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National Health Insurance Act, 2018

This section gives the Act’s short title and says it starts on a date set by the Minister by statutory instrument. This provision defines key terms used in the Act. This section binds the Republic…

accounting controlsaccreditationaccreditation enforcementadministrationadministrative procedureadministrative reviewannual reportingappealsapplication feeapplicationsappointmentappointmentsauditauthority functionsauthority fundingauthority registrationBanking and financebenefit package changesbenefits administrationbenefits packagebenefits suspensionboard governanceboard meetingsboard procedurebookkeepingcertificate of offenceclaims processingclaims submissioncommencementcommitteescompany officerscomplaints handlingcompliancecompliance inspectionsconfidential informationconfidentialityconflicts of interestcontract executioncontractscontributionscontributions exemptionCompany lawdelegationdisbursementdisclosuredocument authenticationeligibilityemployee registrationexecution on judgmentsfalse claimsfeesfees and chargesfinancial statementsfinancial yearfinesforeignersfund accountsfund administrationfund managementgovernancegrants and donationshealth care accesshealth care compliancehealth care enrolmenthealth care provider accreditationhealth care providershealth care serviceshealth insurancehealth insurance portabilityinformation disclosureinstitutional administrationinstitutional establishmentinsured health care servicesinsured service paymentinvestmentsliabilitylitigationloansmedical recordsmedicationsmeeting governancemember informationmember noticemember registrationmembership cardsmembership registrationmembership updatesminutesminutes recordingmisrepresentationmonitoring mechanismsnational health insuranceoffencesoffice establishmentoffice tenurepatient recordspayment defaultpayment mechanismspayment of awarded sumspayrollpenaltiesperformance reviewprescription drug formularyprosecutionprovider accreditationprovider billingprovider complianceprovider payment systempublic authority oversightquality assurancequorumrecord disclosurerecord inspectionrecord transferregister maintenanceregulatory complianceregulatory decisionsregulatory publicationreplacement feesreportingreporting obligationsresignationscheme administrationseal usesenior appointmentsshort titlevacancy
Jurisdiction
Zambia
Structure
64 provisions
Citation
Act 2 of 2018
Dates
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01

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“This section gives the Act’s short title and says it starts on a date set by the Minister by statutory instrument.”

This section gives the Act’s short title and says it starts on a date set by the Minister by statutory instrument. This provision defines key terms used in the Act. This section binds the Republic to the Act and lets the Minister make rules about services not covered by the Scheme and about which individuals the Act applies to. This section establishes the National Health Insurance Management Authority as a body corporate. The Authority has the function of running the Scheme and related health insurance administration tasks.

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Short title and Commencement

This section gives the Act’s short title and says it starts on a date set by the Minister by statutory instrument.

Section 1

Standard unit cost

The Authority must each year establish and update a uniform national schedule of fees and charges for items and services provided by accredited health care providers.

Section 17

Payment for insured health care services

An accredited health care provider must submit a claim in the prescribed manner and form, and must not bill a member directly for an insured health care service after receiving payment from the Fund. The Authority must process payment c…

Section 33

Annual report

The Authority must submit an annual report to the Minister within 90 days after the financial year ends, and the Minister must arrange for an annual income-and-expenditure statement to be laid before the National Assembly.

Section 48

Functions of Board

Board members, committee members, and Authority staff are protected from proceedings over acts or omissions done in good faith while carrying out powers, functions, or duties under the Act.

Section 7

04

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Showing 64 of 64 provisions

Provision 47Offence 10Commencement 4Short title 2

Part

PART I

§ 1Short title and CommencementShort title

This section gives the Act’s short title and says it starts on a date set by the Minister by statutory instrument.

1. This Act may be cited as the National Health Insurance Act, 2018, and shall come into operation on the date appointed by the Minister by statutory instrument. Short title and Commence- ment
Section 1Verify source
§ 23. Application and power of exemptionInterpretation

This provision defines key terms used in the Act.

2. In this Act, unless the context otherwise requires— Interpretation “ accreditation ” means the process of recognition of a health care provider as one that is allowed to provide insured health care services for the purposes of this Act; “ accredited health care provider ” means a health care provider that is accredited by the Authority under section 28; “ actuarial assessment ” means the periodic valuation of a Scheme, made in accordance with actuarial methods; 66 No. 2 of 2018] National Health Insurance Act No. 7 of 2017 “ admission ” means a procedure where a person is accommodated overnight or for such other prescribed period by a health care provider for the purposes of receiving necessary in-patient services and “ admitted ” and cognate expressions shall be construed accordingly; “ Authority ” means the National Health Insurance Management Authority established under section 4; “ bank ” has the meaning assigned to the word in the Banking and Financial Services Act, 2017; “ benefit ” means a direct insured health care service in the form of treatment or an indirect insured health care service consisting of a reimbursement of the expenses borne by a member and provided by an accredited health care provider and may include authorised tertiary health care services or a cash benefit; “ benefit package ” means the benefits a member is entitled to under the Scheme; “ billing ” means making a claim by an accredited health care provider for insured health care service expenses; “ Board ” means the Board of the Authority constituted under section 6; “ casual employee ” has the meaning assigned to the words Cap. 268 in the Employment Act; Cap. 1 Cap. 1 Act No. 24 of 2009 “ Chairperson ” means the Chairperson of the Board, appointed under section 6; “ child ” has the meaning assigned to the word in the Constitution; “ citizen ” has the meaning assigned to the word in the Constitution; “ committee ” means a committee of the Board constituted under section 8; “ Council ” means the Health Professions Council established under the Health Professions Act, 2009; “ dependant ” means a person, who resides with a member, and relies on the member’s income for survival; “ emergency medical condition ” means the sudden, and at the time unexpected onset of a health condition that requires immediate medical or surgical treatment, where failure to provide medical or surgical treatment would result in serious impairment to bodily functions or serious dysfunction of a body organ or part or would place the person’s life in serious jeopardy; National Health Insurance [No. 2 of 2018 67 “ employee ” has the meaning assigned to the word in the Employment Act; “ employer ” has the meaning assigned to the word in the Employment Act; “ established resident ” has the meaning assigned to the word in the Immigration and Deportation Act, 2010; “ family member ” means a registered child, spouse and dependant of a member; “ Fund ” means the National Health Insurance Fund established under section 41; “ health care expense ” means an amount payable in respect of an insured health care service provided to a member by an accredited health care provider; “ health care provider ” includes an institution or agency that provides health care services; “ health care service ” has the meaning assigned to the word in the Health Professions Act, 2009; “ health insurance number ” means an identification number, assigned to a member by the Authority and stated on a member’s membership card; “ health practitioner ” has the meaning assigned to the words in the Health Professions Act, 2009; “ inpatient service ” means a health care service provided by a patient who is admitted overnight by a health care provider; “ inspector ” means a person appointed as an inspector under section 40; Cap. 268 Cap. 268 Act No. 18 of 2010 Act No. 24 of 2009 Act No. 24 of 2009 “ insured health care service ” means a health care service available under the Scheme; “ medical doctor ” means a health practitioner registered as such under the Health Professions Act, 2009; “ member ” means a member of the Scheme as provided Act No. 24 of 2009 under section 13; “member contribution” means such amount as may be prescribed for purposes of section 15; “membership card” means a card issued to a person registered under the Scheme; “out patient service” means a health care service or procedure provided by a health care provider to a patient who is not admitted by a health care provider; 68 No. 2 of 2018] National Health Insurance “patient” means a member who is receiving or has received treatment from an accredited health care provider; “pension scheme” means a pension scheme established under any other law; “private health insurer” means a company that provides health insurance; “provider payment system” means the manner of payment to a health care provider for delivery of health services to members; “Scheme” means the National Health Insurance Scheme established under section 12; “treatment” means medical, surgical, obstetric or dental treatment or such other medical treatment as may be prescribed; and “Vice-Chairperson means the Vice-Chairperson of the Board elected under section 6. Application and power of exemption
Section 2Verify source
§ 3Application and power of exemptionProvision

This section binds the Republic to the Act and lets the Minister make rules about services not covered by the Scheme and about which individuals the Act applies to.

