Health Insurance (Jersey) Law 1967

View PDF (415 KB)

Jersey Law 12/1967

“HEALTH INSURANCE (JERSEY) LAW, 1967”,

CONFIRMÉ PAR

Ordre de Sa Majesté en Conseil

en date du 8 juin 1967.

____________

(Enregistré le 30 juin 1967).

ARRANGEMENT OF ARTICLES.
Article
	PART I
	INTRODUCTORY
1.	Interpretation
2.	General administration
	PART II
	INSURED PERSONS
3.	Insured persons
4.	Child of the family
5.	Dependant wife
6.	Employed persons and employers
7.	Self-employed persons and non-employed persons
8.	Crown servants
9.	Members of forces
10.	Insured persons outside the Island
	PART III
	CONTRIBUTIONS
11.	Source of funds
12.	Exceptions from liability to pay contributions
13.	Contributions of employed persons and employers
14.	General provisions as to payment and collection of contributions, etc
	PART IV
	BENEFIT
15.	Right to benefit
16.	Descriptions of benefit
17.	Qualifying period
18.	Medical benefit
19.	Medical services
20.	Dental benefit
21.	Dental services
22.	Ophthalmic benefit
23.	Ophthalmic services
24.	Pharmaceutical benefit
25.	Supply of pharmaceutical benefit by approved medical practitioners or approved dentists
26.	Orders in relation to benefit
28.	Limitation of amount of money benefit
29.	Claims and notices sent by post
	PART V
	HEALTH INSURANCE FUND
30.	Health Insurance Fund
31.	Actuarial reports
32.	Civil proceedings to recover sums due to Health Insurance Fund
33.	Recovery of sums due to Health Insurance Fund by deductions from earnings
34.	Recovery in bankruptcy, etc
	PART VI
	APPROVAL OF MEDICAL PRACTITIONERS, DENTISTS, OPTICIANS AND SUPPLIERS OF PHARMACEUTICAL BENEFIT
35.	Approval of medical practitioners, dentists, opticians and suppliers of pharmaceutical benefit
36.	Power to take disciplinary proceedings
	PART VII
	ADMINISTRATION
37.	Determination of claims and questions
38.	Expenses of persons required to attend proceedings
39.	Powers of inspection
40.	Information as to, and proof of, births, marriages and deaths
	PART VIII
	MISCELLANEOUS AND GENERAL
41.	Supplementary schemes
42.	Power to modify or wind up existing schemes
43.	Reciprocal agreements with other countries
44.	General provisions as to offences and penalties
45.	General provisions as to prosecutions
46.	General provisions as to Acts, regulations and orders
47.	Amendment of Insular Insurance Law
48.	Saving
49.	Provisions as to commencement
50.	Short title
First Schedule – Contribution rates
Second Schedule – Pharmaceutical Benefit Advisory Committee
Third Schedule –Health Services Disciplinary Tribunal
Fourth Schedule – Health Insurance Tribunal

HEALTH INSURANCE (JERSEY) LAW, 1967.

____________

A LAW to establish a system of insurance in relation to medical, dental and ophthalmic services and pharmaceutical supplies required in connexion therewith, and for purposes ancillary thereto, sanctioned by Order of Her Majesty in Council of the

8th day of JUNE, 1967.

____________

(Registered on the 30th day of June, 1967).

____________

STATES OF JERSEY.

____________

The 15th day of November, 1966.

____________

THE STATES, subject to the sanction of Her Most Excellent Majesty in Council, have adopted the following Law : -

PART I

INTRODUCTORY

ARTICLE 1

INTERPRETATION

(1) In this Law, unless the context otherwise requires –

“the appointed day” has the meaning assigned thereto by Article 49;

“approved dentist” means a dentist for the time being approved under Article 35;

“approved medical practitioner” means a medical practitioner for the time being approved under Article 35;

“approved optician” means an optician for the time being approved under Article 35;

“approved supplier” means an authorized seller of poisons or other person for the time being approved under Article 35 as a supplier of pharmaceutical benefit;

“authorized seller of poisons” has the same meaning as in the Pharmacy, Poisons and Medicines (Jersey) Law, 1952;1

“beneficiary” means, in relation to any benefit, the person entitled to that benefit;

“benefit” means benefit under this Law;

“child of the family” has the meaning assigned thereto by Article 4;

“the Committee” has the meaning assigned thereto by Article 4;

“compulsory insurance age” means the age of seventy in the case of a man and sixty-five in the case of a woman;

“contribution week” means the period of seven days commencing from midnight between Sunday and Monday;

“dental services” has the meaning assigned thereto by Article 21;

“dentist” has the same meaning as “registered dentist” in the Dentists (Registration) (Jersey) Law, 1961,2 and includes an ancillary dental worker of any class established by regulations made under Article 10 of the said Law;

“dependant” means, in relation to an insured person, a child of the family or the dependant wife of the insured person;

“dependant wife” has the meaning assigned thereto by Article 5;

“determining officer” means the determining officer appointed in accordance with the provisions of paragraph (1) of Article 37;

“employed contributor’s employment” has the meaning assigned thereto by Article 6;

“employer’s contribution” means a contribution payable by a person otherwise than as an insured person;

“employed person” has the meaning assigned thereto by Article 6;

“employment” includes any trade, business, profession, office or vocation and “employed” shall be construed accordingly except in the expression “employed person”;

“entry into insurance” means, in relation to any person, the date on which he becomes an insured person;

“the Family Allowances Law” means the Family Allowances (Jersey) Law, 1951,3as modified in its application for the purposes of this Law by paragraph (4) of this Article;

“the Health Insurance Fund” means the fund established and so called by virtue of Article 30;

“the Health Insurance Tribunal” means the tribunal constituted and so called by virtue of the Fourth Schedule to this Law;

“the Health Services Disciplinary Tribunal” means the tribunal constituted and so called by virtue of the Third Schedule to this Law;

“Her Majesty’s dominions” includes British protectorates and protected states and any territory in respect of which a mandate has been accepted by Her Majesty and is being exercised by the Government of any part of Her Majesty’s dominions;

“the Insular Insurance Law” means the Insular Insurance (Jersey) Law, 1950;4

“insurance stamps” has the meaning assigned thereto by Article 14;

“insured person” means a person insured under this Law;

“insured person in Class A” and “insured person in Class B” have the meanings assigned thereto by Article 3;

“medical practitioner” has the same meaning as “registered medical practitioner” in the Medical Practitioners (Registration) (Jersey) Law, 1960;5

“medical services” has the meaning assigned thereto by Article 19;

“money benefit” means medical benefit, dental benefit or ophthalmic benefit;

“non-employed person” has the meaning assigned thereto by Article 7;

“officer” has the same meaning as in the Civil Service Administration (Jersey) Law, 1953;6

“optician” has the same meaning as “registered optician” in the Opticians (Registration) (Jersey) Law, 1962;7

“ophthalmic services” has the meaning assigned thereto by Article 23;

“order” means an order made by the Committee under this Law;

“pharmaceutical benefit” has the meaning assigned thereto by Article 24;

“Pharmaceutical Benefit Advisory Committee” means the committee constituted and so called by virtue of the Second Schedule to this Law;

“pharmaceutical chemist” has the same meaning as “registered pharmacist” in the Pharmacy, Poisons and Medicines (Jersey) Law, 1952;8

“prescribed” means prescribed by order;

“self-employed person” has the meaning assigned thereto by Article 7;

“States’ Auditor” means the auditor of the public accounts of the States.

(2) For the purposes of this Law –

(a) the upper limit of the compulsory school age means the age that is for the time being that limit by virtue of Article 20 of the “Loi (1912) sur l’instruction primaire”;9

(b) a person who at any time attains the upper limit of the compulsory school age shall not be treated as being under that limit at any time thereafter, notwithstanding any change in that limit.

(3) For the purposes of this Law –

(a) a person shall be deemed to be over or under any age therein mentioned if he has or has not attained that age ;

(b) a person shall be deemed to be between two ages therein mentioned if he has attained the first-mentioned age but has not attained the second-mentioned age ;

(c) a person shall not be deemed to have attained the age of eighteen years until the commencement of the eighteenth anniversary of the day of his birth, and similarly with respect to any other age;

(d) provision may be made by order that, for the purposes of determining whether a contribution is payable in respect of any person, or at what rate a contribution is payable, that person shall be treated as having attained at the beginning of a contribution week, or as not having attained until the end of the contribution week, any age which he attains during the course of that week.

