S.I. No. 261/2003 - Risk Equalisation Scheme, 2003

1. In this Schedule-

“commencement date”, as it relates to an undertaking, shall be construed in accordance with section 12B of the Act;

“covered persons” means in relation to a scheme undertaking-

(a) insured persons who on the last day of a specific period were named in a health insurance contract effected by that scheme undertaking and who belonged on that day to a specified cell or combination of cells, or

(b) insured persons not already included under paragraph (a) of this definition who during a specific period were formerly named in a health insurance contract effected by that scheme undertaking and who, but for the cessation of their health insurance contract, would have belonged to that cell or those cells on the last day of that period;

“health status weight” and “HSW” means a percentage which on the risk equalisation commencement day shall be 0%, and thereafter shall be such a percentage as the Authority may from time to time determine for the purposes of calculations under this schedule, provided that the Authority shall not make such a determination unless

(a) the Authority has observed from its analysis of returns carried out pursuant to Article 10(2) of Part IV that there are material differences in claims experience within prescribed age and gender cells as between scheme undertakings, and

(b) the Authority has carried out an investigation into the reasons for such material differences, and

(c) as a result of such investigation the Authority has concluded that the said material differences are wholly or substantially attributable to variations as between scheme undertakings in the health status of covered persons rather than in the respective efficiency levels of those undertakings;

and that accordingly the Authority considers that the making of such a determination is in the best overall interests of health insurance consumers, and provided that such percentage shall not in any event be less than 0% or exceed 50%.

2. Any change to the HSW determined by the Authority pursuant to Article 1 of this Schedule shall be notified by it to all registered undertakings, other than those to which a scheme does not apply pursuant to Article 4 of Part I, and shall not have effect earlier than 6 months after the date of the notification.

3. Where the denominator in any quotient specified herein is zero, the result of that calculation shall be deemed to be zero.

4. Cell Definitions (with respect to a specific period, each scheme undertaking and a specified cell) shall be as follows

“cell insured population” and “CIP” means the average of the total number of insured persons in that cell on the first day of the first quarter of the period and on the first day of the second quarter of the period;

“cell equalised benefits” and “CEB” means the sum of all prescribed equalised benefits paid, in respect of settled claims which acquired that status during that period, to or on behalf of covered persons;

“cell claim value” and “CCV” means the sum of all in-patient and day-patient days, in respect of settled claims which acquired that status during that period, in respect of covered persons but disregarding any such hospital stays which have been taken into account under a previous settled claim;

“cell equalised benefits average” and “CEBA” means an amount determined in accordance with the following formula

CEB

___

CCV

“cell utilisation” and “CU” means an amount determined in accordance with the following formula

CCV

___

CIP

5. Scheme Undertakings Definitions (with respect to a specific period and each scheme undertaking) shall be as follows

“undertaking insured population” and “UIP” means the sum for all cells of

CIP

“undertaking equalised benefits” and “UEB” means the sum for all cells of

CEB

“undertaking adult lives” and “UAL” means the sum for all cells, other than the cell or cells which comprise the prescribed age band “age 17 and under”, of

CIP

“undertaking child lives” and “UCL” means the sum for the cell or cells which comprise the prescribed age band “age 17 and under”, of

CIP

“undertaking equivalent adult lives” and “UEAL” means a value determined in accordance with the formula

UAL +

UCL

____

3

“undertaking equivalent adult ratio” and “UEAR” means a value determined in accordance with the formula

UEAL

_____

UIP

6. Market Specific Definitions (with respect to a specific period) shall be as follows

“market insured population(cell)” and “MIP(Cell)” means the sum, for all scheme undertakings for a specified cell, of

CIP

“market insured population (total)” and “MIP (Total)” means the sum, for all cells, of

MIP(Cell)

“market equalised benefits(cell)” and “MEB(Cell)” means the sum, for all scheme undertakings for a specified cell, of

CEB

“market equalised benefit(total)” means the sum, for all cells, of

MEB(Cell)

“market claim value” and “MCV(Cell)” means the sum, for all scheme undertakings for a specified cell, of

CCV

“market equalised benefits average” and “MEBA(Cell)” means an amount, for a specified cell, calculated in accordance with the formula

MEB(Cell)

_________

MCV(Cell)

“market utilisation” and “MU(Cell)” means a value, for a specified cell calculated in accordance with the formula