3. (1) The provisions of this Act shall bind the Republic. (2) The Minister may prescribe health care services that are not covered by the Scheme. Establishment of National Health Insurance Management Authority Functions of Authority (3) The Minister, by statutory instrument, may extend the categories of individuals to whom this Act applies. PART II THE NATIONAL HEALTH INSURANCE MANAGEMENT AUTHORITY
Section 3Verify source

Part

PART II

§ 4Establishment of National Health Insurance ManagementProvision

This section establishes the National Health Insurance Management Authority as a body corporate.

4. (1) There is established the National Health Insurance Management Authority which is a body corporate with perpetual succession and a common seal, capable of suing and being sued in its corporate name and with power, subject to this Act, to do all acts and things that a body corporate may, by law, do or perform. (2) The Schedule applies to the Authority.
Section 4Verify source
§ 5Functions of AuthorityProvision

The Authority has the function of running the Scheme and related health insurance administration tasks.

5. The functions of the Authority are to— (a) implement, operate and manage the Scheme; (b) manage the Fund; (c) accredit health insurance healthcare providers; (d) develop a comprehensive benefit package to be accessed by members; (e) register and issue membership cards to members; (f) facilitate— (i) access by poor and vulnerable people to insured health care services; and (ii) protection of the poor and vulnerable against deprivation of health services; National Health Insurance [No. 2 of 2018 69 (g) receive, process and pay claims for services rendered by accredited health care providers; (h) undertake public education and awareness programmes on health insurance; (i) undertake research in health insurance to inform policy formulation and implementation; (j) advise the Minister on health insurance and health insurance policy formulation; (k) undertake programmes that further the sustainability of the Scheme; (l) develop guidelines, processes and manuals for the effective implementation and management of the Scheme; (m) ensure that an accredited health care provider delivers efficient and quality insured health care services; (n) monitor and ensure compliance with this Act and guidelines, policies, processes and manuals made by the Authority in the performance of its functions under this Act; (o) undertake, in collaboration with relevant regulatory agencies, inspection of health facilities operated by accredited health care providers; (p) receive, investigate and determine complaints by members and accredited health care providers in accordance with section 49; (q) collaborate with corresponding health insurance management authorities in other countries; (r) develop, in consultation with relevant stakeholders, modalities of financing the coverage of indigent people under the Scheme; (s) cause the undertaking of actuarial valuations of the Scheme at prescribed intervals; (t) establish and maintain a register of members and accredited health care providers; and (u) do other things that are connected with, or incidental to, the functions of the Authority under this Act.
Section 5Verify source
§ 6Board of AuthorityOffence

This section sets up the Board, says who appoints or nominates its members, and bars disqualified people from being nominated or appointed.

6. (1) There is constituted a Board of the Authority which consists of the following part-time members appointed by the Minister: (a) a representative each of the— (i) Attorney General; (ii) Health Professions Council of Zambia; (iii) Ministry responsible for social services; Board of Authority 70 No. 2 of 2018] National Health Insurance (iv) Ministry responsible for health; (v) Ministry responsible for finance; (vi) Ministry responsible for labour; (vii) associations for employees in the public sector; (viii) associations for employees in the private sector; (ix) associations for employers in the public sector; (x) associations for employers in the private sector; (xi) associations for religious groupings in Zambia; (xii) Zambia Institute of Chartered Accountants; and (b) two other persons, one of whom has experience in health insurance. (2) The members of the Board referred to in subsection (1) (a) shall be nominated by their respective institutions. (3) The Minister shall appoint the Chairperson from among the members of the Board. (4) The members of the Board shall elect the Vice-Chairperson from among their number. (5) A person shall not be nominated or appointed as a member of the Board if that person— (a) is an undischarged bankrupt; (b) has a mental disability that renders that person incapable of performing the functions of a member of the Board; (c) has been convicted of an offence involving fraud or dishonesty; (d) has been convicted of an offence under any law and sentenced to imprisonment for a period exceeding six months without the option of a fine; or (e) is an employee of the Authority. (6) The Schedule applies to the Board. Functions of Board
Section 6Verify source
§ 7Functions of BoardProvision

The Board must carry out oversight and approval functions for the Authority, including reviewing plans, giving strategic direction, approving budgets and business plans, monitoring performance, and approving certain property acquisitions.

7. Subject to the provisions of this Act, the functions of the Board are to— (a) review the policy and strategic plan of the Authority; (b) provide strategic direction to the Authority, oversee the implementation and successful operation of the policy and functions of the Authority; (c) approve the annual plans and budget of the Authority; (d) monitor and evaluate the performance of the Authority against the plans and budget; (e) approve the acquisition of property, movable and immovable, which may be necessary or expedient for the attainment of the purposes of this Act; and National Health Insurance [No. 2 of 2018 71 (f) approve the business plans of the Authority.
Section 7Verify source
§ 8CommitteesProvision

The Board may create committees, delegate functions to them, appoint members, and committees may set their own procedure, subject to the Board’s directions.

8. (1) The Board may constitute committees that it considers necessary and delegate any of its functions to these committees. Committees (2) The Board may appoint as members of a committee, persons who are, or are not members of the Board, except that at least one member of a committee shall be a member of the Board. (3) A person serving as a member of a committee shall hold office for such period as the Board may determine. (4) Subject to any specific or general direction of the Board, a committee may regulate its own procedure.
Section 8Verify source
§ 9Delegation of functionsProvision
9. The Board may, by direction in writing, and subject to the terms and conditions that it considers necessary, delegate to the Director-General, any of its functions under this Act. Delegation of functions
Section 9Verify source
§ 10Director-General and other staff of AuthorityProvision
10. (1) The Board shall, appoint a Director-General on the terms and conditions that the Emoluments Commission may determine. (2) The Director-General shall be the chief executive officer of the Authority and shall, subject to the control of the Board, be responsible for the day-to-day administration of the Authority. (3) A person shall not be appointed as Director-General unless that person has relevant qualifications or management experience in health economics, health care financing, medical care, health care, insurance or actuarial assessments and evaluations. (4) The Director-General may attend meetings of the Board and of any committee and may address such meetings, but shall have no vote. (5) The Board shall appoint a Board Secretary on the terms and conditions that the Emoluments Commission may determine. (6) The Board may, whenever the Director-General is for any reason unable to discharge the functions of the Director-General’s office, appoint an Acting Director-General to discharge the Director- General’s functions. (7) The Board may appoint, on the terms and conditions that the Emoluments Commission may determine, other staff of the Authority that it considers necessary for the performance of its functions under this Act.
Section 10Verify source
§ 11Provincial and district offices of AuthorityProvision

The Authority must progressively establish and maintain provincial and district offices, with Board approval.