(4) In the application of the Family Allowances (Jersey) Law, 1951,10 for the purposes of this Law, that Law shall have effect as if at the end of paragraph (1) of Article 2 thereof (which defines the word “child” for the purposes of that Law) there were inserted the following sub-paragraph –

“(c) during any period whilst, by virtue of an order made under paragraph (1) of Article 12 of the Health Insurance (Jersey) Law, 1967,11 he is excepted from liability to pay contributions thereunder on the ground set out in sub-paragraph (a)(ii) of paragraph (1) of Article 8 of the Insular Insurance (Jersey) Law, 195012 (which relates to persons in full-time education or full-time unpaid apprenticeship)”.

(5) Any reference in this Law to any other enactment shall be construed as including a reference to that enactment as amended by any subsequent enactment, including this Law.

ARTICLE 2

GENERAL ADMINISTRATION

The administration of this Law shall be vested in the Social Security Committee (in this Law referred to as “the Committee”) and a sufficient number of officers shall be appointed to assist the Committee in the exercise of its functions under this Law and generally for the purpose of carrying this Law into effect.

PART II

INSURED PERSONS

ARTICLE 3

INSURED PERSONS

(1) Subject to the provisions of this Law, every person who on or after the appointed day, being over the upper limit of the compulsory school age, is in the Island and fulfils such conditions as may be prescribed as to residence in the Island and, in the case of a person over compulsory insurance age, makes application in the prescribed manner, shall become insured under this Law and thereafter continue throughout his life to be so insured.

(2) For the purposes of this Law, insured persons shall be divided into the following two classes –

(a) Class A, which shall comprise insured persons not in Class B ;

(b) Class B, which shall comprise –

(i) dependants of insured persons ;

(ii) insured persons over compulsory insurance age.

ARTICLE 4

CHILD OF THE FAMILY

For the purposes of this Law –

(a) “child ”means a person who would be treated as a child for the purposes of the Family Allowances Law ;

(b) a person shall be deemed to have a family which includes a child or children if that person (not being a child) and a child or children (with or without a wife or husband of that person) would be treated for the purposes of that Law as constituting a family, and references to a child of a person’s family shall be construed accordingly.

ARTICLE 5

DEPENDANT WIFE

(1) For the purposes of this Law, the dependant wife of an insured person at any time is the wife of the insured person if they are residing together at that time.

(2) For the purposes of this Article, an insured person and his wife shall not be deemed to have ceased to reside together by reason of any temporary absence of either or both of them, and in particular while receiving medical treatment as an in-patient in a hospital or similar institution or by reason of any absence of either or both of them in such circumstances as may be prescribed.

ARTICLE 6

EMPLOYED PERSONS AND EMPLOYERS

(1) For the purposes of this Law, an insured person is an employed person at any time if at that time he is an employed person for the purposes of the Insular Insurance Law, or would be an employed person for those purposes if he were an insured person within the meaning of that Law and a person is the employer of such a person at any time if at that time he is the employer of that person for the purposes of that Law.

(2) References in this Law to an employed contributor’s employment are references to any employment by virtue whereof a person is an employed person for the purposes of the Insular Insurance Law.

(3) Any order made by virtue of sub-paragraph (b) of paragraph (1) of Article 11 of the Insular Insurance Law13 shall, in so far as it provides for adjusting the rights between themselves of the person prescribed by the order as the employer, the immediate employer and the persons employed, have effect for the purposes of this Law as it has effect for the purposes of that Law.

ARTICLE 7

SELF-EMPLOYED PERSONS AND NON-EMPLOYED PERSONS

(1) For the purposes of this Law, an insured person is a self-employed person at any time if at that time he is a self-employed person for the purposes of the Insular Insurance Law, or would be a self-employed person for those purposes if he were an insured person within the meaning of that Law.

(2) For the purposes of this Law, an insured person is a non-employed person at any time if at that time he is neither an employed person nor a self-employed person.

ARTICLE 8

CROWN SERVANTS

This Law shall apply to persons employed by or under the Crown, subject to any special provision made by or by virtue of any other Article thereof, in like manner as if the employer were a private person, with such modifications as the Committee may by order make thereto for the purpose of adapting the provisions thereof to the case of such persons.

ARTICLE 9

MEMBERS OF FORCES

Subject to any prescribed exceptions, any person who is serving as a member –

(a) of the regular naval, military or air forces of the Crown ; or

(b) of such other of Her Majesty’s forces as may be prescribed ; or

(c) of any prescribed organization in which persons serve under the control of the Admiralty, the Army Council or the Air Council ;

shall not be deemed to be an insured person whilst serving as aforesaid.

ARTICLE 10

INSURED PERSONS OUTSIDE THE ISLAND

Without prejudice to the generality of any other power to make orders, the Committee may by order modify, in such manner as it thinks proper, the provisions of this Law in their application in relation to persons who are or have been outside the Island while insured under this Law and the dependants of such persons.

PART III

CONTRIBUTIONS

ARTICLE 11

SOURCE OF FUNDS

(1) For the purpose of providing the funds required for paying or meeting the cost of benefit, and for making any other payments which under this Law are to be made out of the Health Insurance Fund, contributions shall be payable by insured persons in Class A and by employers of insured persons in Class A or Class B who are employed persons, and sums shall be payable out of monies provided by the States, in accordance with the provisions of this Article.

(2) Subject to the provisions of this Law –

(a) every employed person of any description set out in the first column of Part I of the First Schedule to this Law shall be liable, as from the appointed day, to pay weekly contributions at the rate respectively set out in the second column of the said Part I;

(b) every employer of an employed person of any description set out in the first column of Part II of the said Schedule, or of any person of any such description who is to be treated by virtue of that Part of that Schedule as an employed person, shall be liable, as from the said day, to pay weekly contributions in respect of that person at the rate respectively set out in the second column of the said Part II ;

(c) every self-employed person of any description set out in the first column of Part III of the said Schedule shall be liable, as from the said day, to pay weekly contributions at the rate respectively set out in the second column of the said Part III ;

(d) every non-employed person of any description set out in the first column of Part IV of the said Schedule shall be liable, as from the said day, to pay weekly contributions at the rate respectively set out in the second column of the said Part IV.

(3) The States may by regulations vary any of the rates of contribution set out in Parts I, II, III and IV of the First Schedule to this Law.

(4) The States may by regulations vary the descriptions of persons liable to pay contributions set out in Parts I, II, III and IV of the First Schedule to this Law by reducing the ages between which persons shall be liable to pay contributions under this Law.

(5) Subject to the provisions of this Law, there shall be paid, for any year, out of monies provided by the States such sum as the States may hereafter determine.

(6) Subject to the provisions of this Law and of any order, no person shall be entitled to pay any contribution thereunder other than a contribution which he is liable to pay.

(7) If any employer or insured person fails to pay any contribution which he is liable under this Law to pay, he shall be liable in respect of each such failure to a fine not exceeding ten pounds.

(8) A person shall not be liable to pay more than one contribution as an insured person for any contribution week, and not more than one employer’s contribution shall be payable in respect of any person for any contribution week.

ARTICLE 12

EXCEPTIONS FROM LIABILITY TO PAY CONTRIBUTIONS

(1) Provision may be made by order for excepting persons from liability to pay contributions under this Law for such periods and in such circumstances as may be prescribed.

(2) Where, in any contribution week an employed person is excepted from liability to pay a contribution under the Insular Insurance Law but is not excepted from liability to pay a contribution under this Law, the provisions of this Law shall apply in relation to him in that week as if he were a non-employed person.

(3) Where by virtue of an order made under paragraph (1) of this Article a person is excepted from liability to pay contributions under this Law for periods when he is not in receipt (or is deemed in accordance with the order not to be in receipt) of an income of a specified amount, the contributions which would otherwise have been payable by him shall be recoverable from the authority responsible for providing him with assistance when in need, and contributions so recovered shall, for the purposes of this Law, be treated as having been paid by the person in question :

Provided that where such an authority makes the necessary application to the Committee, the authority may, in lieu of paying the contributions as aforesaid, pay an annual sum in an amount agreed by the Committee.

ARTICLE 13

CONTRIBUTIONS OF EMPLOYED PERSONS AND EMPLOYERS

(1) Except where provision is otherwise made by order, an employer liable to pay a contribution in respect of a person employed by him shall, in the first instance, be liable to pay also, on behalf of and to the exclusion of that person, any contribution as an insured person payable by that person for the same contribution week, and, for the purposes of this Law, contributions paid by an employer on behalf of an insured person shall be deemed to be contributions paid by the insured person.

(2) Notwithstanding any contract or agreement to the contrary, an employer shall not be entitled to deduct from the wages or other remuneration of a person employed by him, or otherwise to recover from such a person, the employer’s contribution in respect of that person; and an employer who deducts or attempts to deduct the whole or any part of the employer’s contribution in respect of any person from that person’s wages or other remuneration shall be liable in respect of each such deduction or attempted deduction to a fine not exceeding ten pounds.