MCV(Cell)

_________

MIP(Cell)

“market proportion” and “MP(Cell)” means a value calculated in accordance with the formula

MIP(Cell)

_________

MIP(Total)

“market equivalent adult lives” and “MEAL” means the sum for all scheme undertakings of

UEAL

“market equivalent adult ratio” and “MEAR” means a value determined in accordance with the formula

MEAL

______

MIP(Total)

7. Age, Gender and Health Status (AGHS) Calculations shall be determined in accordance with the following provisions

“cell standardised benefits — age, gender and health status basis” and “CSBAGHS” with respect to a specific period, each scheme undertaking and a specified cell, means an amount calculated in accordance with the formula

CEBA × MP(Cell) × MU(Cell) × UIP

Except where CCV is less than 20 for that cell, in which case, CSBAGHS shall be calculated in accordance with the formula

MEBA(Cell) × MP(Cell) × MU(Cell) × UIP

“undertaking standardised benefits - age, gender and health status basis — first calculation” and “USBAGHSI” with respect to a specific period and each scheme undertaking means the sum for all cells of

CSBAGHS

“undertaking standardised benefits - age, gender and health status basis — second calculation” and “USBAGHS2” with respect to a specific period and each scheme undertaking means a value determined in accordance with the formula

USBAGHS1 ×

UEAR

______

MEAR

“market standardised benefits - age, gender and health status basis” and “MSBAGHS” with respect to a specific period means the sum, for all scheme undertakings, of

USBAGHS2

“undertaking standardised benefits - age, gender and health status basis” and “USBAGHS” with respect to a specific period and each scheme undertaking means an amount determined in accordance with the formula

USBAGHS2 ×

MEB(Total)

___________

MSBAGHS

“undertaking equalisation adjustment — age, gender and health status basis” and “UEAAGHS” ” with respect to a specific period and each scheme undertaking shall be determined in accordance with the formula

USBAGHS − UEB

8. Age and Gender (AG) Calculations shall be determined in accordance with the following provisions

“cell standardised benefits — age and gender basis” and “CSBAG” with respect to a specific period, each scheme undertaking and a specified cell means an amount calculated in accordance with the formula

CEB

____

CIP

× UIP × MP(Cell)

Except where CEB is less than €5,000, or if CIP is less than 20, in which case CSBAG shall be calculated in accordance with the following formula

MEB(Cell)

_________

MIP(Cell)

× UIP × MP(Cell)

“undertaking standardised benefits — age and gender basis — first calculation” and “USBAG1” with respect to a specific period and each scheme undertaking means the sum for all cells of

CSBAG

“undertaking standardised benefits — age and gender basis — second calculation” and “USBAG2” with respect to a specific period and each scheme undertaking means a value determined in accordance with the formula

USBAG1 ×

UEAR

______

MEAR

“market standardised benefits — age and gender basis” and “MSBAG” with respect to a specific period means the sum, for all scheme undertakings, of

USBAG2

“undertaking standardised benefits — age and gender basis” and “USBAG” with respect to a specific period and each scheme undertaking means an amount determined in accordance with the formula

USBAG2 ×

MEB(Total)

__________

MSBAG

“undertaking equalisation adjustment — age and gender” and “UEAAG” with respect to a specific period and each scheme undertaking means an amount determined in accordance with the formula

USBAG − UEB

9. Determination of Market Equalisation Percentage and Equalisation Contributions shall be in accordance with the following provisions

“undertaking equalisation adjustment” and “UEA” with respect to a specific period and each scheme undertaking means an amount determined in accordance with the following formula

HSW × UEAAGHS + (100% − HSW) × UEAAG

“undertaking phased positive equalisation adjustment” and “UPPEA” with respect to a specific period and each scheme undertaking means for all scheme undertakings in respect of which the determined UEA is greater than zero an amount determined in accordance with the following formula

UEA × P

where P is a value determined in accordance with the following table

Total number of periods from the risk equalisation commencement day up to the current period inclusive

Value

Not more than 2

0.5

3 or more

1.00

provided that in the case of a scheme undertaking which had satisfied the conditions specified in subsection (1) of section 12B of the Act, a value for P determined in accordance with the following table should be substituted for the above, if lower,

Total number of periods (including part periods from the commencement day of that undertaking up to the current period inclusive

Value

6 or less

0

7

T/365

8

0.5

9 or more

1.00

where “T” is the number of days from, and including, the day that undertaking first becomes a scheme undertaking to the end of the period in which it acquired that status.