11. The Authority shall, with approval of the Board, progressively establish and maintain provincial and district offices of the Authority. Director- General and other staff of Authority Provincial and district offices of Authority 72 No. 2 of 2018] National Health Insurance PART III NATIONAL HEALTH INSURANCE SCHEME, COVERAGE AND BENEFITS Establishment of National Health Insurance Scheme
Section 11Verify source

Part

PART III

§ 12Establishment of National Health Insurance SchemeProvision

This section establishes the National Health Insurance Scheme and says contributions and authorised payments under the Act go into and out of the Scheme.

12. (1) There is established the National Health Insurance Scheme into which shall be paid all contributions authorised under this Act and out of which shall be met all payments authorised to be paid under this Act. (2) The objective of the Scheme is to provide universal access to quality insured health care services in accordance with this Act. Membership and registration (1) A citizen or established resident who is above eighteen the Scheme in the shall be registered as a member of
Section 12Verify source
§ 13Membership and registrationCommencement

Employers must register employees with the Authority within 30 days of the employment start date, and other listed persons must also be registered under the Scheme.

13. years prescribed manner and form. (2) The Minister may prescribe conditions and procedures under which a person who is not eligible to become a member of the Scheme under the Act may access insured health care services. (3) Subject to subsections (1) and (2), an employer shall register an employee with the Authority within thirty days of the commencement date of the contract of employment in the prescribed manner and form. (4) A manager of a pension scheme shall ensure that a retiree is registered by the Authority in accordance with this Act. (5) A self-employed citizen and established resident shall register as a member of the Scheme in accordance with this Act. (6) The Authority shall, in accordance with subsection (1), register a person as a member of the Scheme and issue a membership card in accordance with section 19. Possession of health insurance by foreigners
Section 13Verify source
§ 14Possession of health insurance by foreignersProvision

Foreigners entering the Republic must have valid health insurance while they stay, and those arriving without it must register and pay for health insurance on arrival.

14. (1) A foreigner who enters the Republic shall have valid health insurance for the period that the foreigner stays in the Republic. (2) A foreigner who enters the Republic without valid health insurance shall register and pay for health insurance with a health insurer on arrival in the Republic, in the prescribed manner and form. Contributions and payment mechanisms
Section 14Verify source
§ 15Contributions and payment mechanismsProvision

Employers, pension scheme managers, and certain self-employed persons must pay prescribed contributions to the Scheme; employers pay monthly, and the Minister prescribes rates and payment mechanisms with the Authority.

15. (1) An employer shall pay to the Scheme an employee’s contribution consisting of the employer’s contribution and the employee’s contribution at a prescribed percentage. (2) The employer shall pay contributions to the Scheme at the end of each month. National Health Insurance [No. 2 of 2018 73 (3) A manager of a pension scheme shall pay to the Scheme a retiree’s contribution, as prescribed. (4) A self-employed citizen or established resident shall pay a contribution to the scheme, as prescribed. (5) The Minister shall, in consultation with the Authority, prescribe rates of contribution for different benefit packages and payment mechanisms available to the member.
Section 15Verify source
§ 16Persons exempt from contributionsProvision

Some citizens or established residents may be exempt from paying Scheme contributions, including certain disabled people, people over 65, and people classified as poor and vulnerable; the Minister may prescribe additional exempt persons.

16. A citizen or established resident that may be exempted from payment of contributions under the Scheme include— (a) a mentally or physically disabled person who is unable to Persons exempt from contributions work; (b) an elderly person above the age of 65; (c) a person classified as poor and vunerable by the Ministry responsible for social welfare; and (e) any other person as may be prescribed by the Minister.
Section 16Verify source
§ 17Standard unit costProvision

The Authority must each year establish and update a uniform national schedule of fees and charges for items and services provided by accredited health care providers.

17. The Authority shall for each year establish and update a uniform national standard schedule of the fees and charges for items and services provided by accredited health care providers. Standard unit cost
Section 17Verify source
§ 18Negotiated fees, charges and payment mechanismsProvision

The Authority must negotiate fees and charges for insured health care services with accredited health care providers.

18. (1) The Authority shall negotiate with accredited health care providers, a schedule of fees and charges for insured health care services that are fair and optimal. Negotiated fees, charges and payment mechanisms (2) In negotiating a schedule of fees and charges, under subsection (1), the Authority shall take into consideration the— (a) need for a uniform national standard of fees and charges; (b) objective of ensuring that accredited health care providers are compensated at a rate which reflects their health practitioner’s expertise and the value of their service, regardless of geographic region and past fees and charges; (c) need to establish a prescription drug formulary system, including medical interventions, which encourages best- practices in prescribing and discourages the use of ineffective, dangerous, or excessively costly medications where better alternatives are available; and (d) need to use generic medications where such are available while allowing the use of brand-names and off-formulary medications as prescribed in the benefit package.
Section 18Verify source
§ 19Scheme membership cardProvision

The Authority must issue a membership card when a member is registered, replace a lost or damaged card for a prescribed fee, and provide information about the member’s benefits, rights, privileges, and accredited health care providers.

19. (1) The Authority shall, on registration of a member, issue a membership card as prescribed. Scheme membership card 74 No. 2 of 2018] National Health Insurance (2) Where a membership card is lost or defaced or otherwise destroyed, the Authority shall replace the membership card on payment of a prescribed fee. (3) The issuance of the membership card shall be accompanied by adequate information on the benefits, rights and privileges of the member, including the list of accredited health care providers. Benefits of member’s contribution
Section 19Verify source
§ 20Benefits of member’s contributionProvision

Members and family members are to access the Scheme’s benefits package as prescribed.

20. (1) A member and a family member shall access the benefits package under the Scheme as prescribed. Death of member (2) Subject to this Act, insured health care services, in whole or in part, shall be provided at national, provincial and district levels, as prescribed.
Section 20Verify source
§ 21Death of memberProvision

Scheme membership ends when a member dies, and a family member is entitled to continued benefits for four months after the death.

21. (1) Membership to the Scheme shall cease on the death of a member. (2) A family member is entitled to continued benefits for a period of four months following the death of the member. (3) The mechanisms for the continuation of benefits of a family member after the period referred to in subsection (2) shall be as prescribed. Suspension of benefits
Section 21Verify source
§ 22Suspension of benefitsProvision

Benefits may be suspended if a contribution is unpaid, and the Authority must suspend a member for false claims, material misrepresentation, or required non-disclosure.

