health insurance (miscellaneous) amendment bill 2015

A BILL

entitled

HEALTH INSURANCE (MISCELLANEOUS) AMENDMENT ACT 2015

TABLE OF CONTENTS

CitationAmends section 2 of Health Insurance Act 1970Amends section 3A of Health Insurance Act 1970Amends section 26 of Health Insurance Act 1970Amends Health Insurance (Standard Hospital Benefit) Regulations 1971Amends Health Insurance (Mutual Re-Insurance Fund) (Prescribed Sum) Order2014Amends Health Insurance (Artificial Limbs and Appliances) Regulations 1971Amends Health Insurance (Approved Scheme) Regulations 1971General amendment of ActsGeneral amendment of statutory instruments

WHEREAS it is expedient to amend the Health Insurance Act 1970 and variousstatutory instruments made pursuant to that Act, and to make general amendments toeffect the renaming of the “standard hospital benefit” as the “standard health benefit”;

Be it enacted by The Queen’s Most Excellent Majesty, by and with the advice andconsent of the Senate and the House of Assembly of Bermuda, and by the authority of thesame, as follows:

CitationThis Act may be cited as the Health Insurance (Miscellaneous) Amendment Act

2015.

Amends section 2 of Health Insurance Act 1970Section 2 of the Health Insurance Act 1970 is amended—

in the heading, by deleting “hospital treatment of”;

in subsection (1)—

by after “paid to the Board” inserting “(and to an approved health careprovider)”; and

123456

78910

1

2

(a)

(b)

(i)

1

AS TABLED IN THE HOUSE OF ASSEMBLY


in paragraphs (a), (b) and (bb) by, in each case, after “general hospital”inserting “or from an approved health care provider (as the case maybe)”;

in paragraph (c)(ii), by deleting “hospital treatment received by thatperson as may be agreed between the Minister and the Board” andsubstituting “hospital treatment (or health care provided by anapproved health care provider) received by that person as may beagreed between the Minister and the Board or, in respect of an approvedhealth care provider, the Committee”;

in subsection (3), by after “hospital treatment”, both times it appears,inserting “(or health care provided by an approved health care provider)”;

in subsection (5), by after “paid” inserting “to the Board”; and

by inserting after subsection (6)—

In this section, “approved health care provider” means—

a residential care home or nursing home within the meaning of theResidential Care Homes and Nursing Homes Act 1999;

a person providing hospice care; or

a person providing post-acute care at the patient’s, or a caregiver’s,home,

that is approved in writing by the Committee and qualifies under subsection (8) forpayment of the subsidy referred in subsection (1).

To qualify for the payment of subsidy, the health care provider mustprovide such health care as is approved by the Committee, to a person, and at suchfees, as are approved by the Committee.”.

“(7)

(a)

(b)

(c)

(8)

Amends section 3A of Health Insurance Act 1970Section 3A of the Health Insurance Act 1970 is amended—

in subsection (2A)—

in paragraph (b), by deleting “or”; and

in paragraph (c), by deleting the comma and substituting “; or”; and

by inserting after paragraph (c)—

the Board,”; and“(d)

by inserting after subsection (2B)—

The Committee may—“(2C)

(ii)

(iii)

(c)

(d)

(e)

3

(a)

(i)

(ii)

(iii)

(b)

2


establish and supervise a primary care programme for thetreatment of chronic, noncommunicable diseases; and

determine the programme’s eligibility criteria and benefits,

and there shall be paid out of the Mutual Re-Insurance Fund claims, approved bythe Committee, in respect of the programme.”.