“market positive equalisation adjustments” and “MPEA” (with respect to a specific period) means the sum, for all scheme undertakings in respect of which the determined UEA is greater than zero of

UEA

“market positive phased equalisation adjustments” and “MPPEA” (with respect to a specific period) means the sum, for all scheme undertakings in respect of which the determined UEA is greater than zero of

UPPEA

“undertaking phased negative equalisation adjustment” and “UPNEA” (with respect to a specific period and each scheme undertaking) means, for all scheme undertakings in respect of which the determined UEA is less than or equal to zero an amount determined in accordance with the following formula

UEA ×

MPPEA

_______

MPEA

“equalisation contribution” (with respect to a specific period and each scheme undertaking) means

(a) UPPEA for all scheme undertakings in respect of which the determined UEA is greater than zero and/or

(b) UPNEA for all scheme undertakings in respect of which the determined UEA is less than or equal to zero

“market equalisation percentage” with respect to a specific period shall be a percentage determined in accordance with the following formula

MPEA × 100

___________

MEB (Total)

THIRD SCHEDULE

Form No. 1

Return to the Health Insurance Authority, pursuant to Article 9 of the Risk Equalisation Scheme, 2003.

Return for the Period Ending..............................

PART 1 OF RETURN

Data for First Quarter of Period

Gender: Female

Returning undertaking:.................................

Cell

Number of insured persons on first day of that quarter

Cell equalised benefits for that quarter (€000s)

Cell claim value for that quarter

Age 17 and under

Age 18 to age 29

Age 30 to age 39

Age 40 to age 49

Age 50 to age 59

Age 60 to age 69

Age 70 to age 79

Age 80 and over

All cells for that gender combined

Data for First Quarter of Period

Gender: Male

Returning undertaking: .................................

Cell

Number of insured persons on first day of that quarter

Cell equalised benefits for that quarter (€000s)

Cell claim value for that quarter

Age 17 and under

Age 18 to age 29

Age 30 to age 39

Age 40 to age 49

Age 50 to age 59

Age 60 to age 69

Age 70 to age 79

Age 80 and over

All cells for that gender combined

All cells for both genders combined

PART 2 OF RETURN

Data for Second Quarter of Period

Gender: Female

Returning undertaking: .................................

Cell

Number of insured persons on first day of that quarter

Cell equalised benefits for that quarter (€000s)

Cell claim value for that quarter

Age 17 and under

Age 18 to age 29

Age 30 to age 39

Age 40 to age 49

Age 50 to age 59

Age 60 to age 69

Age 70 to Age 79

Age 80 and over

All cells for that gender combined

Data for Second Quarter of Period

Gender: Male

Returning undertaking: .................................

Cell

Number of insured persons on first day of that quarter

Cell equalised benefits for that quarter (€000s)

Cell claim value for that quarter

Age 17 and under

Age 18 to age 29

Age 30 to age 39

Age 40 to age 49

Age 50 to age 59

Age 60 to age 69

Age 70 to age 79

Age 80 and over

All cells for that gender combined

All cells for both genders combined

Return for the Period Ending ................................. as confirmed by

Name: ___________________________

Name: ___________________________

*

Position: _________________________

Position: __________________________

Signature: _________________________

Signature: _________________________

Date: __________________

Date: __________________

Given under my Official Seal,

this 26

th

day of June, 2003.

Micheál Martin

Minister for Health and Children

EXPLANATORY NOTE

(This note is not part of the Instrument and does not purport to be a legal interpretation).

This scheme provides for the operation of risk equalisation arrangements between health insurance undertakings. It provides for them to make statistical returns relating to risk equalisation and includes arrangements for the exemption, of a permanent or limited nature, of undertakings from the operation of the scheme. It sets out details for the operation of the scheme, including the role of The Health Insurance Authority in relation to any commencement of risk equalisation and the calculation of any transfers arising. It also provides for the establishment and maintenance of a risk equalisation fund by the Authority.

*

One of the signatories to be the Managing Director, Chief Executive Officer, Company Secretary, Board Member, Trustee, or a person of similar status.

