NATIONAL HEALTH INSURANCE ACT,
2003 (ACT 650)
ARRANGEMENT OF SECTIONS
PART I—ESTABLISHMENT AND
FUNCTIONS OF THE NATIONAL HEALTH
INSURANCE COUNCIL
Section
1. Establishment of the Council
2. Object and functions of the
Council
3. Membership of the Council
4. Tenure of office of members
5. Meetings of the Council
6. Disclosure of interest
7. Committees of the Council
8. Health Complaint Committee
of the Council
9. Allowances for members
10. Ministerial directives
PART II—TYPES, REGISTRATION AND
LICENSING OF HEALTH INSURANCE
SCHEMES
11. Types of health insurance
schemes
12. Qualification for
application
13. Application for registration
and licence
14. Registration and issue of
licence
15. Further conditions
16. Fee for issue of licence
17. Duration and renewal of a
licence
18. Variation of conditions of
licence
19. Refusal to register and
licence a scheme
20. Suspension or revocation of
licence of a scheme
21. Interim management of a
scheme
22. Representations to the
Minister
23. Prohibition of provision of
health insurance service without
licence
24. Limitation to provision of
health insurance
25. Prohibition in use of name
unless licensed
26. Transfer and joint
operations
27. Gazette notification
28. Display of licence
PART III—DISTRICT MUTUAL HEALTH
INSURANCE SCHEMES
29. Establishment of district
mutual health insurance scheme
30. Head office of a district
mutual health insurance scheme
31. Application for membership
32. Members of district mutual
health insurance schemes
33. Benefit of members and
subsidy
34. Contribution by members
35. Investments and management
of funds of a district mutual
health insurance scheme
36. Minimum membership
37. Transfer of residence
38. Indigent members
PART IV—PRIVATE HEALTH INSURANCE
SCHEMES
Sub Part I—Private Commercial
Health Insurance Schemes
39. Establishment of private
commercial health insurance
scheme
40. Membership
41. Business venture
42. Contribution of members
43. Provision of security
44. Withdrawal from the security
deposit
45. Application of Insurance Law
1989 (P.N.D.C.L. 227)
Sub-Part II—Private Mutual
Health Insurance Scheme
46. Establishment of private
mutual health insurance scheme
47. Headquarters of a private
mutual health insurance schemes
48. Management of a private
mutual health insurance scheme
49. Security deposit
50. Benefit of members
51. Contribution by members
52. Minimum membership
53. No subsidy for private
mutual health insurance scheme
PART V—GENERAL PROVISIONS
APPLICABLE TO OPERATION OF
HEALTH INSURANCE SCHEMES
54. Governing body, appointment
of scheme managers and other
employees
55. Participation by dependants
56. Financial obligation of
schemes
57. Annual reports, accounts and
audit of schemes
58. Amendment of annual report
59. Standards of principal
officers of scheme
60. Notification of certain
changes
61. Furnishing of information to
Council
62. Inspection of annual report
63. Financial year of schemes
64. Minimum health care benefits
65. Health insurance identity
card
66. Termination or suspension of
membership
67. Settlement of complaints
68. Quality assurance
69. Safeguards to prevent over
or under use of healthcare
services
70. Accreditation of healthcare
providers and health facilities
71. Tariffs payable to
healthcare providers
72. Actuary
73. Powers of actuary
74. Inspection of schemes
75. Directives of Council
PART VI—NATIONAL HEALTH
INSURANCE FUND
76. Establishment of a National
Health Insurance Fund
77. Object of the Fund
78. Sources of money for the
Fund
79. Formula for disbursement
from the Fund
80. Bank account for the Fund
81. Conditions for provision of
subsidy to district mutual
health insurance schemes
82. Management of the Fund
83. Investment of the Fund
84. Expenses of the Fund
85. Accounts, auditing, and
annual report
PART VII—NATIONAL HEALTH
INSURANCE LEVY
86. Imposition of national
health insurance levy
87. Exempt supply
88. Zero-rated supply
89. Relief from levy
90. Collection of the levy
91. Payment of levy into the
Fund
PART VIII—ADMINISTRATIVE,
FINANCIAL AND MISCELLANEOUS
PROVISIONS
92. Executive Secretary of the
Council
93. Units of the Council
94. Appointment of internal
auditor
95. Appointment of other staff
96. Delegation of appointment
97. District offices of the
Council
98. Expenses of the Council
99. Accounts and audit
100. Annual report and other
reports of the Council
101. No cancellation of a scheme
registered with Registrar of
companies
102. Offences
103. Regulations
104. Interpretation
105. Disapplication of
P.N.D.C.L. 227 to health
insurance schemes
106. Transitional provision
107. Commencement of payment of
levy
SCHEDULE
Part I—Exempt supplies
Part II—Zero-rated supplies
Part III—Relief
THE SIX HUNDRED AND FIFTIETH\
ACT OF THE PARLIAMENT OF THE
REPUBLIC OF GHANA
ENTITLED
THE NATIONAL HEALTH INSURANCE
ACT, 2003
AN ACT to secure the provision
of basic healthcare services to
persons resident in the country
through mutual and private
health insurance schemes; to put
in place a body to register,
license, and regulate health
insurance schemes and to
accredit and monitor healthcare
providers operating under health
insurance schemes; to establish
a National Health Insurance Fund
that will provide subsidy to
licensed district mutual health
insurance schemes; to impose a
health insurance levy and to
provide for purposes connected
with these.
