Health Insurance Act 1994 (Information Returns) (Amendment) Regulations 2022.
Statutory Instruments
Source: Statutory Instruments

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paragraphs: (1) These Regulations may be cited as the Health Insurance Act 1994 (Information Returns) (Amendment) Regulations 2022.
(2) The Principal Regulations, the Health Insurance Act 1994 (Information Returns) (Amendment) Regulations 2011 ( S.I. No. 690 of 2011 ), the Regulations of 2013, the Regulations of 2015 and these Regulations may be cited together as the Health Insurance Act 1994 (Information Returns) Regulations 1994 to 2022.
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paragraphs: In these Regulations—
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paragraphs: Regulation 2(1) (as amended by Regulation 3 of the Regulations of 2015) of the Principal Regulations is amended—
(a) by inserting after the definition of “fixed price procedure” the following definition:
“‘Fund’ and ‘high cost claim credit’ have the meanings assigned to them by section 6A(1) of the Act of 2004;”,
(b) by inserting after the definition of “medical condition” the following definition:
“‘member number’ means an identifiable unique number corresponding to an insured person and all consecutive or continuous contracts held by the said insured person;”, and
(c) by inserting after the definition of “net provider payment” the following definition:
“‘notifiable claim’ means an amount or amounts discharged or reimbursed on application by, or on behalf of, an insured person to a registered undertaking, under the terms of a health insurance contract where such amount exceeds €10,000 for that contract;”.
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paragraphs: Regulation 5 (as amended by Regulation 4 of the Regulations of 2013) of the Principal Regulations is amended—
(a) in paragraph (2), by substituting “Notwithstanding paragraph (3)(c), Form No. 1” for “Form No. 1”,
(b) in paragraph (3)—
(i) in subparagraph (a), by substituting for clauses (vii) and (viii) the following:
“(vii) the cell claim value for the quarter, with a breakdown of the sum of in-patient and day-patient days between publicly funded hospitals and private hospitals;
(viii) the cell claim value (overnight stays) for the quarter, with a breakdown of the sum of all in-patient days between publicly funded hospitals and private hospitals;”,
(ii) in subparagraph (b), by substituting “by gender; and” for “by gender.”, and
(iii) by inserting after subparagraph (b) the following subparagraph:
“(c) for all notifiable claims, the details specified herein, split by contract period and split monthly based on date of provision of services and date of payment, in the form specified by the Authority pursuant to section 11G of the Act of 2004:
(i) details of insured individual for each health insurance contract including membership number, age, gender, type of cover and whether the type of cover is specified as advanced cover by the Authority under section 11E of the Act of 1994;
(ii) details of risk equalisation credit claimed from the Fund under section 11C of the Act of 1994 excluding high cost claim credits.
(iii) breakdown of the notifiable claim amount into that relating to services rendered—
(I) in a publicly funded hospital,
(II) in a private hospital, and
(III) by a hospital consultant;
(iv) the total amount reimbursed for drugs which are not on the Reimbursement List established by the Health Service Executive under section 17 of the Health (Pricing and Supply of Medical Goods) Act 2013 ;
(v) the cell claim value (publicly funded hospitals);
(vi) the cell claim value (private hospitals);
(vii) the cell claim value (overnight stays) (publicly funded hospitals) and
(viii) the cell claim value (overnight stays) (private hospitals).”.
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paragraphs: The Principal Regulations are amended by substituting for Schedule 2 (as amended by Regulation 6 of the Regulations of 2013) the following: