I thank the committee for facilitating the proposed changes to the health insurance regulations. The motion seeks the approval of the Houses of the Oireachtas of draft regulations to be made under the Health Insurance Acts. Three sets of regulations are involved, the Risk Equalisation (Amendment) Scheme 2005, the Health Insurance Act 1994 (Minimum Benefit) (Amendment) Regulations 2005, and the Health Insurance Act 2001 (Open Enrolment) Regulations 2005. Copies of these have been laid before Dáil Éireann and Seanad Éireann. Amendments are proposed to the risk equalisation scheme and the minimum benefit regulations, while the open enrolment regulations are to be replaced.
Under the risk equalisation scheme, insurers make periodic returns covering January to June and July to December. It is desirable, therefore, that any amendments to the regulations be made in advance of 1 July 2005, the first day of the next six month data return period. The proposed amendments arise from the Health Insurance Authority's working experience of the scheme. Amendments (b) to (d) introduce a provision that specifically recognises the authority’s powers of interpretation of the scheme. Three substitutions for existing definitions are also proposed. The purpose of these changes, which are linked, is to clarify the existing definitions for the claims taken into account in the scheme for the purposes of calculating risk differentials and also potentially risk equalisation payments. The changes provide that all claims settled in a particular period, with the exception of claims in respect of any person who is serving a waiting period for eligibility for services, qualify for inclusion.
The need for the proposed changes was set out in the authority's first two reports made under the risk equalisation scheme, in which it addressed consistency of returns and the need to address differences in interpretation of definitions. As mentioned, the purpose of these changes is to clarify certain definitions and not to change the purpose or scope of the scheme.
Section 8(6) of the Health Insurance Act provides that adult members of restricted membership undertakings who have opted out of risk equalisation are to lose their rights to have previous cover recognised when moving to other insurers. Under article 4 of the risk equalisation scheme 2003, the Garda and Prison Officer restricted membership undertakings availed of the opt out provision. Section 8 also provides for the extension of the right to take out health insurance to persons of all ages. Previously, there was no obligation on insurers to cover persons aged 65 years and over who were not renewing cover.
In replacing the existing open enrolment regulations, the proposed regulations provide for these changes while retaining the basic structure of the existing regulations for the serving of waiting periods before cover takes effect. In a community-rated market it is necessary to have protections in place for the insurers operating in the market and for the market itself.
As set out in the White Paper on health insurance, the proposed regulations provide for an initial waiting period of 104 weeks for persons aged 65 years and over who are not renewing cover, while retaining the existing waiting periods for those under 65 years. which is 52 weeks. For pre-existing conditions, it is proposed that the existing waiting periods be retained.
The envisaged amendments are limited to updating references to the proposed open enrolment regulations contained in the minimum benefit regulations and, likewise, substituting the term "relevant" for "ancillary" in line with that change made in the 2001 Act.