10. (1) In this part of the Scheme a reference to

“health insurance consumer” shall be construed in accordance with section 12(10)(a)(i) of the Act;

“insured risks among registered undertakings” shall be construed in accordance with section 12(10)(a)(ii) of the Act;

“the best overall interests of health insurance consumers” shall be construed in accordance with section 12(10)(a)(iii) of the Act.

(2) The Authority shall evaluate and analyse each return made to it, and all such returns collectively, for the purpose of ascertaining the differences, if any, in the nature and distribution of insured risks among scheme undertakings. From that evaluation and analysis, the Authority shall, for the particular period under consideration, determine, in accordance with the Second Schedule, the market equalisation percentage.

(3) The Authority shall prepare and furnish a written report to the Minister giving details of the evaluation and analysis carried out. The report shall specify the market equalisation percentage determined and the health status weight adopted for the purpose of such determination and may contain such other information and advice concerning the carrying on of health insurance business, and developments in relation to health insurance generally, as the Authority considers ought to be included as a result of the evaluation and analysis.

(4) The report shall include a recommendation to the Minister, where, as a result of its evaluation and analysis, the Authority determines the nature and distribution of risks among scheme undertakings, as expressed in the scheme by the market equalisation percentage, to be not less than 2%, and not more than 10%. In any such recommendation, the Authority shall inform the Minister whether he/she ought or ought not, as it considers appropriate having had regard to the best overall interests of health insurance consumers, to exercise his/her powers under Article 13. The Authority's report shall contain the reasons for the recommendation provided. The Authority shall not be required to include a recommendation in any report submitted after the Minister has exercised the said powers.

(5) Where, pursuant to sub-article (4), the Authority is required to include in a report to the Minister a recommendation that he/she ought or ought not, as it considers appropriate, to exercise the aforementioned powers, the Authority shall not finally decide what the nature of the said recommendation shall be until the conditions specified in subsection 12(5) of the Act have been fulfilled by it.

(6) Where, on foot of a recommendation from the Authority that he/she ought to exercise the aforementioned powers, the Minister, following consideration of the Authority's report, proposes to make such a determination, he/she shall not finally decide to do so until the conditions specified in subsection (12)(6) of the Act have been fulfilled by him/her.

(7) Where, as a result of its evaluation and analysis, the Authority in its report advises that the nature and distribution of risks, among scheme undertakings, as expressed in the scheme by the market equalisation percentage, has been calculated to be more than 10%, the Minister shall make a determination to exercise the aforementioned powers, unless it appears to him/her having consulted the Authority in relation to the overall best interests of health insurance consumers that there are good reasons for not doing so. The Minister shall not finally decide whether to make the said determination until the conditions specified in subsection 12 (6) of the Act have been fulfilled by him/her.

(8) Any scheme undertaking which has made a return shall, on being requested to do so by the Authority, furnish to the Authority such information or documents in its possession or capable of being procured by it and forming the basis of that return as may be specified in the said request. The undertaking concerned shall comply with such a request not later than 7 days from the date the request is made.

(9) Any registered undertaking which has made representations, under subsection 12(5) of the Act to the Authority or, under subsection 12(6) of the Act to the Minister, shall on being requested to do so by the Authority, or the Minister, as the case may be, furnish to the Authority or the Minister such information or documents in its possession or capable of being procured by it and forming the basis of those representations as may be specified in the said request. The undertaking concerned shall comply with such a request not later than 7 days from the date the request is made.

(10) A report made by the Authority in accordance with sub-article (3) and involving a recommendation of the kind provided for under sub-article (4) shall reach the Minister not later than 120 days from the end of the period to which it relates. The Minister shall make a determination under this Article in respect of such a report not later than 60 days from the date of receipt of the said report and recommendation from the Authority.

(11) A report made by the Authority in accordance with sub-article (3) and involving advice of the kind provided for under sub-article (7) shall reach the Minister not later than 90 days from the end of the period to which it relates. The Minister shall make a determination under this Article in respect of such a report not later than 90 days from the date of receipt of the said report and advice from the Authority.

(12) The Authority may, if it thinks fit, release a report prepared by it under sub-article (3) to registered undertakings, subject to any release not being effected earlier than 14 days from the date on which the said report was received by the Minister.