22. (1) The benefits of a member other than a member whose contribution is paid in accordance with section 15 (1), (2) and (3) under the Scheme may be suspended where a contribution in respect of that member is not paid to the Scheme. (2) The Authority shall suspend a member where that member presents a false claim, makes material misrepresentation or fails to disclose factual information required for the purposes of the Act. (3) The period of suspension shall be for a month during which the amount remains unpaid or such longer period. (4) The provisions of this section are without prejudice to any other remedy available to the Authority.
Section 22Verify source
§ 2324. PortabilityProvision

A member must give the Authority updated information when certain membership-related changes happen.

23. (1) A member shall provide to the Authority updated information in case of— (a) an employment status shift resulting from change of employment, termination of employment, or retirement; (b) modification of the family membership resulting from the death of a member, birth of a child, or arrival or departure of a family member; Information on change of membership status National Health Insurance [No. 2 of 2018 75 (c) modification of financial status; (d) geographic relocation; and (e) any other change that impacts membership status. (2) A member shall provide an update under subsection (1), within a month after the change occurs. (3) Despite subsection (2), updated information in case of death shall be provided as soon as practicable but not later than four months.
Section 23Verify source
§ 24PortabilityProvision

A member may access insured health care services from an accredited provider anywhere in the Republic, and the Authority must put in place and enforce procedures so benefits remain portable across work areas.

24. (1) A member may access an insured health care service offered by an accredited health care provider anywhere within the Republic. Portability (2) The Authority shall develop and enforce mechanisms and procedures which shall ensure benefits are portable across the areas of work within the Republic.
Section 24Verify source
§ 25Material modificationsCommencement

The Authority must tell a member about any material change in a benefit package or coverage if the change is not already reflected in the latest summary of benefits or coverage, and must do so at least 60 days before it takes effect.

25. The Authority shall, where there is any material modification in any benefit package or coverage that is not reflected in the most recently provided summary of benefits or coverage, provide notice of that modification to a member, not later than sixty days prior to the date on which the modification is to come into operation. Material modifications PART IV ACCREDITATION OF HEALTH CARE PROVIDERS
Section 25Verify source

Part

PART IV

§ 26Prohibition of provision of insured health care services withoutProvision

A health care provider may not provide Scheme services to a member unless accredited, and the Authority may not pay for services from an unaccredited provider except in an emergency; in that emergency case, payment is required.

26. (1) A health care provider shall not provide a health care service under the Scheme to a member if that health care provider is not accredited in accordance with this Act. (2) TheAuthority shall not pay for an insured health care service provided by a health care provider that is not accredited. Prohibition of provision of insured health care services without accreditation (3) Despite subsection (2), a health care provider that is not accredited in accordance with this Act may provide an insured health care service to a member in case of an emergency where an accredited health care provider is not immediately accessible or under the circumstances of the case it is not practicable to the member to attend before an accredited health care provider. (4) The Authority shall pay for an insured health care service provided under subsection (3) by a health care provider that is not accredited in accordance with this Act. 76 No. 2 of 2018] National Health Insurance Application for accreditation to provide insured health care services Grant or rejection of application for accreditation
Section 26Verify source
§ 27Application for accreditation to provide insured health careProvision

A health care provider seeking to provide an insured health care service to a member must apply to the Authority for accreditation and pay the prescribed fee.

27. (1) A health care provider that wishes to provide an insured health care service to a member shall apply to the Authority for accreditation in the prescribed manner and form on payment of a prescribed fee. (2) The Authority shall, on receipt of an application made under subsection (1), cause to be undertaken an assessment of the application in order to determine whether the applicant meets the requirements for accreditation, as prescribed.
Section 27Verify source
§ 28Grant or rejection of application for accreditationProvision

The Authority must decide an accreditation application within 90 days, grant it if requirements are met, reject it if they are not, and give reasons for any rejection.

28. (1) The Authority shall, within ninety days of receipt of an application for accreditation, under section 27— (a) grant accreditation where the applicant meets the requirements; or (b) reject the application where the applicant does not meet the requirements. (2) The Authority shall, where it rejects an application in accordance with subsection (1) (b), inform the applicant of the reasons for the rejection. (3) Where the Authority does not make a determination or communicate its decision on an application within the period specified in subsection (1),accreditation shall be considered to have been granted. Dispensing with accreditation
Section 28Verify source
§ 29Dispensing with accreditationProvision

Some accredited health care providers must notify the Authority in writing, surrender accreditation, and in some cases transfer members’ medical records after the Authority directs them to do so.

29. (1) An accredited health care provider that is wound up or decides to dispense with accreditation shall within sixty days of such winding up or dispensing with accreditation notify theAuthority, in writing, of the decision and surrender the accreditation. (2) The Authority shall cancel an accreditation surrendered in accordance with subsection (1), subject to the conditions that the Authority may impose in the interest of the member enrolled with the accredited health care provider. (3) A health care provider that dispenses with that provider’s accreditation shall, within thirty days of the Authority’s direction to do so, transfer the medical records of members in that provider’s possession to the Authority. (4) The Authority shall, before directing a health care provider to transfer medical records in accordance with subsection (3), consult the affected members on the alternative accredited health care providers that the members may wish to be enrolled with. National Health Insurance [No. 2 of 2018 77
Section 29Verify source
§ 30Suspension or revocation of accreditationCommencement

The Authority may suspend or revoke a health care provider’s accreditation for fraud, non-compliance, or unlawful operation, but must notify the provider first and give it a chance to respond or fix the problem.

30. (1) The Authority may suspend or revoke a health care provider’s accreditation if that accredited health care provider— (a) obtained the accreditation by fraud or submission of false Suspension or revocation of accreditation information or statements; (b) does not comply with a term or condition of the accreditation; or (c) operates in contravention of this Act or any other law relating to the provision of a health care service. (2) The Authority shall, before suspending or revoking a health care provider’s accreditation in accordance with subsection (1), notify the health care provider of the intention to suspend or revoke the accreditation and shall— (a) give reasons for the intended suspension or revocation; and (b) require the health care provider to— (i) show cause, within such reasonable period as the Authority may specify in the notice, why the accreditation should not be suspended or revoked; or (ii) remedy the default. (3) The Authority shall not suspend or revoke a health care provider’s accreditation if the health care provider takes remedial measures to the satisfaction of the Authority within the period specified in accordance with subsection (2). (4) The Authority shall, in making the final determination on the suspension or revocation of a health care provider’s accreditation consider the remedial measures made by the health care provider in accordance with subsection (3). (5) The Authority shall, where a health care provider’s accreditation is suspended or revoked in accordance with this section, publish the suspension or revocation, as the case may be, in a daily newspaper of general circulation in the Republic. (6) The revocation of a health care provider’s accreditation in accordance with this section does not affect any liability incurred by the health care provider before the revocation, and any legal proceedings commenced or continued against the health care provider before the revocation may be continued against that health care provider. (7) A health care provider whose accreditation is suspended or revoked shall, within thirty days of the Authority’s direction to do so, transfer the medical records of members in its possession to an accredited health care provider that the Authority may direct. 78 No. 2 of 2018] National Health Insurance Publication of accredited health care providers Reporting requirements for accredited health care providers (8) The Authority shall, before directing a health care provider to transfer medical records in accordance with subsection (7), consult the affected members on the alternative accredited health care providers they wish to be enrolled with.
Section 30Verify source
§ 31Publication of accredited health care providersProvision

The Authority must publish the names of accredited health care providers every year in the Gazette and a daily newspaper with general circulation in the Republic.