(3) An employer shall be entitled, suject to and in accordance with any order, to recover from an insured person the amount of any contribution paid or to be paid by him on behalf of that person, and, notwithstanding anything in any enactment, any order under this paragraph may authorize recovery by deductions from the insured person’s wages or remuneration:

Provided that any such order shall provide that –

(a) where the insured person does not receive any wages or other pecuniary remuneration in respect of an employed contributor’s employment either from the employer or from any other person, the employer shall not be entitled to recover the amount of any such contribution from him ; and

(b) where the insured person does receive any such wages or remuneration from the employer, the employer shall not be entitled to recover any such contribution otherwise than by deduction from the wages or remuneration.

(4) The Committee may, in such cases and on such conditions as it may prescribe, make an arrangement with any employer who is liable to pay employer’s contributions under this Law whereby, in respect of persons engaged by that employer through an employment exchange or other agency approved by the Committee, or in the employ of that employer on the date of the arrangement, the performance of all or any of the duties required under this Part of this Law to be performed by the employer in respect of those persons, whether on his own behalf or on behalf of those persons, shall be undertaken on behalf of the employer by the employment exchange or other agency.

(5) For the purposes of this Article, references to a person’s remuneration shall be construed, in relation to any period, as including any payments which by virtue of an order made under paragraph (3) of Article 7 of the Insular Insurance Law14 are to be deemed for the purposes of that paragraph to be remuneration paid to him in respect of any day in that period.

ARTICLE 14

GENERAL PROVISIONS AS TO PAYMENT AND COLLECTION OF CONTRIBUTIONS, ETC

(1) Provision may be made by order –

(a) for any matters incidental to the payment and collection of contributions under this Law;

(b) for treating for the purpose of any right to benefit, contributions paid after the due dates as paid on those dates or on such later dates as may be prescribed, or as not having been paid, and for treating, for the purpose aforesaid, contributions payable by an employer on behalf of an insured person, but not paid, as paid where the failure to pay is shown not to have been with the consent or connivance of, or attributable to any negligence on the part of, the insured person;

(2) Where, under any order made by virtue of paragraph (1) of this Article, contributions are payable by means of adhesive stamps, those stamps (in this Law referred to as “insurance stamps”) shall be prepared and issued in such manner as the Committee may direct, and the Committee may make such arrangements as it thinks fit for the sale of such stamps, remunerating the selling agents by means of commission, salary or otherwise.

(3) Any order made by virtue of this Article providing for the payment of contributions, at the option of the persons liable to pay, either –

(a) by means of insurance stamps; or

(b) by some alternative method, the use of which involves greater expense in administration than would be incurred if the contributions were paid by means of insurance stamps;

may include provision for the payment to the Committee by any person who adopts any alternative method, and for the recovery by the Committee, of the prescribed fees in respect of the difference in the expense of administration.

PART IV

BENEFIT

ARTICLE 15

RIGHT TO BENEFIT

Subject to the provisions of this Law, an insured person shall be entitled to claim for himself and any of his dependants the benefits by this Law provided:

Provided that an insured person who is the dependant of an insured person shall not be entitled to claim benefit in his own right as an insured person.

ARTICLE 16

DESCRIPTIONS OF BENEFIT

The descriptions of benefit provided by this Law are as follows –

(a) medical benefit;

(b) dental benefit;

(d) pharmaceutical benefit.

ARTICLE 17

QUALIFYING PERIOD

(1) An insured person shall not be entitled to claim benefit for himself or any of his dependants in respect of any services provided or benefit supplied before the expiration of thirteen contribution weeks from his entry into insurance being, in the case of a person liable to pay contributions under this Law, weeks in respect of which such contributions have been paid:

Provided that where the insured person has been a person of any such class as is referred to in paragraph (2) of this Article, this paragraph shall not apply to him until the expiration of six months from the date on which he ceased to be a person of that class.

(2) The classes of persons referred to in paragraph (1) of this Article are –

(a) dependants of insured persons;

(b) persons to whom Article 9 of this Law (which relates to members of the forces) applies;

(3) The proviso to paragraph (1) of this Article shall not have effect until the thirteenth Monday next following the day which is the appointed day for the purposes of paragraph (2) of Article II of this Law.

ARTICLE 18

MEDICAL BENEFIT

(1) Subject to the provisions of this Law, where an insured person has paid fees to an approved medical practitioner for medical services provided to him or any of his dependants, he shall be entitled to medical benefit at such rate as the States shall by regulations fix in respect of the fee charged for such services on each occasion when they have been provided.

(2) Regulations made by the States under paragraph (1) of this Article may provide that in such cases or classes of case as may be provided in the Regulations, an insured person shall be entitled to a different rate of medical benefit.

(3) Regulations made by the States under paragraph (1) of this Article may provide that an insured person shall be entitled to a different rate of medical benefit where an inclusive fee has been charged for attendance, advice and treatment given at the confinement of a woman and during the period ending with (and including) the seventh day next following the date of the confinement.

(4) In this Article –

(a) “confinement” means labour resulting in the issue of a living child, or labour after twenty-eight weeks of pregnancy resulting in the issue of a child, whether alive or dead;

(b) the reference to the date of confinement shall be taken as referring, where labour began on one day results in the issue of a child on another day, to the date of the issue of the child, or if the woman is confined of more than one child, to the date of the issue of the last of them.

ARTICLE 19

MEDICAL SERVICES

In this Law, “medical service” means any proper and necessary service provided by a medical practitioner, but does not include any service falling within any of the following classes, namely –

(a) any medical service which involves the application of special skill and experience of a degree or kind which general medical practitioners as a class cannot reasonably be expected to possess;

(b) any medical service in respect of which a fee or other remuneration is payable to a medical practitioner out of the Insular Insurance Fund under the Insular Insurance Law;

(c) medical services provided by a medical practitioner in respect of which he would not be entitled to recover any fees from the insured person or any other person if this Law had not been passed;

(d) any medical service in respect of which any money benefit, other than medical benefit, is payable under this Law;

(e) medical services of such other classes as may be prescribed;

(f) medical services provided to persons of such classes as may be prescribed.

ARTICLE 20

DENTAL BENEFIT

(1) Subject to the provisions of this Law, where an insured person has paid fees to an approved medical practitioner or an approved dentist for dental services provided to him or any of his dependants, he shall be entitled to dental benefit at such rate or rates as the States shall by regulations fix in respect of such services.

ARTICLE 21

DENTAL SERVICES

In this Law, “dental service” means any such service as the States shall by regulations specify, but does not include –

(a) dental services provided by a medical practitioner or dentist in respect of which he would not be entitled to recover any fees from the insured person or any other person if this Law had not been passed;

(b) dental services provided to persons of such classes as may be prescribed.

ARTICLE 22

OPHTHALMIC BENEFIT

(1) Subject to the provisions of this Law, where an insured person has paid fees to an approved optician for ophthalmic services provided to him or any of his dependants, he shall be entitled to ophthalmic benefit at such rate or rates as the States shall by regulations fix in respect of such services.

ARTICLE 23

OPHTHALMIC SERVICES

In this Law, “ophthalmic service” means any such service as the States shall by regulations specify, but does not include –

(a) ophthalmic services provided by an optician in respect of which he would not be entitled to recover any fees from the insured person or any other person if this Law had not been passed;

(b) ophthalmic services provided to persons of such classes as may be prescribed.

ARTICLE 24

PHARMACEUTICAL BENEFIT

(1) Subject to the provisions of this Law, an insured person shall be entitled to pharmaceutical benefit, that is to say, a prescribed medicine, prescribed drug, prescribed appliance or prescribed material, on an order in the prescribed form given by an approved medical practitioner or an approved dentist for the treatment of the insured person or any of his dependants:

Provided that an approved medical practitioner or an approved dentist shall not be entitled to pharmaceutical benefit on an order given by himself for his own treatment.

(2) Subject to the provisions of Article 25 of this Law, pharmaceutical benefit may be obtained from and supplied only by approved suppliers.

(3) The Committee may by order provide for the payment to an approved supplier by an insured person, in such manner as may be prescribed, of such amount as may be prescribed in respect of the supply by that approved supplier of pharmaceutical benefit (hereinafter referred to as “a prescription charge”) and different amounts may be prescribed for different descriptions of pharmaceutical benefit.

(4) Any order made under paragraph (3) of this Article may provide that in such cases or classes of case as may be prescribed, an insured person shall pay such different rate of prescription charge as shall be prescribed, or shall pay no prescription charge.

