IE
(LRC Revised)
Statutory Text (1 Articles)
Number 16 of 1994
HEALTH INSURANCE ACT 1994
REVISED
Updated to 1 April 2026
Changes to legislation
as of 10 July 2026, this Act is up to date with all changes known to be in force.
This Revised Act is an administrative
consolidation of the
Health Insurance Act 1994
. It is prepared by the Law Reform
Commission in accordance with its function under the
Law Reform Commission Act
1975
(3/1975) to keep the law under review and to undertake revision and
consolidation of statute law.
All Acts up to and including the
Mental Health Act 2026
(11/2026), enacted 7 May 2026, and all statutory instruments up to and including
the
Health Insurance Act 1994 (Section 11E(2)) (Amendment) Regulations 2026
(S.I. No. 216 of 2026), made 22 May 2026, were considered in the preparation of this
Revised Act.
Disclaimer: While every care has been
taken in the preparation of this Revised Act, the Law Reform Commission can assume
no
responsibility for and give no guarantees, undertakings or warranties concerning the
accuracy, completeness or up to date nature of the information provided and does not
accept any liability whatsoever arising from any errors or omissions. Please notify
any
errors, omissions and comments by email to revisedacts@lawreform.ie.
Number
16
of
1994
HEALTH INSURANCE ACT 1994
REVISED
Updated to 1 April 2026
ARRANGEMENT OF SECTIONS
PART I
Preliminary and General
Section
1.
Short title and commencement.
1A.
Principal
objective of Minister and Authority in performing respective functions
under Act.
2.
Interpretation.
2A.
Certain
arrangements by employers to constitute health insurance
contracts.
3.
Regulations.
4.
Offences.
5.
Repeals.
6.
Expenses.
PART II
Health Insurance Contracts
6A.
Interpretation of Part II.
6B.
Duration of
entrustment act.
7.
Prohibition of non-community rated health insurance contracts.
7A.
Premiums
which may be charged under health insurance contracts in certain
circumstances.
7AB.
Submission
of new type of health insurance contract and furnishing of certain other
types of health insurance contract to Authority.
7AC.
Register of
Health Insurance Contracts.
7B.
Provision of
information.
7C.
Registered
insurers shall make all reasonable efforts to obtain certain information
in respect of insured persons, etc.
7D.
Obligation to
make information returns to Authority.
7E.
Evaluation
and analysis of information returns, etc.
7F.
Overcompensated undertaking required to make payment to Exchequer if it
has made more than reasonable profit.
7G.
Disclosure of
contents of information returns.
7H.
Registered
undertaking to provide certain premium information to policy holders or
certain other persons.
8.
Obligation to provide health insurance.
9.
Prohibition of termination of, or refusal to renew, health insurance contracts.
10.
Minimum level of health insurance cover.
11.
Prohibition of inducements by registered undertakings.
11A.
Risk
Equalisation Scheme.
11B.
Application
of Risk Equalisation Scheme.
11C.
Payment from
Fund of risk equalisation credits.
11D.
Risk
Equalisation Fund.
11E.
Specification by Authority of certain health insurance contracts as not
providing for advanced cover.
11F.
Scheme
regulations.
11G.
Power to
specify form of documents for purposes of Risk Equalisation
Scheme.
12.
Risk
equalisation schemes.
(Repealed)
12A.
Risk
equalisation schemes - further provisions.
(Repealed)
12B.
Limited
exemption from requirement to make returns and otherwise comply with risk
equalisation scheme.
(Repealed)
13.
Advertising and promotion of health insurance business.
PART III
Registration of Health Insurance Undertakings
14.
The Register.
15.
Removal from Register.
16.
Prohibition on carrying on of health insurance business by persons other than registered
undertakings.
17.
Levy on registered undertakings.
18.
Records.
PART IIIA
Enforcement Notices
18A.
Interpretation of Part IIIA.
18B.
Issue of
enforcement notices.
18C.
Application
for cancellation of direction specified in enforcement notice.
18D.
Rules of
Court.
PART IIIB
Appointment and Powers of Authorised Officers
18E.
Authorised
officers of Authority.
18F.
Powers of
authorised officers.
18G.
Privileged
legal material.
PART IV
The Health Insurance Authority
19.
Establishment day.
20.
Establishment of Authority.
21.
Functions of Authority.
22.
Conferral of additional functions on Authority.
23.
Consultants and advisers.
24.
Power to borrow.
25.
Gifts.
26.
The Registrar.
27.
Staff of Authority.
28.
Superannuation of staff of Authority.
29.
Membership of either House of the Oireachtas or of European Parliament.
30.
Advances by Minister to Authority.
31.
Disclosure by member of Authority of interest in proposed contract.
32.
Accounts and audits of Authority.
33.
Reports and information to Minister.
33A.
Annual
report with respect to the operation of a scheme.
(Repealed)
33B.
Equality of
treatment of undertakings.
34.
Disclosure of information.
35.
Liability of
Authority for acts, omissions etc.