31. The Authority shall publish annually in the Gazette and a daily newspaper of general circulation in the Republic the names of accredited health care providers.
Section 31Verify source
§ 32Reporting requirements for accredited health care providersOffence

The Minister must set reporting requirements for accredited health care providers, and the Authority may ask providers for information and documents they hold. Providers must give the requested material, and failure to comply is an offence.

32. (1) The Minister shall, in consultation with relevant stakeholders, prescribe the reporting requirements for accredited health care providers in respect of insured health care services provided by the accredited health care providers, including the periods for reporting the following: (a) statistical data on members enrolled with the health care provider; (b) the insured health care services provided during the reporting period and the conditions under which the services were provided; (c) the number and skills of staff of the health care provider; (d) the type and state of equipment and infrastructure of the health care provider; (e) the inventory of medicines including stock levels available; (f) the relationship with other accredited health care providers and the details thereof; and (g) such other administrative, financial or medical information relevant to the provision of quality insured health care services. (2) The Authority may request, from an accredited health care provider, information and documents, including medical records and explanations, which are in the possession of the health care provider, relating to the provision of insured health care services and that health care provider shall disclose the information or submit the documents to the Authority. (3) An accredited health care provider that fails to comply with this section commits an offence. Payment for insured health care services
Section 32Verify source
§ 33Payment for insured health care servicesProvision

An accredited health care provider must submit a claim in the prescribed manner and form, and must not bill a member directly for an insured health care service after receiving payment from the Fund. The Authority must process payment claims within a period it agrees with the provider.

33. An accredited health care provider that provides a health care service to a member, shall submit a claim in the prescribed manner and form. (2) The Authority shall process a claim for payment in respect of insured health care services rendered by an accredited health care provider within such period as the Authority may agree on with the accredited health care provider. National Health Insurance [No. 2 of 2018 79 (3) An accredited health care provider that receives payment from the Fund shall not bill a member directly for any insured health care service.
Section 33Verify source
§ 34Confidential patient record system and provider paymentOffence

Accredited health care providers must keep a standardised, confidential patient record system and implement a prescribed provider payment system. Members must provide requested information, and people receiving information under this section must keep it confidential and not use or disclose it unless authorised by law.

34. (1) An accredited health care provider shall, implement a standardised and confidential patient record system to maintain accurate patient records and simplify the provider payment system as prescribed by the Minister, in consultation with the Authority. (2) A member shall, on request, submit to the Authority, an employer, an accredited health care provider or any other authorised person information required for the better carrying out of the provisions of this Act. (3) A person who receives information under this section, in the course of that person’s functions under this Act, shall keep such information confidential and shall not disclose or make use of the information, except as authorised by law. (4) An accredited health care provider shall implement a prescribed provider payment system. (5) A person who contravenes subsection (4) commits an offence and is liable, on conviction to a fine not exceeding five hundred thousand penalty units or to imprisonment for a term not exceeding five years, or to both.
Section 34Verify source
§ 35Member’s enrolment with accredited health care providerProvision

The Minister may set the processes and procedures for enrolling or removing a member from an accredited health care provider.

35. The Minister may prescribe the processes and procedures for enrolment, or removal of a member from an accredited health care provider.
Section 35Verify source
§ 36Duty to provide insured health care servicesProvision

An accredited health care provider must provide a member the insured health care services listed in the benefits package.

36. An accredited health care provider shall provide to a member, the insured health care services specified in the benefits package. Confidential patient record system and provider payment system Member’s enrolment with accredited health care provider Duty to provide insured health care services PART V QUALITY ASSURANCE
Section 36Verify source

Part

PART V

§ 37Compliance with quality standardsProvision

An accredited health care provider must comply with quality assurance systems set by the Authority or other relevant regulatory agencies.

37. (1) An accredited health care provider shall comply with national quality assurance systems set by the Authority or other relevant regulatory agencies. Compliance with quality standards (2) The Authority shall liaise with appropriate authorities to ensure that national quality assurance systems developed by regulatory agencies are relevant to current developments in the provision of national health insurance and have a positive impact on the delivery of health care services. 80 No. 2 of 2018] National Health Insurance Quality assurance
Section 37Verify source
§ 38Quality assuranceProvision

An accredited health care provider must join quality assurance and performance review programmes and appoint staff to handle quality, patient records, and claims submission tasks.

38. (1) An accredited health care provider shall take part in programmes for quality assurance and performance review to ensure that they provide quality health care services. (2) An accredited health care provider shall appoint persons, on their personnel establishment, whose responsibility is to— (a) ensure quality and cost effective health care service delivery in conformity with national standards; (b) manage the patient record system; and (c) ensure accurate and expedient, submission of claims in accordance with prescribed procedures. Contracts and monitoring mechanisms
Section 38Verify source
§ 39Contracts and monitoring mechanismsProvision

The Authority must contract with each accredited health care provider and, together with the provider, put monitoring mechanisms in place.

39. (1) The Authority shall enter into a contract with each accredited health care provider for provision of insured health care services under the Scheme. (2) The Authority and accredited health care provider shall ensure that monitoring mechanisms are put in place to safeguard against— (a) overutilisation of insured health care services; (b) underutilisation of insured health care services; (c) unnecessary diagnostic and therapeutic procedures and interventions; (d) irrational and inappropriate prescription of medicines; (e) inappropriate referral practices; (f) inappropriate or unnecessary healthcare service being continued as part of insured health care services; (g) fraud; and (h) any other circumstances that are likely to arise. Inspections
Section 39Verify source
§ 40InspectionsOffence

The Authority must appoint inspectors, and inspectors can inspect accredited health care provider premises and related records, but must show ID and respect privacy and confidentiality.

40. (1) The Authority shall, in consultation with the Council, and the Registrar responsible for Pensions and Insurance, appoint inspectors for purposes of this Act. (2) An inspector may, at all reasonable times, enter and inspect any premises, which is being used by an accredited health care provider to ensure compliance with this Act and regulations issued under this Act. (3) An inspector shall, on entering the premises of an accredited health care provider, present that inspectors’identity card to a person in charge. (4) An inspector may inspect a patient’s records, treatment, diagnosis and fees sheet to ascertain the validity of any billing, except that an inspector shall, in so doing, pay particular regard to ethical procedures, privacy and confidentiality. National Health Insurance [No. 2 of 2018 81 (5) A person shall not— (a) delay or obstruct an inspector in the performance of the inspectors’ functions; (b) refuse to give an inspector such reasonable assistance as the inspector may require for the purpose of executing the inspectors’ duties and powers under this Act; or (c) give an inspector false or misleading information in answer to an inquiry made by the inspector. (6) A person who contravenes subsection (4), commits an offence and is liable, on conviction, to a fine not exceeding two hundred thousand penalty units or imprisonment for a term not exceeding two years, or to both. (7) An inspector shall submit to the Authority a written report relating to an inspection conducted under this Act. (8) Where the Authority receives a report, submitted under subsection (5), indicating that the accredited health care provider is not complying with a provision of this Act, the Authority shall serve the accredited health care provider with a written notice specifying the violation and stating that the Board may suspend or revoke the accreditation of the health care provider if the counteracting responses do not offer sufficient grounds exculpating the accredited health care provider. PART VI NATIONAL HEALTH INSURANCE FUND
Section 40Verify source

Part

PART VI

§ 41Establishment of National Health Insurance FundProvision

The section establishes the National Health Insurance Fund and says how its money must be used and managed.