(5) Any order made under paragraph (3) of this Article may provide that, where an insured person is excepted from liability to pay a prescription charge, the amount of that charge may be recovered from the authority responsible for providing him with assistance when in need.

(6) The Committee shall by order make provision for the remuneration of approved suppliers in respect of pharmaceutical benefit supplied by them in accordance with the provisions of this Law and any such order may prescribe the terms and conditions subject to which pharmaceutical benefit shall be supplied and the terms and conditions subject to which payment for pharmaceutical benefit supplied by approved suppliers will be made.

(7) No order shall be made under paragraph (1) of this Article except after consultation with the Pharmaceutical Benefit Advisory Committee, and no order under paragraph (6) thereof (other than the first order thereunder) shall come into force until the expiration of six months from the date on which it is made.

ARTICLE 25

SUPPLY OF PHARMACEUTICAL BENEFIT BY APPROVED MEDICAL PRACTITIONERS OR APPROVED DENTISTS

Provision may be made by order for enabling approved medical practitioners and approved dentists to supply pharmaceutical benefit, at the cost of the Health Insurance Fund, in cases where it is required for the treatment of an insured person or any of his dependants before the benefit can conveniently be obtained from an approved supplier.

ARTICLE 26

ORDERS IN RELATION TO BENEFIT

(1) Provision may be made by order for such purposes as appear to the Committee to be necessary or expedient for ensuring the due administration of this Law in relation to benefit and in particular but without prejudice to the generality of the foregoing –

(a) for the issue to insured persons of evidence of insurance and for requiring insured persons to produce such evidence to such persons and at such times as may be specified in the order;

(b) for requiring the surrender to the Committee of such evidence on the happening of such events as may be specified in the order;

(c) for disqualifying a person for the receipt of any money benefit unless he makes a claim therefor in the prescribed manner and within the prescribed time and furnishes the prescribed information and evidence;

(d) for requiring approved medical practitioners, approved dentists and approved opticians to submit accounts to insured persons and their dependants in the prescribed form and within the prescribed time;

(e) for entitling an insured person to recover from an approved medical practitioner, approved dentist or approved optician the amount of any money benefit which the insured person has become disqualified for receiving by reason of a failure on the part of the medical practitioner, dentist or optician to comply with any requirement made by virtue of sub-paragraph (d) of this paragraph;

(f) for the payment to an approved medical practitioner, approved dentist or approved optician, in such circumstances as may be prescribed, of any benefit to which an insured person would be entitled in respect of medical, dental or ophthalmic services provided by the medical practitioner, dentist or optician to the insured person or any of his dependants if the insured person had paid fees for those services;

(g) for the payment, to any public or parochial authority which has paid fees to an approved medical practitioner, approved dentist or approved optician in respect of medical, dental or ophthalmic services provided to an insured person or any of his dependants, of any benefit to which the insured person would be entitled if he had paid fees for those services, or of such annual amount as may be agreed between the authority and the Committee as representing the aggregate in that year of such benefit;

(h) as to the information and evidence to be furnished by persons applying for the supply of pharmaceutical benefit.

(2) Provision may also be made by order –

(a) for enabling a person to be appointed to exercise, on behalf of a claimant or beneficiary who may be or become unable for the time being to act, any right or power which the claimant or beneficiary may be entitled to exercise under this Law, and for authorizing a person so appointed to receive and deal with any sum payable by way of money benefit on behalf of the claimant or beneficiary;

(b) in connexion with the death of any person, for enabling a claim for money benefit to be made or proceeded with in the name of the deceased person, for authorizing the payment or distribution of such benefit to or amongst persons claiming as the personal representatives, legatees, heirs or creditors of the deceased person, or in cases of illegitimacy of deceased persons, to or amongst others, and for dispensing with strict proof of the title of persons so claiming.

ARTICLE 27

MONEY BENEFIT TO BE INALIENABLE

Subject to the provisions of this Law, money benefit shall not be capable of being assigned, charged or attached, nor shall it pass to any other person by operation of law, nor shall any claim be set off against the same.

ARTICLE 28

LIMITATION OF AMOUNT OF MONEY BENEFIT

Where the amount of the fee in respect of which any money benefit is payable is less than the amount of the benefit, the amount of the benefit shall be reduced to the amount of the fee.

ARTICLE 29

CLAIMS AND NOTICES SENT BY POST

For the purposes of this Part of the Law, any claim or notice sent by post shall be deemed to have been made or given on the day on which it was posted.

PART V

HEALTH INSURANCE FUND

ARTICLE 30

HEALTH INSURANCE FUND

(1) For the purposes of this Law, there shall be established, under the control and management of the Committee, a fund called “the Health Insurance Fund” into which shall be paid all contributions payable under this Law by employers and insured persons and all sums payable under this Law out of monies provided by the States, and the proceeds of all fines imposed under this Law, and out of which shall be paid all claims for money benefit and all sums payable in respect of pharmaceutical benefit provided under this Law, and all expenses incurred by the Committee in carrying this Law into effect.

(2) Accounts of the Health Insurance Fund shall be prepared in such form, in such manner and at such times as the Committee may determine, and the States’ Auditor shall examine and certify every such account, and copies thereof (together with the report of the States’ Auditor thereon) shall be laid before the States.

(3) Any monies forming part of the Health Insurance Fund may from time to time be paid over to the Treasurer of the States and by him invested, in accordance with such directions as may be given by the Finance Committee, in any loans issued by the States or by Her Majesty’s Government or by the Government of any of Her Majesty’s possessions overseas, or in such securities or in securities of such class as the States, on the recommendation of the Finance Committee, may approve.

(4) There shall be presented to the States annually an account of the securities in which monies forming part of the Health Insurance Fund are for the time being invested.

ARTICLE 31

ACTUARIAL REPORTS

(1) An actuary, appointed for the purpose by the Committee, shall review the operation of this Law during the period ending with the thirty-first day of December next after the expiration of five years from the appointed day and thereafter during the period ending with the thirty-first day of December in every fifth year and, on each such review, make a report to the Committee on the financial condition of the Health Insurance Fund and the adequacy or otherwise of the contributions payable under this Law to support the benefits thereunder having regard to its liabilities under this Law:

Provided that the Committee may at any time reduce the period to be covered by a review and report under this paragraph and accelerate the making of that and subsequent reviews and reports accordingly.

(2) A copy of every report under this Article shall be laid before the States as soon as may be after it is made.

ARTICLE 32

CIVIL PROCEEDINGS TO RECOVER SUMS DUE TO HEALTH INSURANCE FUND

Proceedings for the recovery of sums due to the Health Insurance Fund may be instituted by the Treasurer of the States, either in term or in vacation, and, notwithstanding any enactment or rule of law to the contrary, any such proceedings may be brought at any time within three years from the time when the matter complained of arose.

ARTICLE 33

RECOVERY OF SUMS DUE TO HEALTH INSURANCE FUND BY DEDUCTIONS FROM EARNINGS

(1) Where judgment has been obtained for the payment of any sum due to the Health Insurance Fund by any individual (hereafter in this Article referred to as “the judgment debtor”) then, notwithstanding any enactment or rule of law to the contrary and without prejudice to any other means of recovery, the sum payable under the judgment together with the recoverable costs (hereafter in this Article referred to as “the judgment debt”) may be recovered in accordance with the provisions of this Article.

(2) Where it is desired to recover any judgment debt under this Article –

(a) the Committee may serve notice on the employer for the time being of the judgment debtor requiring him to furnish the Committee, within such time (not being less than seven days) as may be specified in the notice with a certificate of the amount earned by the judgment debtor in the employ of the employer during such past period or periods as may be so specified; and

(b) whether or not such a certificate as aforesaid has been required to be furnished, the Committee may serve notice on the employer for the time being of the judgment debtor requiring him to make such deductions from the earnings of the judgment debtor as may, having regard to all the circumstances of the case, appear to the Committee to be reasonable and to pay the amounts so deducted to the Committee at such times as may be specified in the notice, and the amount so paid shall be applied towards the satisfaction of the judgment debt:

Provided that where the judgment debt has been ordered to be paid by instalments, the Committee shall not require such deductions to be made as would at any date reduce the judgment debt by a greater amount than that by which it would have been reduced had the instalments been paid.

(3) Any employer who refuses or without lawful excuse fails to furnish a certificate which under sub-paragraph (a) of paragraph (2) of this Article he is required to furnish within such time as may be so required, or who furnishes a certificate which is false in a material particular, shall be liable to a fine not exceeding ten pounds.

(4) Any notice under sub-paragraph (b) of paragraph (2) of this Article may at any time be varied by a subsequent notice under that sub-paragraph.