SCHEDULE 1
The Health Insurance Authority
SCHEDULE 2
European Union Framework for State Aid in the Form
of Public Service Compensation (2011) (2012/C8/03)
SCHEDULE 3
Amount Specified for Purposes of Definition of
"Hospital Bed Utilisation Credit"
SCHEDULE 4
Amount of Premium to be paid from Fund in Respect of Certain Classes
of Insured Person Based on Age and Sex of Insured Persons and their Type of Insurance
Cover on Date Contract is Effected
SCHEDULE 5
Amount And Percentage Specified For Purposes Of Definitions Relating
To High Cost Claims
44
Number
16
of
1994
HEALTH INSURANCE ACT 1994
REVISED
Updated to 1 April 2026
AN ACT TO REGULATE FURTHER, IN THE INTERESTS OF THE COMMON GOOD, THE PROVISION OF
VOLUNTARY HEALTH INSURANCE SO AS TO PROVIDE,
INTER ALIA
, FOR THE ESTABLISHMENT OF THE HEALTH INSURANCE AUTHORITY, FOR THE ESTABLISHMENT OF
SCHEMES FOR THE EQUALISATION OF RISKS BETWEEN HEALTH BENEFITS UNDERTAKINGS, FOR A
MINIMUM RANGE OF COVER UNDER SUCH INSURANCE, FOR UNIFORMITY OF THE PREMIUMS CHARGED
BY EACH PARTICULAR SUCH UNDERTAKING IN RESPECT OF SPECIFIED RANGES OF SUCH COVER AND
FOR THE ESTABLISHMENT OF A REGISTER OF SUCH UNDERTAKINGS AND TO PROVIDE FOR RELATED
MATTERS. [30
th June
, 1994]
BE IT ENACTED BY THE OIREACHTAS AS FOLLOWS
Section
1.
Short title and commencement.
1A.
Principal
objective of Minister and Authority in performing respective functions
under Act.
2.
Interpretation.
2A.
Certain
arrangements by employers to constitute health insurance
contracts.
3.
Regulations.
4.
Offences.
5.
Repeals.
6.
Expenses.
PART II
Health Insurance Contracts
6A.
Interpretation of Part II.
6B.
Duration of
entrustment act.
7.
Prohibition of non-community rated health insurance contracts.
7A.
Premiums
which may be charged under health insurance contracts in certain
circumstances.
7AB.
Submission
of new type of health insurance contract and furnishing of certain other
types of health insurance contract to Authority.
7AC.
Register of
Health Insurance Contracts.
7B.
Provision of
information.
7C.
Registered
insurers shall make all reasonable efforts to obtain certain information
in respect of insured persons, etc.
7D.
Obligation to
make information returns to Authority.
7E.
Evaluation
and analysis of information returns, etc.
7F.
Overcompensated undertaking required to make payment to Exchequer if it
has made more than reasonable profit.
7G.
Disclosure of
contents of information returns.
7H.
Registered
undertaking to provide certain premium information to policy holders or
certain other persons.
8.
Obligation to provide health insurance.
9.
Prohibition of termination of, or refusal to renew, health insurance contracts.
10.
Minimum level of health insurance cover.
11.
Prohibition of inducements by registered undertakings.
11A.
Risk
Equalisation Scheme.
11B.
Application
of Risk Equalisation Scheme.
11C.
Payment from
Fund of risk equalisation credits.
11D.
Risk
Equalisation Fund.
11E.
Specification by Authority of certain health insurance contracts as not
providing for advanced cover.
11F.
Scheme
regulations.
11G.
Power to
specify form of documents for purposes of Risk Equalisation
Scheme.
12.
Risk
equalisation schemes.
(Repealed)
12A.
Risk
equalisation schemes - further provisions.
(Repealed)
12B.
Limited
exemption from requirement to make returns and otherwise comply with risk
equalisation scheme.
(Repealed)
13.
Advertising and promotion of health insurance business.
PART III
Registration of Health Insurance Undertakings
14.
The Register.
15.
Removal from Register.
16.
Prohibition on carrying on of health insurance business by persons other than registered
undertakings.
17.
Levy on registered undertakings.
18.
Records.
PART IIIA
Enforcement Notices
18A.
Interpretation of Part IIIA.
18B.
Issue of
enforcement notices.
18C.
Application
for cancellation of direction specified in enforcement notice.
18D.
Rules of
Court.
PART IIIB
Appointment and Powers of Authorised Officers
18E.
Authorised
officers of Authority.
18F.
Powers of
authorised officers.
18G.
Privileged
legal material.
PART IV
The Health Insurance Authority
19.
Establishment day.
20.
Establishment of Authority.
21.
Functions of Authority.
22.
Conferral of additional functions on Authority.
23.
Consultants and advisers.
24.
Power to borrow.
25.
Gifts.
26.
The Registrar.
27.
Staff of Authority.
28.
Superannuation of staff of Authority.
29.
Membership of either House of the Oireachtas or of European Parliament.
30.
Advances by Minister to Authority.
31.
Disclosure by member of Authority of interest in proposed contract.
32.
Accounts and audits of Authority.
33.
Reports and information to Minister.
33A.
Annual
report with respect to the operation of a scheme.
(Repealed)
33B.
Equality of
treatment of undertakings.
34.
Disclosure of information.
35.
Liability of
Authority for acts, omissions etc.
SCHEDULE 1
The Health Insurance Authority
SCHEDULE 2
European Union Framework for State Aid in the Form
of Public Service Compensation (2011) (2012/C8/03)
SCHEDULE 3
Amount Specified for Purposes of Definition of
"Hospital Bed Utilisation Credit"
SCHEDULE 4
Amount of Premium to be paid from Fund in Respect of Certain Classes
of Insured Person Based on Age and Sex of Insured Persons and their Type of Insurance
Cover on Date Contract is Effected
SCHEDULE 5
Amount And Percentage Specified For Purposes Of Definitions Relating
To High Cost Claims
Number
16
of
1994