41. (1) There is established the National Health Insurance Fund for the purpose of the Scheme. (2) Despite the generality of subsection (1), the Fund shall be held and applied for the purposes of— (a) paying for the cost of insured health care services accessed Establishment of National Health Insurance Fund by members of the Scheme; (b) paying administrative and management expenses; and (c) programmes for the promotion of access to insured health care services that the Minister may, in consultation with the Authority, determine. (3) The Fund shall consist of— (a) contributions paid into the Fund in accordance with this Act; (b) monies as may be appropriated by Parliament for the purpose of the Scheme; 82 No. of 2018] National Health Insurance (c) monies as may be paid to the Fund by way of loans, grants or donations; (d) such monies as may, by or under any other law, be payable to the Fund; (e) interest arising out of any investment of the Fund; and (f) such other monies as may vest or accrue to the Fund. (4) Subject to the approval of the Minister, the Authority may— (a) accept monies by way of grants or donations from a source within or outside Zambia; (b) raise by way of loans or otherwise, such monies as it may require for the discharge of its functions; and (c) charge and collect fees for services provided by the Authority. (5) The Authority shall not, in any year, expend on activities or programmes referred to in subsection 2(b) and (c) more than a prescribed percentage of the monies held by the Fund in that year.
Section 41Verify source
§ 42Administration and management of FundProvision

The Authority must administer and manage the Fund, keep proper accounts and records, and establish prudent controls. It may invest unused Fund money if the Board authorises the manner.

42. (1) The Authority shall administer and manage the Fund for the purposes specified in section 41(2). (2) The Authority may invest any monies of the Fund that are not immediately required for the purposes of the Fund in the manner authorised by the Board. (3) The Authority shall ensure that prudent controls are established for the Fund relating to— (a) fiscal controls and accounting procedures governing the Fund; (b) actuarial correctness of the Fund; (c) reporting procedures for matters relating to the Fund; and (d) investment of the monies of the Fund. (4) The Authority shall cause to be kept proper books of accounts and other records relating to the accounts of the Fund. Administra- tion and management of Fund Fund accounts and disbursement
Section 42Verify source
§ 43Fund accounts and disbursementProvision

The Authority must operate a Scheme account at a bank determined by the Board, and fund monies for the Scheme must be paid into the designated Fund account. The Authority must not use a Fund account to pay money for a different Scheme.

43. (1) The Authority shall, for purposes of the Fund, operate an account in respect of the Scheme at a bank as the Board may determine. (2) Monies paid into the Fund for the purpose of the Scheme shall be deposited in the Fund account designated for the Scheme. (3) TheAuthority shall not disburse from a Fund account monies to be applied for the purposes of a Scheme other than the Scheme in respect of which the Fund account is operated. National Health Insurance [No. of 2018 83
Section 43Verify source
§ 44Annual reportProvision

The Authority must send the Minister an annual report within 90 days after the financial year ends, and the report must include financial information and audited statements.

44. (1) As soon as practicable, but not later than ninety days after end of the financial year, the Authority shall submit to the Minister a report concerning the activities relating to the Fund during the financial year. Annual report (2) The report referred to in subsection (1) shall include information on the financial affairs relating to the Fund and there shall be appended to the report— (a) an audited statement of financial position; (b) an audited statement of comprehensive income; and (c) such other information as the Minister may require. (3) The Fund shall be audited by the Auditor-General or an auditor appointed by the Board and approved by the Auditor- General. (4) The Board may order any other audit in addition to the annual audit specified under subsection (3). (5) The Minister shall cause to be prepared an annual statement of the income and expenditure of the Authority to be laid before the National Assembly. PART VII FINANCIAL PROVISIONS (1) The funds of the Authority shall consist of such monies
Section 44Verify source

Part

PART VII

§ 45Funds of AuthorityProvision

The Authority’s funds may come from parliamentary appropriations, fees, loans, grants, donations, and other accruals, and the Authority may use those funds to accept grants or donations, raise money, and invest surplus funds with the required approvals.

45. as may— Funds of Authority (a) be appropriated to the Authority by Parliament for the purposes of the Authority; (b) be paid to the Authority by way of fees, loans, grants or donations; and (c) otherwise vest in or accrue to the Authority. (2) TheAuthority may, subject to the approval of the Minister— (a) accept monies by way of grants or donations from any source within or outside the Republic; and (b) raise by way of loans or otherwise, such monies as it may require for the discharge of its functions. (3) There shall be paid from the funds of the Authority— (a) the emoluments of the Members and staff of the Authority; (b) such traveling and other allowances for the members of the Board, members of committees of the Board and staff of the Authority when engaged on the business of the Authority at such rates as the members of the Board may approve; and 84 No. of 2018] National Health Insurance Financial year Accounts and audit Annual report (c) any other expenses incurred by the Authority in the performance of its functions under this Act. (4) The Authority may, with the approval of the Board, invest in a manner that it considers appropriate such of its funds as it does not immediately require for the discharge of its functions.
Section 45Verify source
§ 46Financial yearProvision

The Authority’s financial year is a 12-month period ending on 31 December each year.

46. The financial year of the Authority shall be the period of twelve months ending on 31st December in each year.
Section 46Verify source
§ 47Accounts and auditProvision

The Authority must keep proper accounting books and records, have its accounts audited every year, and pay the auditor’s fees.

47. (1) The Authority shall cause to be kept proper books of account and other records relating to its accounts. (2) The accounts of the Authority shall be audited annually by the Auditor-General or an auditor appointed by the Auditor-General. (3) The auditor’s fees shall be paid by the Authority.
Section 47Verify source
§ 48Annual reportProvision

The Authority must submit an annual report to the Minister within 90 days after the financial year ends, and the Minister must arrange for an annual income-and-expenditure statement to be laid before the National Assembly.

48. (1) As soon as practicable, but not later than ninety days after the end of the financial year, the Authority shall submit to the Minister a report concerning the Authority’s activities during the financial year. (2) The report referred to in subparagraph (1) shall include information on the financial affairs of the Authority and there shall be appended to the report— (a) an audited statement of financial position; (b) an audited statement of comprehensive income; and (c) such other information as the Minister may require. (3) The Minister shall cause to be prepared an annual statement of the income and expenditure of the Authority to be laid before the National Assembly. PART VIII GENERAL PROVISIONS Health Complaints Committee and appeals
Section 48Verify source

Part

PART VIII

§ 49Health Complaints Committee and appealsProvision

The Board appoints the Health Complaints Committee, the Committee handles complaints and related matters, the Authority must run awareness on complaint rights, and an aggrieved person may appeal to the Board within 30 days.