(5) A copy of every notice served under sub-paragraph (b) of paragraph (2) or paragraph (4) of this Article shall be served also on the judgment debtor.

(6) Where any employer fails to deduct any amount which he is required by virtue of sub-paragraph (b) of paragraph (2) of this Article to deduct, or to pay to the Committee any amount so deducted, the amount may be recovered from him as a debt due to the Health Insurance Fund.

(7) Service of any notice under this Article may be effected by sending it by the recorded delivery service to the person on whom it is to be served at his usual or last-known place of abode or his principal place of business or, in the case of a company, at its registered office.

ARTICLE 34

RECOVERY IN BANKRUPTCY, ETC

(1) Where the Royal Court has granted –

(a) an application by any person to place his property under the control of the Court (“de remettre ses biens entre les mains de la Justice”) ; or

(b) an application for the holding of a “bénéfice d’inventaire” on the estate of any deceased person ;

the “autorisés” or the Viscount, as the case may be, shall pay out of the property of such person or the estate of such deceased person any amount due to the Health Insurance Fund by such person or such deceased person at the time of the granting of the application.

(2) In the event of any “dégrèvement”, “réalisation”, “désastre”, bankruptcy or composition with creditors, any amount due to the Health Insurance Fund shall rank for payment pari passu with other privileged debts and in priority to all other debts.

PART VI

APPROVAL OF MEDICAL PRACTITIONERS, DENTISTS, OPTICIANS AND SUPPLIERS OF PHARMACEUTICAL BENEFIT

ARTICLE 35

APPROVAL OF MEDICAL PRACTITIONERS, DENTISTS, OPTICIANS AND SUPPLIERS OF PHARMACEUTICAL BENEFIT

(1) Every medical practitioner, every dentist and every optician who complies with such conditions as the States may by regulations specify shall be approved by the Committee for the purposes of this Law if he applies to the Committee for such approval in the prescribed manner.

(2) Every authorized seller of poisons shall be approved by the Committee as a supplier of pharmaceutical benefit for the purposes of this Law if he applies to the Committee for such approval in the prescribed manner and in the application undertakes to supply pharmaceutical benefit at the prices fixed, and in accordance with the terms and conditions prescribed, from time to time under this Law.

(3) The Committee may also approve any other person as a supplier of pharmaceutical benefit for the purposes of this Law if the Committee considers him competent and if he undertakes to supply the same at the prices fixed, and in accordance with the terms and conditions prescribed, from time to time under this Law.

(4) The Committee shall keep a list of approved medical practitioners, dentists, opticians and suppliers and such list shall be open at all reasonable times to the inspection of any person without fee.

ARTICLE 36

POWER TO TAKE DISCIPLINARY PROCEEDINGS

(1) Where it is represented to the Committee by any person that the conduct of any approved medical practitioner, approved dentist, approved optician or approved supplier (hereafter in this Article referred to as a “practitioner”) has been such as to be prejudicial to the efficient administration of this Law or as to create an unreasonable charge on the Health Insurance Fund, the Committee shall refer the matter to the Health Services Disciplinary Tribunal and the said Tribunal shall enquire into the matter and, if of the opinion that the representation is well-founded, shall recommend to the Committee –

(a) that the approval of the practitioner be withdrawn ; or

(b) where the representation is that the conduct of the practitioner has been such as to create an unreasonable charge on the Health Insurance Fund, that he be required to pay into the Fund an amount not exceeding the amount estimated by the said Tribunal to be that of the additional charges imposed on the Fund by reason of the conduct aforesaid.

(2) Where the Health Services Disciplinary Tribunal recommends to the Committee that the approval of a practitioner should be withdrawn, the Committee may withdraw such approval either for a definite or an indefinite period and may, at any time thereafter, restore such approval if it is of the opinion that it is proper and equitable to do so.

(3) Where the Health Services Disciplinary Tribunal recommends to the Committee that a practitioner should be required to pay an amount into the Health Insurance Fund, the Committee may confirm the recommendation and, in such a case, the practitioner shall pay the said amount to the Committee within the period of twenty-eight days from the date of the communication to him of the decision of the Committee, or within such longer period as the Committee may allow and, if he fails to do so, the Committee shall withdraw his approval and the provisions of paragraph (2) of this Article shall apply accordingly.

(4) Where the approval of a practitioner is withdrawn in accordance with the provisions of paragraph (2) of this Article or where a practitioner is required to pay an amount into the Health Insurance Fund in accordance with the provisions of paragraph (3) of this Article, the practitioner may appeal to the Inferior Number of the Royal Court, either in term or in vacation, against the decision of the Committee.

(5) Where a practitioner appeals against a decision of the Committee under paragraph (3) of this Article and the appeal is abandoned or dismissed, the said paragraph shall have effect as if for the reference therein to the period of twenty-eight days there were substituted a reference to twenty-eight days from the date on which the appeal was abandoned or dismissed.

(6) The decision of the Inferior Number of the Royal Court on an appeal under this Article shall be final and without further appeal, but without prejudice to the right of the Inferior Number of the Royal Court to refer the matter to the Superior Number of the Royal Court.

(7) Provision may be made by order –

(a) as to the procedure to be followed in proceedings before the Health Services Disciplinary Tribunal ; and

(b) for summoning persons to attend and give evidence or produce documents and for authorizing the administration of oaths to witnesses.

It is hereby declared that the power to prescribe procedure includes power to make provision as to the representation of a person, at any hearing of a case, by an advocate or solicitor.

PART VII

ADMINISTRATION

ARTICLE 37

DETERMINATION OF CLAIMS AND QUESTIONS

(1) Subject to the provisions of this Law, provision shall be made by order for the determination by an officer appointed by the Committee (to be known as “the determining officer”) of any question arising under or in connexion with this Law, including any claim for benefit.

(2) Paragraph (1) of this Article shall not apply to any question –

(a) whether or not any person is liable to pay contributions as an employed person, self-employed person or non-employed person, or as an employer ;

(b) whether any person is or was a child or is or was under the upper limit of the compulsory school age ;

(3) Any such question as is referred to in sub-paragraph (a) of paragraph (2) of this Article shall be determined in like manner, subject to the prescribed modifications and adaptations, as the corresponding question arising in respect of a liability to pay contributions under the Insular Insurance Law ; and any decision of any such question, if given for the purposes of that Law, shall have effect also for the purposes of this Law, or if given for the purposes of this Law, shall have effect also for the purposes of that Law.

(4) Any such question as is referred to in sub-paragraph (b) or (c) of paragraph (2) of this Article shall be determined in like manner, subject to the prescribed modifications and adaptations, as the corresponding question arising in respect of an allowance under the Family Allowances Law ; and any decision of any such question, if given for the purposes of that Law, shall have effect also for the purposes of this Law, or if given for the purposes of this Law, shall have effect also for the purposes of that Law.

(5) Orders under paragraph (1) of this Article shall provide –

(a) for appeals to the Health Insurance Tribunal from any decision of the determining officer ;

(b) for the reference to the Inferior Number of the Royal Court for decision of any question of law arising in connexion with the determination of a question by the determining officer or of an appeal by the Health Insurance Tribunal ;

(c) for appeals to the Inferior Number of the Royal Court from a decision of the determining officer or of the Health Insurance Tribunal on any question of law.

(6) The decision of the Inferior Number of the Royal Court on any reference or appeal by virtue of paragraph (5) of this Article shall be final and without further appeal, but without prejudice to the right of the Inferior Number of the Royal Court to refer the question at issue to the Superior Number of the Royal Court.

(7) Subject to the provisions of this Article, any order made thereunder may, in relation to proceedings before the determining officer or the Health Insurance Tribunal in accordance with the order, include provision –

(a) as to the procedure which is to be followed, the form which is to be used for any document, the evidence which is to be required and the circumstances in which any official record or certificate is to be sufficient or conclusive evidence ;

(b) as to the time to be allowed for making any claim or appeal, for raising any question with a view to the review of any decision or for producing any evidence ;

(c) for summoning persons to attend and give evidence or produce documents and for authorizing the administration of oaths to witnesses.

It is hereby declared that the power to prescribe procedure includes power to make provision as to the representation of one person, at any hearing of a case, by another person, whether having professional qualifications or not.

(8) Provision may be made by order that where in any proceedings –

(a) for an offence under this Law ; or

(b) involving any question as to the payment of contributions under this Law ; or

any question arises which is required by an order under this Article to be determined in accordance with the provisions of the order, or is required by paragraph (3) or (4) of this Article to be determined in like manner as a corresponding question arising under the Insular Insurance Law or the Family Allowances Law, the decision of that question on its determination as aforesaid shall be conclusive for the purpose of those proceedings ; and an order under this Article may make provision for obtaining such a decision when it has not been given, and for adjourning the proceedings until such a decision has been given.