PART V

DETERMINATION OF PAYMENTS

11. (1) In this part of the Scheme a reference to

“corrected former equalisation contribution” has the meaning assigned to it in sub-article (4);

“current period” has the meaning assigned to it in sub-article (3);

“first period” has the meaning assigned to it in sub-article (2);

“former equalisation contribution” has the meaning assigned to it in sub-article (5);

“former incorrect equalisation contribution” has the meaning assigned to it in sub-article (4);

“prior period adjustment” has the meaning assigned to it in sub-article (7);

“revised equalisation contribution” has the meaning assigned to it in sub-article (5).

(2) Calculations to determine payments under paragraph (a) of sub-section (4) of section 12 of the Act, shall be carried out by, or on behalf of the Authority, in respect of each period commencing with the period (referred to in this Article as the “first period”) beginning on the risk equalisation commencement day.

(3) Following receipt of a return as specified under Article 9 from all returning undertakings, the Authority shall determine as part of its evaluation and analysis an equalisation contribution for each scheme undertaking for the period concerned (referred to in this Article as the “current period”), in accordance with the Second Schedule.

(4) The Authority shall determine in accordance with the Second Schedule for each scheme undertaking, for each previous period in respect of which a material calculation error has occurred and has not previously been corrected

(a) the equalisation contribution for that period, based on the returns or the most recent previous data adjustments received and before making any adjustment for that calculation error, increased by the addition of interest at a compound annual rate equal to the prevailing European Central Bank marginal lending facility rate during the term between the last day of that period and the last day of the current period (referred to in this Article as the “former incorrect equalisation contribution”), and

(b) the equalisation contribution for that period, based on the information specified in paragraph (a) of this sub-article, but after making any adjustment for that calculation error, increased by the addition of interest at a compound annual rate equal to the prevailing European Central Bank marginal lending rate during the term between the last day of that period and the last day of the current period (referred to in this Article as the “corrected former equalisation contribution”),

provided that no such determination shall be made for any period before the first period.

(5) The Authority shall determine in accordance with the Second Schedule for each scheme undertaking, for each previous period in respect of which a new data adjustment has been submitted

(a) the equalisation contribution for that period, based on the returns or the most recent previous data adjustments received and after making any adjustment for a calculation error for that period in accordance with sub-article (4)(b), increased by the addition of interest at a compound annual rate equal to the prevailing European Central Bank marginal lending facility rate plus 5 percentage points during the term between the last day of that period and the last day of the current period (referred to in this Article as the “former equalisation contribution”), and

(b) the equalisation contribution for that period, based on the information specified in paragraph (a) of this sub-article, but incorporating any newly submitted data adjustment increased by the addition of interest at a compound annual rate equal to the prevailing European Central Bank marginal lending rate plus 5 percentage points during the term between the last day of that period and the last day of the current period (referred to in this Article as the “revised equalisation contribution”),

provided that no such determination shall be made for any period before the first period.

(6) The Authority shall have the power, in making a determination under this Article, to disregard

(i) any data adjustment or calculation error, where it considers the amount involved would not be material in the context of the overall payments to or from the risk equalisation fund, or

(ii) any data adjustment, where it considers that a material lapse in time has occurred between the period or periods to which such adjustment may relate and the date on which the Authority becomes aware of same.

(7) The prior period adjustment for the current period for each scheme undertaking shall be the sum for each period in respect of which a new determination has been made under sub-articles (4) and (5) of values determined in accordance with the formula

A − B + C − D

where

A is the corrected former equalisation contribution,

B is the former incorrect equalisation contribution,

C is the revised equalisation contribution, and

D is the former equalisation contribution.

(8) The contribution for the current period for each scheme undertaking shall be the sum of

(a) that undertaking's equalisation contribution for the current period and

(b) that undertaking's prior period adjustments, if any.

(9) If the contribution for a scheme undertaking is greater than zero then that amount shall be the payment by that undertaking to the Authority under paragraph (a)(i of subsection (4) of section 12 of the Act. The Authority shall notify that undertaking accordingly, at the earliest practicable date, and the payment shall be made within 30 days of the date of such notification.

(10) Where a scheme undertaking fails to pay the amount due to the Authority in accordance with a notification under sub-article (9), that amount (or such part of that amount which from time to time remains unpaid) shall be increased by the addition of interest at a compound annual rate of the prevailing European Central Bank marginal lending rate plus 5 percentage points from the day upon which that amount first became payable until the day on which it is paid.