(a)

(b)

Amends section 26 of Health Insurance Act 1970Section 26 of the Health Insurance Act 1970 is amended—

in subsection (1) by deleting “An employer” and substituting “Subject tosubsection (5), an employer”;

in subsection (2)—

by deleting “who proposes” and substituting “with an approved schemewho wishes to continue”;

by, after “approved scheme shall”, inserting “annually, in theprescribed form with the prescribed fee,”;

by deleting “proposed” both times it appears; and

by deleting “give its approval thereto” and substituting “renew itsapproval of the scheme”;

in subsection (3) by deleting “approve any proposed scheme” andsubstituting “renew its approval of a scheme”; and

by inserting after subsection (4)—

After the coming into operation of the Health Insurance(Miscellaneous) Amendment Act 2015, the Council shall not approve any new(proposed) scheme, but may renew its approval of an existing approved scheme.”.

“(5)

Amends Health Insurance (Standard Hospital Benefit) Regulations 1971The Health Insurance (Standard Hospital Benefit) Regulations 1971 are

amended—

in the title and generally throughout the text by deleting “standard hospitalbenefit” and substituting “standard health benefit”;

in regulation 3—

in paragraph (iii), by deleting “necessary for the initial treatment ofaccidental injuries suffered within forty-eight hours preceding the timeof treatment or of acute illness”;

in paragraph (vi), by deleting “Health Insurance”; and

in paragraph (xiv)(bb), by deleting “Health Insurance”;

in regulation 5 by inserting after paragraph (vii)—

4

(a)

(b)

(i)

(ii)

(iii)

(iv)

(c)

(d)

5

(a)

(b)

(i)

(ii)

(iii)

(c)

3


screening mammograms that do not adhere to RecommendationsA or B of the United States Preventive Services Task Force(USPSTF) Guidelines, unless there is a referral from a registeredmedical practitioner;”;

“(viiA)

in regulation 9 by—

deleting “$301.85” and substituting “$338.07”;


deleting “$29.18” and substituting “$63.74”; and


in regulation 10 by—

deleting “$1,207.40” and substituting “$1,352.28”;


deleting “$29.18” and substituting “$63.74”; and


in regulation 11—

in paragraph (1)(a)(i), by deleting “$150.93” and substituting “$169.04”;

in paragraph (1)(a)(ii), by deleting “$34.83” and substituting “$39.01”;

in paragraph (1)(b)(i), by deleting “$603.70” and substituting “$676.14”;and

in paragraph (1)(b)(ii), by deleting “$139.32” and substituting“$156.03”; and

in regulation 12—

in paragraph (1)(a), by deleting “$34.83” and substituting “$39.01”; and

in paragraph (1)(b), by deleting “$139.32” and substituting “$156.03”.

Amends Health Insurance (Mutual Re-Insurance Fund) (Prescribed Sum) Order 2014Paragraph 2 of the Health Insurance (Mutual Re-Insurance Fund) (Prescribed Sum)

Order 2014 is amended—

in paragraph (a), by deleting “$14.00” and substituting “$18.40”;

in paragraph (b), by deleting “and”;

in paragraph (c), by deleting “$0.67 per month.” and substituting “$1.00per month; and”; and

by inserting after paragraph (c)—

to the Board, the sum of $23.64 per month.”.“(d)

(d)

(i)

(ii)

(iii)

(iv)

(e)

(i)

(ii)

(iii)

(iv)

(f)

(i)

(ii)

(iii)

(iv)

(g)

(i)

(ii)

6

(a)

(b)

(c)

(d)

4


Amends Health Insurance (Artificial Limbs and Appliances) Regulations 1971Regulation 3(2) of the Health Insurance (Artificial Limbs and Appliances)

Regulations 1971 is amended by deleting “$15,000” both times it occurs and, each time,substituting “30,000”.

Amends Health Insurance (Approved Scheme) Regulations 1971The Health Insurance (Approved Scheme) Regulations 1971 are amended—

in regulation 2(2), by deleting “approve a proposed” and substituting“renew approval of a”;

in regulation 3, by deleting “grant or” and “proposed”; and

in the Schedule—

in the first line, by deleting “Proposed”;

by deleting paragraph 1 of the Notes; and

in paragraph 2(f) of the Notes, after “surety”, by inserting “, required bysection 26(3) of the Act,”.