ARTICLE 38

EXPENSES OF PERSONS REQUIRED TO ATTEND PROCEEDINGS

(1) The Committee may pay such travelling and other allowances, including compensation for loss of remunerative time, as it may determine –

(a) to any member of the Health Insurance Tribunal, the Health Services Disciplinary Tribunal or the Pharmaceutical Benefit Advisory Committee ;

(b) to any person required to attend before the Health Insurance Tribunal or the Health Services Disciplinary Tribunal.

(2) The Committee may also pay to any such member as aforesaid any other expenses incurred in connexion with his work as such which appear to the Committee to be reasonable.

ARTICLE 39

POWERS OF INSPECTION

(1) Any officer of the Committee generally or specially authorized in writing in that behalf (in this Article referred to as an “inspector”) shall, for the purposes of the execution of this Law, be entitled, subject to the production by him if so required of evidence of his authority, to do all or any of the following things, namely –

(a) to enter at all reasonable times any premises or place liable to inspection under this Article ;

(b) to make such examination and inquiry as may be necessary for ascertaining whether the provisions of this Law are being or have been complied with in any such premises or place ;

(c) to examine, either alone or in the presence of any other person, as he thinks fit, with respect to any matters under this Law on which he may reasonably require information, every person whom he finds in any such premises or place, or whom he has reasonable cause to believe to be or to have been an insured person, and to require every such person to be so examined ;

(d) to require the production of, and to inspect, examine and copy any record or other document kept in pursuance of any order or used or issued for the purposes of this Law or any order ;

(e) to exercise such other powers as may be necessary for carrying this Law into effect.

(2) The occupier of any premises or place liable to inspection under this Article (being any such premises or place as are referred to in sub-paragraph (a) of paragraph (4) of this Article) and any person who is or has been employing any person, and the servants and agents of any such occupier or other person, and any insured person, shall furnish to an inspector all such information and produce for inspection all such documents as the inspector may reasonably require for the purpose of ascertaining whether contributions are or have been payable, or have been duly paid, by or in respect of any person, or whether any person is or was entitled to benefit.

(3) If any person –

(a) wilfully delays or obstructs an inspector in the exercise of any power under this Article ; or

(b) refuses or neglects to answer any question or to furnish any information or to produce any record or document when required to do so under this Article ;

he shall be liable, in the case of a first offence, to a fine not exceeding ten pounds and, in the case of a second or subsequent offence, to a fine not exceeding fifty pounds :

Provided that no person shall be required under this Article to answer any question or to give any evidence tending to incriminate himself.

(4) The premises and places liable to inspection under this Article are –

(a) any premises or place where an inspector has reasonable grounds for supposing that any persons are employed, except that they do not include any private dwelling-house not used by or by permission of the occupier for the purposes of a trade or business ;

(b) any premises or place used, or which during the preceding year have been used, by an approved supplier for the purposes of his business.

ARTICLE 40

INFORMATION AS TO, AND PROOF OF, BIRTHS, MARRIAGES AND DEATHS

(1) The States may make regulations to provide for the furnishing by the superintendent-registrar and registrars, subject to the payment of such fee as may be prescribed by the regulations, of such information for the purposes of this Law, including copies or extracts from the registers in their custody, as may be so prescribed.

(2) Where the age, marriage or death of a person is required to be ascertained or proved for the purposes of this Law, any person shall –

(a) on presenting to the superintendent-registrar, or to the registrar having the custody of the register wherein particulars of the birth, marriage or death, as the case may be, of the first-mentioned person are entered, a duly completed requisition in writing in that behalf ; and

(b) on payment of a fee, in the case of a birth certificate of sixpence and in the case of a marriage or death certificate of one shilling ;

be entitled to obtain a certified copy of the entry of those particulars.

(3) Requisitions for the purposes of paragraph (2) of this Article shall be in such form and contain such particulars as may from time to time be specified by the Committee, and suitable forms thereof shall, on request, be supplied without charge by the Committee.

(4) In this Article, “superintendent-registrar” and “registrar” mean respectively the superintendent-registrar and a registrar of births, marriages and deaths appointed in pursuance of the “Loi (1842) sur l’Etat Civil”.15

PART VIII

MISCELLANEOUS AND GENERAL

ARTICLE 41

SUPPLEMENTARY SCHEMES

(1) Any body of persons claiming to represent, or to be entitled to be treated as representing, insured persons of any class and (if in so far as the class is a class of employed persons) their employers may submit to the Committee a scheme (in this Law referred to as a “supplementary scheme”) for supplementing the rights conferred on those insured persons by this Law, whether by providing for additional payments in respect of medical, dental and ophthalmic services or for the supply of additional medicines, drugs, appliances or materials, or by providing for payments in cases for which benefit is not provided by this Law, or otherwise.

(2) The Committee may by order approve, whether with or without amendment, any supplementary scheme if the Committee is satisfied that it is expedient that the scheme should come into operation :

Provided that the Committee, before approving a supplementary scheme, shall take steps to ascertain, so far as practicable, the views of any insured persons or employers affected thereby who in the opinion of the Committee are not represented by the body submitting the scheme.

(3) Subject to the provisions of this Article, a supplementary scheme may –

(a) apply for the purposes of the scheme (including in particular the purpose of determining any question as to the application of the scheme to any person or class of persons) any of the provisions of this Law or of any orders, with or without modifications ;

(b) make such provision for the constitution of a body to be charged with the administration of the scheme and with respect to the supervision of the administration of the scheme and accounts as the Committee considers to be necessary for the purpose of giving effect to the scheme (including provision for the making of returns to the Committee as to matters affecting the operation of the scheme) ;

(c) provide for the participation of the Committee in the administration of the scheme to such an extent and for such purposes as may be therein specified ;

(d) provide for the defraying, out of any funds which may be available for the purposes of the scheme, of such fees and other charges as may be determined by the Committee, in respect of the participation of the Committee in the administration of the scheme as aforesaid ;

(e) contain such other provisions as the Committee considers to be necessary for the purpose of giving effect to the scheme.

(4) No part of the funds required for providing benefits under a supplementary scheme or otherwise in connexion therewith shall be derived from monies provided by the States :

Provided that nothing in this paragraph shall prevent the making, in respect of persons whose remuneration is or may be defrayed out of monies provided by the States, of a scheme whereunder contributions are payable by employers.

(5) The provisions (other than this Article) of this Law, and the provisions of any orders shall not, except in so far as they are applied by a supplementary scheme, apply to or have effect in relation to or for the purposes of the scheme.

(6) A supplementary scheme, when approved by the Committee, shall continue in force until determined in accordance with the provisions thereof.

(7) The Committee may by order –

(a) vary or amend the provisions of a supplementary scheme in any manner and at any time if so requested by –

(i) the body by whom it was submitted or any other body of persons which, in the opinion of the Committee, is concerned as representing insured persons or employers ; or

(ii) the body charged with the administration of the scheme ; and

(b) where it appears to the Committee that, having regard to any periodic audit and valuation, the fund constituted under the scheme –

(i) is or is likely to become, and is likely to continue to be, insufficient to discharge its liabilities ; or

(ii) is and is likely to continue to be more than reasonably sufficient to discharge its liabilities ;

after consultation with the last mentioned body, make such modifications in any of the rates of contribution or in relation to any benefit under the scheme as appear to the Committee to be required in order to make the fund, as the case may be, sufficient or no more than reasonably sufficient to discharge its liabilities ;

and a supplementary scheme may empower the body charged with the administration of the scheme to make, if the Committee so directs, such temporary modification in any of the rates of contribution or in relation to any benefit under the scheme as are, in the opinion of the Committee, sufficient to secure the solvency of the fund constituted under the scheme.

ARTICLE 42

POWER TO MODIFY OR WIND UP EXISTING SCHEMES

Provision for modifying or winding up, in connexion with the enactment of this Law, any scheme for the provision of medical, dental or ophthalmic services or the supply of pharmaceutical requirements (including any scheme established by or under any enactment and any scheme evidenced only by one or more policies of insurance) may be made by order of such Committee of the States as may be determined by the Finance Committee to be appropriate in relation to the scheme to which the order is to apply or, if the Finance Committee determines that there is no such appropriate Committee, by the Finance Committee itself.