49. (1) There is constituted the Health Complaints Committee of the Board. (2) The Board shall appoint persons as members of the Committee who have experience in health, legal or financial matters. (3) The Committee shall— (a) hear and resolve complaints that may be submitted to the Authority by members, accredited health care providers and members of the health profession; (b) hear and determine matters relating to accredited health care providers; and National Health Insurance [No. of 2018 85 (c) perform any other functions relating to the management of the welfare of members as may be determined by the Board. (4) The Authority shall develop an awareness process to ensure that members and accredited health care providers are aware of their right to lodge complaints to the Committee where there is failure to settle a complaint internally. (5) A person aggrieved with a decision of the Committee may, within thirty days of receiving the decision, appeal to the Board.
Section 49Verify source
§ 50AppealsProvision

A person aggrieved by a decision of the Board Appeals may appeal to the High Court.

50. A person who is aggrieved by a decision of the Board Appeals may appeal to the High Court.
Section 50Verify source
§ 5152. RegistersProvision

If a judgment is entered against the Authority, enforcement steps like execution or attachment cannot be issued against it or its property, and the Authority must pay the awarded amount from its revenues to the entitled person.

51. Where a judgment order is obtained against the Authority, execution, attachment or process of any nature shall not be issued against the Authority or against any property of the Authority, but the Authority shall cause to be paid out of its revenues an amount that may, by the judgment or order, be awarded against the Authority to the person entitled to that amount. Immunity from execution of judgments
Section 51Verify source
§ 52RegistersProvision

The Authority must keep prescribed registers, and accredited health care providers must keep a register of their enrolled members.

52. (1) The Authority shall establish and maintain a register Registers in the prescribed manner and form of— (a) members; (b) employers, pensions schemes and self employed citizens or established residents; and (c) accredited health care providers. (2) An accredited health care provider shall establish and maintain a register of members enrolled with that provider.
Section 52Verify source
§ 53General offencesOffence

This section makes it an offence for a person to make false statements, evade or fail to pay contributions, miss required registration steps, refuse required information, obstruct an officer, or fail to produce required documents.

53. (1) A person shall not— (a) make a false statement or representation in connection with registration for membership; (b) obtain or procure a prescribed health care service by knowingly making a false or fraudulent statement or uttering a false document; (c) make a claim for payment in respect of prescribed health care services that the person has not rendered; (d) fail to pay to the Scheme within the period specified any contribution which the person is liable to pay under the Act; (e) where required to pay contributions to the Scheme, evade payment of a contribution; General offences 86 No. 2 of 2018] National Health Insurance Fine in lieu of prosecution (f) when required to register as a member or to ensure the registration of another person as a member, fail to do so within the period specified by or under this Act; (g) when required by or under this Act to furnish any information, without lawful excuse, fail or refuse to furnish that information; (h) obstruct any officer of the Authority in the discharge of the officer’s duties; or (i) without lawful excuse, fail to produce documents which the person is required by or under this Act to produce. (2) A person who contravenes subsection (1) commits an offence and is liable, on conviction, to a fine not exceeding two hundred thousand penalty units or imprisonment to a term not exceeding two years or to both.
Section 53Verify source
§ 54Fine in lieu of prosecutionOffence

The Authority may impose a fine instead of prosecution in qualifying cases, but needs written consent from the Director of Public Prosecutions if criminal proceedings have already started.

54. (1) Where a person commits an offence under this Act agrees to pay a specified fine proposed by the Authority which does not exceed the maximum penalty provided by this Act for the offence in question, the Authority may impose that fine on that person, except that where criminal proceedings have been instituted against that person for the offence, the power conferred by this subsection shall not be exercised without the written consent of the Director of Public Prosecutions. (2) The Authority shall furnish the person with a certificate setting out the nature of the offence, the date of its occurrence, and the fine imposed under subsection (1), and such certificate may be used by that person as prima facie proof of the facts stated in the certificate. (3) Where a fine imposed in terms of subsection (1) is not paid on demand, the Authority may take steps for, or towards, its recovery in any manner permitted by this Act with respect to the recovery of unpaid contribution. (4) The imposition of a fine under subsection (1), shall not be treated as a conviction of the person of a criminal offence, but no prosecution for the offence in question shall thereafter be instituted or maintained. (5) This section shall not in any way affect liability for the payment of contributions due under this Act. National Health Insurance [No. 2 of 2018 87 Offences by body corporate
Section 54Verify source
§ 55Offences by body corporateOffence

If a body corporate or unincorporate body commits an offence under the Act, a director, manager, or shareholder suspected of that offence and charged may be liable on conviction to the penalty for the offence, unless they prove lack of knowledge, consent, or connivance, or that they took reasonable steps to prevent it.

55. Where an offence under this Act is committed by a body corporate or unincorporate body, and the director, manager or shareholder of that body is suspected to have committed the offence and is charged of that offence, that director, manager or shareholder of the body corporate or unincorporate body is liable, on conviction, to the penalty specified for the offence, unless the director, manager or shareholder proves to the satisfaction of the court that the act constituting the offence was done without the knowledge, consent or connivance of the director, manager or shareholder or that the director, manager or shareholder took reasonable steps to prevent the commission of the offence.
Section 55Verify source
§ 56General penaltyOffence

If an offence under this Act has no specific penalty, the offender is liable on conviction to a fine of up to 200,000 penalty units, imprisonment for up to 2 years, or both.

56. A person who commits an offence under this Act for which a penalty is not provided is liable, on conviction, to a fine not exceeding two hundred thousand penalty units or to imprisonment for a term not exceeding two years, or to both. General penalty
Section 56Verify source
§ 57RegulationsProvision

The Minister may make regulations by statutory instrument to prescribe matters needed to carry out the Act.

57. (1) The Minister may, by statutory instrument, prescribe anything which by this Act is required to be prescribed or is necessary for the carrying out of the provisions of this Act. Regulations (2) Without prejudice to the generality of subsection (1), regulations made under that subsection may provide for— (a) the procedure for applying for and registration as a member; (b) the manner and form of applying for accreditation as a health care provider for purposes of the Scheme; (c) different rate of contributions for different benefit packages; (d) the procedure for replacing a defaced, damaged, lost or expired membership card; (e) a standard schedule of fees for items and services provided by accredited health care providers; (f) payment of a prescribed fee in respect of such replacement; and (g) investment guidelines for the Scheme. National Health Insurance [No. 2 of 2018 89 SCHEDULE (Sections 4 (2) and 6(6))
Section 57Verify source

Part

SCHEDULE

§ 1Short title and CommencementShort title

The Board controls the Authority’s seal, the Secretary keeps it, and specified officers authenticate its use. Some contracts or instruments may be executed without the seal.