General amendment of ActsThe following Acts—

Bermuda Hospitals Board Act 1970;

Government Employees (Health Insurance) Act 1986; and

Health Insurance Act 1970,

are amended generally throughout the text by deleting “standard hospital benefit” or“standard hospital benefits” and, in each case, substituting “standard health benefit”.

General amendment of statutory instrumentsThe following statutory instruments—

Bermuda Hospitals Board (Hospital Fees) Regulations 2014;

Government Employees (Health Insurance) (Benefits) Order 1997;

Government Employees (Health Insurance) (Rates) Order 2001;

Health Insurance (Approved Scheme) Regulations 1971;

Health Insurance (Artificial Limbs and Appliances) Regulations 1971;

Health Insurance (Double Cover) Regulations 1971;

Health Insurance (Exemption) Regulations 1971;

Health Insurance (Licensing of Insurers) Regulations 1971;

Health Insurance (Mental Illness, Alcohol and Drug Abuse) Regulations1973; and

7

8

(a)

(b)

(c)

(i)

(ii)

(iii)

9

(a)

(b)

(c)

10

(a)

(b)

(c)

(d)

(e)

(f)

(g)

(h)

(i)

5


Health Insurance (Plans) Regulations 1987,

are amended generally throughout the text by deleting “standard hospital benefit” andsubstituting “standard health benefit”.

(j)

6

HEALTH INSURANCE (MISCELLANEOUS) AMENDMENT BILL 2015

EXPLANATORY MEMORANDUM

This Bill seeks to amend the Health Insurance Act 1970 and various statutoryinstruments made pursuant to that Act, and to make general amendments to effect therenaming of the “standard hospital benefit” as the “standard health benefit”.

Clause 1 is self-explanatory.

Clause 2 amends section 2 of the Health Insurance Act 1970. Currently, section 2 limitssubsidy coverage to services provided by the Bermuda Hospitals Board. The amendmentsallow subsidy payments also to be made in certain circumstances to health care providersapproved by the Health Insurance Committee. This would allow flexibility for subsidy fundsto be used to pay for services in clinically appropriate, lower cost settings than the generalhospital such as in residential care or nursing homes or in a patient’s home.

Clause 3 amends section 3A of the Health Insurance Act 1970 by inserting a newsubsection (2C). This new subsection allows the Committee to establish and supervise aprimary care programme for the treatment of chronic, noncommunicable diseases, andprovides that claims shall be paid out of the Mutual Re-insurance Fund.

Clause 4 amends section 26 of the Health Insurance Act 1970 to provide that whilstexisting approved schemes may continue to be approved on an annual basis, no newschemes will be approved.

Clause 5 amends the Health Insurance (Standard Hospital Benefit) Regulations 1971to increase the standard premiums and deductions as set out. Regulation 3(iii) is amendedto clarify that outpatient surgery provided at the general hospital is covered by the standardhealth benefit and, in regulation 5, a new exemption is added for screening mammogramsthat do not adhere to Recommendations A and B of the United States Preventive ServicesTask Force Guidelines.

Clause 6 amends the Health Insurance (Mutual Re-Insurance Fund) (Prescribed Sum)Order 2014 to increase payments made out of the Mutual Reinsurance Fund as set out.

Clause 7 amends Health Insurance (Artificial Limbs and Appliances) Regulations 1971to increase the maximum liability for an artificial limb or appliance from $15,000 to$30,000.

Clause 8 amends the Health Insurance (Approved Scheme) Regulations 1971 inconsequence of the amendment of section 26 of the Health Insurance Act 1971 in clause 4.

Clause 9 amends the specified Acts to change all references to “standard hospitalbenefit” to the new terminology “standard health benefit”.

Clause 10 amends the specified statutory instruments to change all references to“standard hospital benefit” to the new terminology “standard health benefit”.

i

health insurance (miscellaneous) amendment bill 2015

Documents