ARTICLE 43

RECIPROCAL AGREEMENTS WITH OTHER COUNTRIES

(1) For the purpose of giving effect to any agreement with the government of the United Kingdom or of any part of Her Majesty’s dominions or the government of any other country (including any agreement between the government of the United Kingdom and the government of any part of Her Majesty’s dominions or of any other country which has been extended or applies to the Island) providing for reciprocity in matters relating to the treatment of sickness and bodily defects, it shall be lawful for the States, by Act, to make provision for modifying or adapting this Law in its application to cases affected by the agreement.

(2) The modifications of this Law which may be made by virtue of paragraph (1) of this Article shall include provision –

(a) for securing that acts, omissions and events having any effect for the purposes of the law of the country in respect of which the agreement is made shall have a corresponding effect for the purposes of this Law (but not so as to confer a right to double benefit) ;

(b) for making any provisions as to administration and enforcement contained in this Law, or in any enactment thereunder, applicable also for the purposes of the law of the said country ;

ARTICLE 44

GENERAL PROVISIONS AS TO OFFENCES AND PENALTIES

(1) If any person –

(a) makes or knowingly utters or, unless he shows a lawful excuse, has in his possession any fictitious insurance stamp ; or

(b) makes or, unless he shows a lawful excuse, has in his possession, any die, plate, instrument or materials for making any fictitious insurance stamp ; or

(c) buys, sells or offers for sale, takes or gives in exchange, or pawns or takes in pawn any insurance card or any used insurance stamp or any fictitious insurance stamp ; or

(d) fraudulently removes any insurance stamp from any insurance card ; or

(e) affixes any used insurance stamp or any fictitious insurance stamp to any insurance card ; or

(f) fraudulently erases or otherwise removes any mark from any used insurance stamp with the intent that further use should be made of such stamp ; or

(g) for the purpose of obtaining any benefit or payment under this Law, whether for himself or some other person, or for any other purpose connected with this Law –

(i) knowingly makes any false statement or false representation or withholds any material information ; or

(ii) produces or furnishes, or causes or knowingly allows to be produced or furnished, any document or information which he knows to be false in a material particular ; or

(h) with intent to deceive –

(i) forges or alters any document issued for the purposes of this Law ; or

(ii) uses, or lends to or allows to be used by any other person, any such document ; or

(iii) has in his possession any document so closely resembling such a document as to be calculated to deceive ;

he shall be liable to a fine not exceeding one hundred pounds or to imprisonment for a term not exceeding three months or to both such fine and such imprisonment.

(2) Provision may be made by order for the recovery of monetary penalties in respect of any offence under this Law, being a contravention of or failure to comply with any provisions of the order, so, however, that such penalties shall not exceed ten pounds for each offence, together with, in the case of a continuing offence, a further ten pounds for each day during which the offence continues after conviction thereof.

(3) Where any offence under this Law which has been committed by a body corporate is proved to have been committed with the consent or connivance of, or to be attributable to any negligence on the part of, any director, manager, secretary or other officer of the body corporate, he as well as the body corporate, shall be deemed to be guilty of that offence and shall be liable to be proceeded against and punished accordingly.

(4) In any proceedings under paragraph (1) of this Article with respect to used stamps, a stamp shall be deemed to have been used if it has been affixed to an insurance card or cancelled or defaced in any way whatsoever and whether it has actually been used for the purpose of payment of a contribution or not.

(5) In this Article –

“fictitious insurance stamp” means any facsimile, imitation or representation of any insurance stamp and includes any stamp which has been fraudulently printed or impressed from a genuine die ;

“insurance card” means any card issued under any order for the purpose of the payment of contributions by affixing insurance stamps thereto.

(6) Nothing in this Article shall be construed as preventing the recovery by means of civil proceedings of any sums due to the Health Insurance Fund.

ARTICLE 45

GENERAL PROVISIONS AS TO PROSECUTIONS

(1) Any proceedings which may be taken against any person under this Law may be taken at any time not later than twelve months from the date of the commission of the alleged offence or within the period of three months from the date on which evidence, sufficient in the opinion of the Committee to justify the proceedings, comes to the knowledge of the Committee or, where the person in question was outside the Island at that date, within the period of twelve months from the date on which he first lands in the Island thereafter, whichever of the said periods last expires.

(2) For the purposes of paragraph (1) of this Article, a certificate, purporting to be signed on behalf of the Committee, as to the date on which such evidence as aforesaid came to the knowledge of the Committee shall be conclusive evidence thereof.

(3) In any proceedings for an offence under this Law, the wife or husband of the accused shall be competent to give evidence, whether for or against the accused :

Provided that the wife or husband shall not be compellable either to give evidence or, in giving evidence, to disclose any communication made to her or him by the accused during the marriage.

ARTICLE 46

GENERAL PROVISIONS AS TO ACTS, REGULATIONS AND ORDERS

(1) Except in so far as this Law otherwise provides, any power conferred thereby to make any Act, regulations or order may be exercised –

(a) either in relation to all cases to which the power extends, or in relation to all those cases subject to specified exceptions, or in relation to any specified cases or classes of case ;

(b) so as to make, as respects the cases in relation to which it is exercised –

(i) the full provision to which the power extends or any less provision (whether by way of exception or otherwise) ;

(ii) the same provision for all cases in relation to which the power is exercised or different provision for different cases or classes of case, or different provision as respects the same case or class of case for different purposes of this Law ;

(iii) any such provision either unconditionally or subject to any specified condition.

(2) Without prejudice to any specific provision of this Law, any Act, regulations or order under this Law may contain such incidental or supplementary provisions as appear to the States or, as the case may be, the Committee making the order, to be expedient for the purposes of the Act, regulations or order.

(3) The Subordinate Legislation (Jersey) Law, 1960, shall apply to orders made under this Law.

ARTICLE 47

AMENDMENT OF INSULAR INSURANCE LAW

(1) In paragraph (1) of Article 1 of the Insular Insurance Law,16 after the definition of “entry into insurance” there shall be inserted the definition –

“ ‘the Health Insurance Law’ means the Health Insurance (Jersey) Law, 1967;”.

(2) For paragraph (1) of Article 10 of the Insular Insurance Law17 there shall be substituted the following paragraph –

“(1) Provision may be made by order –

(a) for any matters incidental to the payment and collection of contributions under this Law, including the coordination thereof with the payment and collection of contributions under the Health Insurance Law and the modification in that behalf of that Law ;

(b) for treating, for the purpose of any right to benefit, contributions paid after the due dates as paid on those dates or on such later dates as may be prescribed, or as not having been paid, and for treating, for the purpose aforesaid, contributions payable by an employer on behalf of an insured person, but not paid, as paid where the failure to pay is shown not to have been with the consent or connivance of, or attributable to any negligence on the part of, the insured person ;

(c) for treating contributions of the wrong class or at the wrong rate as paid on account of contributions properly payable or on account of contributions under the Health Insurance Law, and for treating contributions under that Law which were not payable as paid on account of contributions under this Law, notwithstanding anything in that Law ;

(d) for the return of contributions under this Law paid in error ;

(e) (without prejudice to any other remedy) for the recovery, on prosecutions brought under or by virtue of this Law, of contributions under this Law or under the Health Insurance Law.”

ARTICLE 48

SAVING

For the avoidance of doubt, it is hereby declared that nothing in this Law shall be deemed to authorize any person to undertake any work, provide any service or supply any goods which, under any other enactment, he is prohibited from undertaking, providing or supplying.

ARTICLE 49

PROVISIONS AS TO COMMENCEMENT

(1) In this Law, the expression “the appointed day” means, subject to the following provisions of this Article, such day as the States may by Act appoint and different days may be appointed for different purposes of this Law or for the same purpose in relation to different cases or classes of case.

(2) Any Act under paragraph (1) of this Article may, if the day thereby appointed is appointed for some only of the purposes of this Law or in relation only to some cases or classes of case, contain such incidental or supplementary provisions as appear to the States to be necessary or expedient as respects the period when this Law is to have a partial operation only or as respects the transition from that period to the period when this Law is in full operation.

(3) Without prejudice to the generality of the provisions of paragraph (2) of this Article, the provisions which may be made thereunder include, in particular, provision for modifying and supplementing the provisions of this Law in relation to the period to which the Act is to apply, and such modifications may include provisions reducing the rates of any contributions payable for any period during which this Law is to operate as respects some only of the benefits thereby conferred.

ARTICLE 50

SHORT TITLE

This Law may be cited as the Health Insurance (Jersey) Law, 1967.