1. (1) The seal of the Authority shall be such device as may be determined by the Board and shall be kept by the Secretary. Seal of Authority (2) The affixing of the seal shall be authenticated by the Chairperson or Vice-Chairperson and the Director-General or one other person authorised in that behalf by a resolution of the Board. (3) A contract or instrument which, if entered into or executed by a person, not being a body corporate, is not required to be under seal, may be entered into or executed without seal on behalf of the Board, the Director-General or by any other person generally or specifically authorised by the Board in that behalf. (4) A document purporting to be a document under the seal of the Authority or issued on behalf of the Authority shall be received in evidence and shall be deemed to be so executed or issued, as the case may be, without further proof, unless the contrary is proved.
Section 1Verify source
§ 23. Application and power of exemptionProvision

This section sets how the Board runs its meetings, including notice, quorum, voting, and minutes.

2. (1) Subject to the other provisions of this Act, the Board may regulate its own procedure. Proceedings of Board (2) The Board shall meet for the transaction of business at least once every three months at such places and times as the Board may determine. (3) A meeting of the Board may be called by the Chairperson upon giving notice of not less than fourteen days and shall be called if not less than one-third of the members of the Board so request, in writing, except that if the urgency of a particular matter does not permit the giving of such notice, a special meeting may be called upon giving a shorter notice. (4) Seven members of the Board shall constitute a quorum at a meeting of the Board. (5) There shall preside at a meeting of the Board— (a) the Chairperson; (b) in the absence of the Chairperson, the Vice-Chairperson; and (c) in the absence of the Chairperson and the Vice- Chairperson, a member of the Board as the members of the Board present may elect from amongst themselves for the purpose of that meeting. 90 No. of 2018] National Health Insurance (6) A decision of the Board on any question shall be determined by a majority of the votes of the members of the Board present and voting at the meeting and, in the event of an equality of votes, the person presiding at the meeting shall have, in addition to a deliberative vote, a casting vote. (7) Where a member of the Board is, for any reason unable to attend the meeting of the Board, that member of the Board may, in writing, nominate another person from the same organisation to attend the meeting in that member of the Board’s stead and that person shall be considered to be a member of the Board for purposes of that meeting. (8) The Board may invite any person whose presence is, in its opinion desirable, to attend and to participate in the deliberation of a meeting of the Board, but that person shall have no vote. (9) The validity of any proceedings, act or decision of the Board shall not be affected by any vacancy in the membership of the Board or any defect in the appointment of any member of the Board or by reason that any person not entitled to do so, took part in the proceedings. (10) The Board shall cause minutes to be kept of the proceedings of every meeting of the Board and of every committee of the Board. Tenure of office of Member and vacancy
Section 2Verify source
§ 3Application and power of exemptionOffence

Board members serve three-year terms, may be reappointed once for another like period, and must not serve more than two consecutive terms.

3. (1) Subject to the other provisions of this Act, a member of the Board shall hold office for a period of three years from the date of appointment and may be reappointed for a further like period but shall not successively hold office for more than two terms. (2) The office of a member of the Board becomes vacant if the member of the Board— (a) dies; (b) is adjudged bankrupt; (c) is absent from three consecutive meetings of the Board of which the member of the Board has had notice, without the prior approval of the Board; (d) resigns from office; (e) becomes mentally incapable of performing the duties of a member of the Board; (f) is convicted of an offence under this Act or any other law; or (g) ceases to represent the institution that nominated that member of the Board. National Health Insurance [No. of 2018 91 (3) Subject to the other provisions of this Act, a member of the Board shall, on the expiration of the period for which the member of the Board is appointed, continue to hold office until another member of the Board, is appointed to succeed that member of the Board, but in no case shall the member of the Board hold office for more than three month after the expiration of the member of the Board’s term. (4) A member of the Board may resign from office by giving not less than one month’s notice, in writing, to the Chairperson and the Minister. (5) The Minister shall, where the office of a member of the Board becomes vacant, appoint another person in place of the member of the Board who vacates office, and such member of the Board shall hold office for the remainder of the term.
Section 3Verify source
§ 4Establishment of National Health Insurance ManagementProvision

Members of the Board or its committee are to be paid allowances, and the Emoluments Commission may determine the amount on the Board’s recommendation.

4. A member of the Board or committee of the Board, shall be paid such allowances as the Emoluments Commission may, on the recommendation of the Board, determine. Allowances of member Disclosure of interest
Section 4Verify source
§ 5Functions of AuthorityCommencement

People at Board or committee meetings must disclose a private conflict of interest promptly and must not join the discussion or vote unless the Board or committee directs otherwise.

5. (1) A person who is present at a meeting of the Board or a committee of the Board at which any matter is the subject of consideration, and in which that person or that person’s relative or associate, is directly or indirectly interested in a private capacity shall, as soon as practicable after the commencement of the meeting, disclose that interest and shall not, unless the Board or the committee otherwise directs, take part in any consideration or discussion of, or vote on, any question relating to that matter. (2) A disclosure of interest made under this paragraph shall be recorded in the minutes of the meeting at which the disclosure is made. (3) A person who contravenes subparagraph (1) commits an offence and is liable, upon conviction, to a fine not exceeding two hundred thousand penalty units or to imprisonment for a period not exceeding two years, or to both.
Section 5Verify source
§ 6Board of AuthorityOffence

A person must not publish or disclose protected Act-related information to an unauthorised person without written consent from or on behalf of the Board.

6. (1) A person shall not, without the consent in writing, given by or on behalf of the Board, publish or disclose to an unauthorised person, otherwise than in the course of that person’s duties, the contents of any document, communication or information whatsoever, which relates to, and which has come to that person’s knowledge in the course of that person’s duties under this Act. Prohibition of publication of, or disclosure of information to, unauthorised person 92 No. 2 of 2018] National Health Insurance (2) A person who contravenes subparagraph (1) commits an offence and is liable, on conviction, to a fine not exceeding two hundred thousand penalty units or to imprisonment for a period not exceeding two years, or to both. (3) A person who, having information which to that person’s knowledge has been published or disclosed in contravention of subparagraph (1), unlawfully publishes or communicates that information to another person, commits an offence and is liable, on conviction, to a fine not exceeding two hundred thousand penalty units or to imprisonment for a period not exceeding two years, or to both.
Section 6Verify source
§ 7Functions of BoardProvision

Board members, committee members, and Authority staff are protected from proceedings over acts or omissions done in good faith while carrying out powers, functions, or duties under the Act.

7. An action or other proceeding shall not lie or be instituted against a member of the Board or committee of the Board or a member of staff of the Authority for, or in respect of, an act or thing done or omitted to be done in good faith in the exercise or performance, of any of the powers, functions or duties conferred under this Act. Immunity
Section 7Verify source

Legislative relationships

6 referenced instruments

Names are derived from the stored provision headings and citation-enrichment layer. Treat this as a research index and verify each relationship against the source text.

A–F

3 instruments

  • Authority A person must not publish or disclose protected Act

    Section 6

  • Authority that it considers necessary for the performance of its functions under this Act

    Section 10

  • Authority under this Act

    Section 5

N–S

3 instruments

  • Scheme as provided Act

    Section 2

  • Scheme is to provide universal access to quality insured health care services in accordance with this Act

    Section 12

  • Scheme under the Act

    Section 13

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Statute information is organised from identified legislative sources for professional research. Corrections can be reported to hello@esheria.ai.