Health Insurance Act 1994 (Risk Equalisation Scheme) Regulations 2013.
Statutory Instruments
Source: Statutory Instruments

num: 1
paragraphs: (1) These Regulations may be cited as the Health Insurance Act 1994 (Risk Equalisation Scheme) Regulations 2013.
(2) These Regulations shall come into operation on 1 March 2013.
num: 2
paragraphs: In these Regulations—
(a) the period from 1 January 2013 to 30 March 2013,
(b) the period from 31 March 2013 to 30 April 2013, and
(c) thereafter, any calendar month;
num: 3
paragraphs: (1) Subject to paragraph (2), an undertaking shall, before making its first RES claim, and thereafter at such times as it considers appropriate, give notice in the specified form to the Authority of the names and posts (being posts which fall within the classes of posts specified in the form for the purposes of this paragraph) held by the persons who are authorised by the undertaking to make RES claims and annual RES returns on its behalf.
(2) The notice referred to in paragraph (1) shall—
(a) require the signatures of the persons referred to in that paragraph to be set out in the notice, and
(b) be completed and signed by—
(i) in the case of an undertaking which is a body corporate, the secretary of the undertaking, and
(ii) in the case of any other undertaking, the person who is, or performs the duties of, the secretary of the undertaking.
(3) A reference in these Regulations to a RES claim or annual RES return made by an undertaking (howsoever expressed) shall be construed to mean a RES claim or annual RES return, as the case may be, made by an authorised person on behalf of the undertaking.
num: 4
paragraphs: (1) The Authority shall establish procedures with undertakings in relation to the making of interim RES claims.
(2) Without prejudice to the generality of paragraph (1), the procedures referred to in that paragraph shall govern the method by which an interim RES claim made by an undertaking is satisfied, including the crediting by the Authority of a bank account within the State nominated by the undertaking for that purpose.
(3) An interim RES claim made by an undertaking shall be—
(a) in the specified form,
(b) in respect of the period from 1 January 2013 to 30 March 2013, made not earlier than 31 March 2013 and not later than 21 April 2013, and
(c) in respect of any subsequent period, made not earlier than the first day of the month immediately following the period to which the RES claim relates and not later than the 21st day of that month.
(4) Subject to paragraph (6), where the Authority receives an interim RES claim from an undertaking and is satisfied that the amount of the risk equalisation credits properly due to the undertaking, for the period to which the interim RES claim relates, covers the claimed RES amount, it shall pay from the Fund the claimed RES amount to the undertaking.
(5) Subject to paragraph (6), where the Authority receives an interim RES claim from an undertaking and is not satisfied that the amount of the risk equalisation credits properly due to the undertaking (“the due amount”), for the period to which the interim RES claim relates, covers the claimed RES amount, it shall only pay from the Fund the due amount to the undertaking.
(6) Neither paragraph (4) nor (5) shall be construed to prevent the Authority from making adjustments to its payments from the Fund to an undertaking in respect of the undertaking’s interim RES claims to take account of any monthly excess or shortfall.
num: 5
paragraphs: (1) An undertaking shall make an annual RES claim to the Authority—
(a) in the specified form, and
(b) not later than 2 months after the year to which the annual RES claim relates.
(2) An undertaking shall make an annual RES return to the Authority—
(a) in the specified form, and
(b) not later than 4 months after the year to which the annual RES return relates.
(3)(a) Where the aggregate of the claimed RES amounts paid by the Authority from the Fund to an undertaking in respect of the interim RES claims made by the undertaking for a year exceeds the amount recoverable from the Fund shown on the undertaking’s annual RES claim for that year, the undertaking shall repay the amount of the excess into the Fund with that annual RES claim.
(b) Where the aggregate of the claimed RES amounts paid by the Authority from the Fund to an undertaking in respect of the interim RES claims made by the undertaking for a year is less than the amount recoverable from the Fund shown on the undertaking’s annual RES claim for that year, the Authority shall pay, from the Fund and to the undertaking, that amount that the Authority is satisfied is so payable in respect of the shortfall.
(4) Where an undertaking fails to make an annual RES claim or annual RES return within the time limits prescribed by this Regulation, the Authority may refuse to pay any claimed RES amounts in respect of interim RES claims made by the undertaking after such failure until such time as the Authority receives that annual RES claim or annual RES return, as the case may be.
(5) Where an annual RES claim or annual RES return has been made to the Authority by an undertaking and the undertaking subsequently discovers that an error has been made in the annual RES claim or annual RES return, or both, the undertaking shall
(a) make a supplementary annual RES claim in the specified form to the Authority or supplementary annual RES return in the specified form to the Authority, or both, as the case may require, not later than 2 months after discovering the error (and paragraph (3) shall, with all necessary modifications, apply to the supplementary annual RES claim or supplementary annual RES return, or both, as the case may be, as that paragraph applies to the supplementary annual RES claim or supplementary annual RES return, or both, as the case may be), and
(b) at the same time, submit to the Authority a report in writing setting out—
(i) the reasons why the error occurred, and
(ii) the steps that the undertaking has taken, or will take, to prevent a recurrence of that kind of error or any similar kind of error.
num: 6
paragraphs: (1) The Authority may, by notice in writing given to an undertaking, require the undertaking to furnish, within such period as is specified in the notice, such information about a relevant contract provided by the undertaking as may reasonably be required by the Authority for the purposes of these Regulations.
(2) An undertaking given a notice referred to in paragraph (1) shall comply with the requirements of the notice.
num: 7
paragraphs: (1) The Authority shall be entitled, in respect of a RES claim, to make all such enquiries as it considers necessary to establish whether the RES claim is or was properly due.
(2) An undertaking shall—
(a) keep sufficient records to enable the requirements of these Regulations to be satisfied,
(b) make those records available for inspection within the State by an authorised officer,
(c) for the purposes of any such inspection, retain those records for a period of not less than 6 years from the date on which they were created, and
(d) furnish such information about a RES claim made by the undertaking as may reasonably be required by the Authority.