SCHEDULES

FIRST SCHEDULE

(Article II)

CONTRIBUTION RATES

PART I

EMPLOYED PERSONS

Description of employed person	Weekly rate of contribution
	s. d.
Men between the ages of 18 and 70... ...	2 0
Women between the ages of 18 and 65 ...	2 0
Boys under the age of 18 ... ... ... ...	1 0
Girls under the age of 18 ... ... ... ...	1 0

PART II

EMPLOYERS

Description of employed person	Weekly rate of contribution
	s. d.
Men between the ages of 18 and 70... ...	1 0
Women between the ages of 18 and 65 ...	1 0
Boys under the age of 18 ... ... ... ...	6
Girls under the age of 18 ... ... ... ...	6

For the purpose of this Part of this Schedule, a person over compulsory insurance age, not being an insured person, shall be treated as an employed person if he would be an insured person were he under compulsory insurance age and would be an employed person were he an insured person.

PART III

SELF-EMPLOYED PERSONS

Description of self-employed person	Weekly rate of contribution
	s. d.
Men between the ages of 18 and 70... ...	3 0
Women between the ages of 18 and 65 ...	3 0
Boys under the age of 18 ... ... ... ...	1 6
Girls under the age of 18 ... ... ... ...	1 6

PART IV

NON-EMPLOYED PERSONS

Description of non-employed person	Weekly rate of contribution
	s. d.
Men between the ages of 18 and 70... ...	3 0
Women between the ages of 18 and 65 ...	3 0
Boys under the age of 18 ... ... ... ...	1 6
Girls under the age of 18 ... ... ... ...	1 6

SECOND SCHEDULE

(Articles 1 and 24)

PHARMACEUTICAL BENEFIT ADVISORY COMMITTEE

1.-(1) In this Schedule, “the Advisory Committee” means the Pharmaceutical Benefit Advisory Committee.

(2) References in this Schedule to approved suppliers are references to approved suppliers who are pharmaceutical chemists.

2. The Advisory Committee shall consist of : -

(a) a chairman and two other persons appointed by the Committee ;

(b) a pharmaceutical chemist appointed by the Committee ;

(d) two approved medical practitioners and two approved suppliers, appointed in accordance with the provisions of paragraph 6 of this Schedule.

3. The Committee shall appoint a secretary of the Advisory Committee and there shall be paid to the secretary such remuneration and allowances as the Committee thinks fit.

4.-(1) The chairman and other appointed members of the Advisory Committee shall hold office for a period of twelve months ending on the twelfth day of April and shall be re-eligible :

Provided that the first chairman and members shall be appointed as soon as may be after the appointed day and shall remain in office until the twelfth day of April next following.

(2) The chairman or any appointed member of the Advisory Committee shall cease to hold office –

(a) if he tenders his resignation in writing to the Committee ; or

(b) if he appoints a special attorney without whom he may not transact in matters real or personal ; or

(d) if, without reasonable excuse, he absents himself from three consecutive meetings of the Advisory Committee.

(3) A person appointed to fill a casual vacancy in the office of chairman or member of the Advisory Committee shall hold office until the date on which the person in whose place he is appointed would have ceased to hold office.

5. The following persons shall be ineligible for appointment under paragraph 2(a) of this Schedule, namely, members of the States, medical practitioners, dentists, opticians and pharmaceutical chemists, and persons who hold any paid office or other place of profit under the Crown or the States or any administration of the States or any parochial authority.

6. The approved medical practitioners and approved suppliers to be appointed in pursuance of paragraph 2(d) of this Schedule shall be appointed respectively by the persons who on the twenty-first day preceding that on which the term of office is to commence are approved medical practitioners or, as the case may be, approved suppliers.

7. The Advisory Committee shall appoint one of the members appointed in pursuance of paragraph 2(a) of this Schedule to be vice-chairman of the Advisory Committee, and in the absence of the chairman the vice-chairman shall preside at meetings of the Advisory Committee.

8. Subject to the provisions of paragraph 7 of this Schedule, any member of the Advisory Committee may appoint a deputy to act on his behalf at any meeting of the Advisory Committee at which he is unable to be present and if a deputy has been so appointed and his appointment notified to the secretary of the Advisory Committee he shall be entitled to act in the place of the person by whom he is appointed :

Provided that an approved medical practitioner or an approved supplier may only appoint a person of like qualifications to act on his behalf.

9. On any matter on which the votes of the Advisory Committee are divided, the manner in which the members have voted shall be recorded.

10. The Committee may by order make provision for regulating any matter which, in its opinion, requires regulating for the purpose of carrying any of the provisions of this Schedule into effect.

THIRD SCHEDULE

(Articles 1 and 36)

HEALTH SERVICES DISCIPLINARY TRIBUNAL

1. In this Schedule, “the Tribunal” means the Health Services Disciplinary Tribunal.

2. The States, on the recommendation of the Committee, shall appoint from among the advocates and solicitors of the Royal Court of not less than five years standing, to hold office during such period as the States may direct, a chairman of the Tribunal to preside at sittings of the Tribunal and a deputy chairman of the Tribunal to preside at such sittings where the chairman is unable to preside or is an interested party to the matter before the Tribunal.

3.-(1) The States, on the recommendation of the Committee, shall constitute a panel of not less than five persons who may be called upon to serve as members of the Tribunal.

(2) The following persons shall be ineligible for inclusion in the said panel, namely, Jurats, members of the States, advocates and solicitors of the Royal Court, medical practitioners, dentists, opticians and pharmaceutical chemists, and persons who hold any paid office or other place of profit under the Crown or the States or any administration of the States or any parochial authority.

(3) The constitution of the said panel may be reviewed from time to time, and the States, on the recommendation of the Committee, may make such additions thereto and deletions therefrom as they consider necessary.

4.-(1) The Committee shall constitute four panels of persons who may be called upon to serve as members of the Tribunal, namely –

(a) a panel of not less than four medical practitioners ;

(b) a panel of not less than four dentists ;

(d) a panel of not less than four pharmaceutical chemists.

(2) In relation to the constitution of each of the panels mentioned in sub-paragraph (1) of this paragraph, the Committee shall consult with such insular organization as it may recognize as representative of the profession concerned.

(3) The constitution of the said panels may be reviewed from time to time and, subject to sub-paragraph (2) of this paragraph, the Committee may make such additions thereto or deletions therefrom as it considers necessary.

5. The Tribunal shall consist of the chairman or deputy chairman and of four members selected by the Committee for each sitting, two from the panel constituted under paragraph 3 of this Schedule and two from a panel constituted under paragraph 4 of this Schedule, being persons belonging to the same profession as the person whose case is being investigated.

6. The Committee shall appoint a secretary of the Tribunal and there shall be paid to the secretary such remuneration and allowances as the Committee thinks fit.

FOURTH SCHEDULE

(Articles 1 and 37)

HEALTH INSURANCE TRIBUNAL

1. In this Schedule, “the Tribunal” means the Health Insurance Tribunal.

2. The Tribunal shall consist of a chairman and five other members appointed by the States, on the recommendation of the Committee.

3.-(1) The chairman and members of the Tribunal shall hold office for a term of three years ending on the twelfth day of April and shall be re-eligible :

Provided that the first chairman and members shall be appointed as soon as may be after the appointed day and shall remain in office until the twelfth day of April of the third year next following that in which they are appointed.

(2) The chairman or any appointed member of the Tribunal shall cease to hold office –

(a) if he tenders his resignation in writing to the Committee ; or

(b) if he appoints a special attorney without whom he may not transact in matters real or personal ; or

(d) if, without reasonable excuse, he absents himself from a session of the Tribunal at which he is summoned to attend.

(3) A person appointed to fill a casual vacancy in the office of chairman or member of the Tribunal shall hold office until the date on which the person in whose place he is appointed would have ceased to hold office.

4. Of the five other members of the Tribunal, three only, to be selected by the Committee, shall be summoned to attend any particular session of the Tribunal.

5. Where the chairman of the Tribunal is unable to act, the Committee shall designate one of the five other members of the Tribunal to act as deputy chairman.

E.J.M. POTTER,

Deputy Greffier of the States.

1 Tome 1951–1953, page 322.

2 Tome 1961–1962, page 136.

3 Tome 1951–1953, page 87.

4 Tome 1949–1950, page 497.

5 Tome 1957–1960, page 493.

6 Tome 1961–1962, page 145.

7 Tome 1961–1962, page 603.

8 Tome 1951–1953, page 326 and Tome 1957–1960, page 389.

9 Tomes IV-VI, page 303.

10 Tome 1951–1953, page 88.

11 See page 545.

12 Tome 1949–1950, page 511.

13 Tome 1949–1950, page 515.

14 Tome 1949–1950, page 510.

15 Tome I, page 276.

16 Tome 1949–1950, page 497.

17 Tome 1949–1950, page 514.

Page Last Updated: 09 Jun 2015

Jersey Legal Information Board

Promoting access to justice in Jersey

Search this site

Health Insurance (Jersey) Law 1967