(11) If the contribution for a scheme undertaking is less than or equal to zero then the amount, if any, by which such contribution is less than zero shall be the payment to be made to that undertaking from the risk equalisation fund as determined by the Authority under paragraph (a)(ii) of subsection (4) of section 12 of the Act. The Authority shall notify that undertaking accordingly. Subject to sub-articles (12) and (13), any payment under this sub-article shall be issued by the Authority within 14 days of the date of receipt of payment in accordance with sub-article (9).

(12) In the circumstances specified in sub-article (10), the Authority may revise the amount and / or timing of the payment or payments determined under sub-article (11). The Authority shall, as soon as possible, notify scheme undertakings due to receive payments pursuant to sub-article (10) of any revisions made by it pursuant to this sub-article.

(13) In all circumstances, no liability or obligation shall attach to the Authority in relation to any disbursements pursuant to sub-article (11), unless an amount, or amounts, at least equal to the total of any such disbursements has been received by the Authority pursuant to sub-article (9).

(14) If the Authority becomes aware that a calculation error has occurred and it considers that the impact of the calculation error has had a material effect on payments to or from the risk equalisation fund it shall immediately notify the scheme undertakings and the Minister and, within 7 days of that notification, issue those parties with a report setting out the financial implications of the error, the arrangements decided by it to address those implications, the reasons the error occurred and the steps which have been taken to prevent a recurrence.

PART VI

ESTABLISHMENT AND OPERATION OF RISK EQUALISATION FUND

12. (1) Subject to Article 13, the Authority shall cause to be established and maintained a fund, which shall be known as the risk equalisation fund.

(2) (a) The risk equalisation fund shall be a bank account or bank accounts which shall be managed, maintained and controlled by the Authority.

(b) (i) Payments to be made to the Authority, under paragraph (a)(i) of subsection (4) of section 12 of the Act, shall be paid into the risk equalisation fund.

(ii) Payments to be made by the Authority, under paragraph (a)(ii) of subsection (4) of section 12 of the Act, shall be paid out of the risk equalisation fund.

(iii) Any interest accruing on moneys held in the fund shall be paid out in direct proportion to any payments which fall to be made from the fund pursuant to sub-article (ii).

(3) Payments made pursuant to sub-article (b)(i) are received by the Authority in trust for scheme undertakings due payments in accordance with the provisions of this Scheme. Such payments shall be administered and/or paid by the Authority to scheme undertakings in accordance with the provisions of this Scheme.

(4) The Authority shall arrange for the accounts of the risk equalisation fund to be audited by the Comptroller and Auditor General. A copy of these accounts and the report of the Comptroller and Auditor General thereon shall be furnished by the Authority to the Minister not later than 30 days following the receipt by the Authority of the said report.

PART VII

COMMENCEMENT OF RISK EQUALISATION PAYMENTS

13. (1) Articles 11 and 12 shall come into operation with effect from the day (to be known for the purposes of this Scheme as “the risk equalisation commencement day”) determined by the Minister and notified in writing to the Authority and all registered undertakings, other than those to which a scheme does not apply pursuant to Article 4, provided that the day so determined by the Minister shall not precede the date of such determination.

(2) The exercise by the Minister of his/her powers under this Article shall be subject to the provisions of sub-articles (6) and (7) of Article 10.

PART VIII

SPECIFICATION OF PENAL REGULATIONS

14. Sub-articles (1), (3), (5), (6), (7), and (8) of Article 9 and sub-article (8) of Article 10 of the Scheme are hereby declared to be penal regulations for the purposes of subsection 1(b) of section 4 of the Act.

FIRST SCHEDULE

Maximum Equalised Payments in Respect of Settled Claims Relating to Prescribed Health Services

I, Micheál Martin, Minister for Health and Children, in exercise of the powers conferred on me by

sections 3

and

12

of the

Health Insurance Act, 1994

(No. 16 of 1994) as amended and substituted by

sections 9

,

10

and

13

of the

Health Insurance (Amendment) Act, 2001

(No. 17 of 2001) and

section 5

of the

Health Insurance (Amendment) Act, 2003

(No. 11 of 2003) hereby make and prescribe the following Scheme-

PART I

GENERAL