for the health insurance market since 1 January 2013.

Under the scheme, insurers receive risk equalisation credits to compensate for the additional cost of insuring older and less healthy members.

The credits are funded by stamp duty levies payable by open market insurers in respect of each insured life covered.
The stamp duty levies are collected by the Revenue Commissioners and transferred to a risk equalisation fund administered by the Health Insurance Authority (HIA).

Legislation is required each year to revise the applicable risk equalisation credits and the corresponding stamp duty levies necessary to fund them.
Page 1 of 4 Financial Implications of the Act The Risk Equalisation Scheme is designed to be Exchequer neutral, with the amount of the stamp duty levy calculated to offset the costs associated with the provision of the risk equalisation credits.

Any surpluses or deficits that arise under the permanent scheme are rolled over to the following year and are taken into account when recommending revised risk equalisation rates and corresponding stamp duty levies.
Utilisation credits Age / Gender/ Level of cover credits from 1 April 2018 Age Bands ( overnight/day case) Non-Advanced Advanced From 1 April 2018 Men Women Men Women 64 and under €100 / €50 65-69 70-74 75-79 80-84 €100 / €50 €100 / €50 €100 / €50 €100 / €50 85 and above €100 / €50 €0 €400 €725 €1,075 €1,450 €2,175 €0 €300 €550 €850 €1,150 €1,450 €0 €1,000 €1,750 €2,550 €3,450 €4,975 €0 €650 €1,250 €1,925 €2,700 €3,350 Age Bands Stamp duties from 1 April 2018 to 31 March 2019 17 and under 18 and over €59 €177 €148 €444 Objects of the Act The main purposes of the Act are to specify the amount of risk equalisation credits to be paid from the Risk Equalisation Fund in respect of age, gender and level of cover from 1 April 2018 and to make consequential amendments to the Stamp Duty Consolidation Act 1999 to revise the community rating stamp duty levies required to fund the risk equalisation credits.
In addition, amendments were made to the operation of Lifetime Community Rating (LCR) in the health insurance market, two years after the scheme was introduced.

Section 7A of the Health Insurance Act 1994 gave the Minister for Health the power to introduce regulations whereby loadings may be applied to health insurance premiums in certain circumstances.
The Minister invoked this power in introducing Statutory Instrument No 312 of 2014 which introduced Lifetime Community Rating, which resulted in loadings applying in certain circumstances in respect of policies commencing from 1 May 2015.

Lifetime community rating modifies community rating so that the premium that individuals pay for health insurance increases with the age at which they enter the private health insurance market.
A loading of 2% of the gross premium will apply for every year of age higher than age 34 that an individual has attained when they first purchase inpatient private health insurance after 30 April 2015.

Loadings are applied for a maximum Page 2 of 4 of 10 years and to a maximum of 70%.

Prior to this Act there was no maximum duration on loadings applied to a private health insurance policy.
The sections of the Act are outlined briefly below: Section 1 defines the Principal Act as the Health Insurance Act 1994.

Section 2 amends section 7A of the Principal Act to expand the Minister’s regulation making powers in relation to the operation of the scheme.

This section also provides that, where increases in unadjusted net premiums apply, such increases are payable for ten years only.
Section 3 amends section 11C of the Principal Act to provide for 1 April 2018 as the effective date for revised credits to be payable from the Risk Equalisation Fund.

Section 4 amends Schedule 3 to the Principal Act to provide for the revised amounts payable from the Risk Equalisation Fund in respect of the ‘hospital utilisation credit’ in relation to health insurance contracts renewed or effected from 1 April 2018.
Schedule 3 contains revised amounts (i) for the provision of in-patient services on an overnight basis and (ii) for the provision of in-patient services on a day case basis.

Section 5 replaces Table 2 in Schedule 4 to the Principal Act with effect from 1 April 2018 whereby the applicable risk equalisation credits payable from the Risk Equalisation Fund in respect of certain classes of insured persons are revised.
Section 6 amends section 125A of the Stamp Duties Consolidation Act 1999 to specify the applicable stamp duty rates for (i) 1 January 2018 to 31 March 2018 and (ii) 1 April 2018 onwards.

Section 7 provides for the short title, commencement, collective citation and construction of the Bill.

Commencement of the Act The Health Insurance (Amendment) Act 2017 (Act 37 of 2017) was commenced with effect from the 1st of January 2018.

Sections 3, 4 and 5 came into operation on the 1st of April 2018.
The Health Insurance Acts 1994 to 2016 and this Act (other than section 6 ) may be cited together as the Health Insurance Acts 1994 to 2017 and shall be construed together as one.

Regulatory changes under this Act Background Lifetime Community Rating (LCR) was introduced in 2015 to encourage people to take out health insurance at younger ages, and so help to control average claims costs and premium inflation.
A review of LCR, carried out Page 3 of 4 by the HIA in 2017, recommended some amendments to the operation of the scheme.

Following enactment of the Health Insurance (Amendment) Act 2017 in December, an enabling Statutory Instrument was also required to implement the specific details of planned changes to the scheme.
These regulations were drafted in consultation with the commercial health insurers, the Health Insurance Authority, the representative body (Insurance Ireland) on behalf of the industry and various other Government Departments affected by certain provisions (including the Department of Defence, the Department of Foreign Affairs and Trade, the Department of Justice and Equality and the Department of Business, Enterprise and Innovation).
The final version took account of concerns raised by industry in this consultation process, including the potential administrative burden and significant ICT systems changes required to implement planned changes from their perspective.

As a result, three separate implementation dates were provided in the S.I., to alleviate concerns raised and to ensure smooth implementation in a fair and balanced manner.

S.I.

No.
224/2018 Health Insurance Act 1994 (Determination of Relevant Increase under section 7A and Provision of Information under section 7B) (Amendment) Regulations 2018 There are four main provisions in the Instrument, which were implemented on a staggered basis, as follows: • From 1 September 2018 o Members of the Permanent Defence Force and EU Staff working in this country (members of the Joint Sickness Insurance Scheme) will have their periods of membership counted as credited periods, provided health insurance is purchased within 9 months of ceasing to be a member.
• From 1 November 2018 o Periods (of at least 6 months) without insurance cover when outside the State will be counted as credited periods, provided health insurance is purchased within 9 months of return to the country.

• From 1 February 2019 o Periods (of at least 6 months) without insurance cover while in the State will be provided for up to a maximum of three years.
Individuals will be permitted (for the purposes of loadings) to have various separate periods without health insurance cover, following which loadings will not apply upon resumption of insurance cover.

Publication The Department of Health and the Health Insurance Authority published the details of the Act on their websites.

Additionally, notice of the making of S.I.

No.

224/2018 was published in “Iris Oifigiúil” of 29th June 2018.

_______________________ Department of Health, October 2019.

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