Risk Equalisation (Amendment) Scheme, 2007
Statutory Instruments
Source: Statutory Instruments

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paragraphs: This Scheme may be cited as the Risk Equalisation (Amendment) Scheme, 2007.
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paragraphs: The Risk Equalisation Scheme, 2003 is hereby amended—
(a) by the substitution in Article 3—
(i) for the definition of “Act” of the following—
“ ‘Act’ means the Health Insurance Act, 1994 , (No. 16 of 1994) as amended by the Health Insurance (Amendment) Act, 2001 , (No. 17 of 2001), the Health Insurance (Amendment) Act, 2003 (No. 11 of 2003) and the Health Insurance (Amendment) Act, 2007, (No. 3 of 2007);”
(ii) for the definition of “data adjustment” of the following—
“ ‘data adjustment’ has the meaning assigned to it in Article 11 of this Scheme;”
(iii) for the definition of “registered” of the following—
“ ‘registered’ in relation to an undertaking has the meaning assigned to it in section 2 of the Act and also includes undertakings that were formerly registered as set out in section 12(2)(a)(ii) of the Act;”
(iv) for the definition of “scheme undertakings” of the following—
“ ‘scheme undertakings’ means all registered undertakings, having regard to 2(a)(iii) and 2(a)(v);”
(v) for the definition of “undertaking” of the following—
“ ‘undertaking’ has the meaning assigned to it in section 2 of the Act taken in conjunction with section 12(2)(a) of the Act, except that it shall exclude the following—
(a) any restricted membership undertaking to which the provisions of a scheme do not apply pursuant to Article 4, or
(b) any registered undertaking to which the provisions of a scheme do not apply pursuant to Article 5.”
(b) by the insertion of the following definitions in Article 3—
“ ‘corrected return’ has the meaning assigned to it in Article 9 of this Scheme;”
“ ‘curtailment adjustment’ has the meaning assigned to it in Article 11 of this Scheme;”
(c) by the deletion of the definition of “returning undertaking” in Article 3
(d) by the substitution in Articles 8(1), 9(1), 9(4), 9(5), 9(6), 9(8), and 11(3) for “returning undertaking” of “scheme undertaking”
(e) by the substitution for Article 9(5)(a) of the following—
“ (a) the number of insured persons on the first day of each month of the quarter concerned and the first day of the next following period,”
(f) by the substitution in Articles 9(8) and 9(9) for “data adjustment” of “corrected return”
(g) by the insertion of the following definitions in Article 11(1)—
“ ‘curtailment adjustment’ has the meaning assigned to it in sub-article (3);
‘data adjustment’ means for a scheme undertaking for a particular period the aggregate of
(a) its return or the most recent corrected return submitted in accordance with sub-article (8) of Article 9, and
(b) the aggregate of any curtailment adjustments allocated to that period arising from a determination or determinations by the Authority under sub-article (3).”.
(h) by the deletion of “.” at the end of Article 11(3) and the insertion of the following—
“, provided that if the Authority is of the opinion, following, inter alia, an analysis of the returns, that during the period a scheme undertaking has, for whatever reason,
(a) ceased to provide cover to insured persons; or
(b) has very substantially curtailed its operations,
so that, as a result, there is in the opinion of the Authority a material lack of correspondence between its number of insured persons and
(a) its amount of equalised benefits; or
(b) its claim value
for a particular cell or group of cells, then the Authority shall disregard that particular return in its calculation of equalisation contributions for the current period and instead it shall allocate that return (to be known for the purposes of this Scheme as a “curtailment adjustment”) to the latest preceding period in respect of which the Authority did not form such an opinion.”
(i) by the substitution in Article 11(5) for “been submitted” of “arisen”
(j) by the deletion of “plus 5 percentage points” in Articles 11(5)(a) and 11(5)(b)
(k) by the substitution in Article 11(5)(a) for “or the most recent previous data adjustments received” of “received or the most recent data adjustments which have arisen”
(l) by the substitution in Article 11(5)(b) for “any newly submitted data adjustment” of “any new data adjustment which has arisen”