DATE OF ASSENT: 5th September;
2003.
BE IT ENACTED by Parliament as
follows:
PART I—ESTABLISHMENT AND
FUNCTIONS OF THE NATIONAL HEALTH
INSURANCE COUNCIL
Section 1—Establishment of the
Council.
(1) There is established by this
Act a body corporate to be known
as the National Health Insurance
Council referred to in this Act
as the "Council".
(2) The Council shall have
perpetual succession, an
official seal and may sue and be
sued in its own name.
(3) The Council may for the
discharge of its functions
acquire and hold movable and
immovable property and may enter
into contract or other
transaction.
Section 2—Object and Functions
of the Council.
(1) The object of the Council is
to secure the implementation of
a national health insurance
policy that ensures access to
basic healthcare services to all
residents.
(2) For the purposes of
achieving its object, the
Council has the following
responsibilities:
(a) register, licence and
regulate health insurance
schemes,
(b) supervise the operations of
health insurance schemes;
(c) grant accreditation to
healthcare providers and monitor
their performance;
(d) ensure that healthcare
services rendered to
beneficiaries of schemes by
accredited healthcare providers
are of good quality;
(e) determine in consultation
with licensed district mutual
health insurance schemes,
contributions that should be
made by their members;
(f) approve health identity
cards for members of schemes;
(g) provide a mechanism for
resolving complaints by schemes,
members of schemes and
healthcare providers;
(h) make proposals to the
Minister for the formulation of
policies on health insurance;
(i) undertake on its own or in
collaboration with other
relevant bodies a sustained
public education on health
insurance;
(j) devise a mechanism for
ensuring that the basic
healthcare needs of indigents
are adequately provided for;
(k) maintain a register of
licensed health insurance
schemes and accredited
healthcare providers;
(l) manage the National Heath
Insurance Fund established under
Part VI;
(m) monitor compliance with
this Act and Regulations made
under it and pursue action to
secure compliance; and
(n) perform any other function
conferred upon it under this Act
or that are ancillary to the
object of the Council.
Section 3—Membership of the
Council.
(1) The Council is composed of
(a) a chairperson;
(b) a representative of the
Ministry of Health not below the
rank of a Director;
(c) a representative of the
Ghana Health Service not below
the rank of a Director,
(d) one representative of the
Society of Private Medical and
Dental Practitioners nominated
by the Ghana Medical
Association;
(e) one representative of the
Pharmaceutical Society of Ghana;
(f) one representative each of
licensed
(i) mutual health insurance
schemes;
(ii) private health insurance
schemes;
(g) one representative of the
Minister responsible for Finance
not below the rank of a
Director;
(h) one legal practitioner with
experience in health insurance
nominated by the Ghana Bar
Association;
(i) one representative of the
National Insurance Commission;
(j) one person representing
Organised Labour;
(k) two persons representing
consumers one of whom shall be a
woman;
(l) a representative each from
(i) the Ministry of Local
Government;
(ii) Social Security and
National Insurance Trust
(SSNIT); and
(m) the Executive Secretary
appointed under section 92.
(2) The chairperson and the
other members of the Council
shall be appointed by the
President in consultation with
the Council of State.
Section 4—Tenure of Office of
Members.
(1) A member of the Council
other than an ex-officio member
shall hold office for a period
not exceeding three years and is
on the expiration of that period
eligible for re-appointment but
no person shall hold office for
more than two terms in
succession.
(2) Where a member of the
Council other than an ex-officio
member resigns, dies, is removed
from office or is for any reason
unable to act as a member of the
Council, the chairperson shall
notify the President through the
Minister, of the vacancy and the
President shall on the advice of
the nominating authority, where
applicable, and acting in
consultation with the Council of
State, appoint another person to
hold office for the unexpired
portion of the member's term of
office.
(3) A member of the Council
other than an ex-officio member
may at any time resign his or
her office in writing addressed
to the President through the
Minister.
(4) A member of the Council
other than an ex-officio member
who is absent from three
consecutive meetings of the
Council without sufficient cause
shall cease to be a member of
the Council.
(5) The President shall by
letter addressed to a member
nominated by a body as its
representative on the Council
revoke the appointment of that
member at the request of the
body.
(6) A member may be removed from
the Council by the President for
stated misbehaviour or for any
just cause.
(7) The chairperson shall
through the Minister notify the
President in writing of any
vacancy that occurs on the
Council within thirty days of
the occurrence of the vacancy.
Section 5—Meetings of the
Council.
(1) The Council shall meet for
the despatch of business at such
times and places as the
chairperson may determine but
shall meet at least once every
three months.
(2) The chairperson shall at the
request in writing of not less
than one-third of the membership
of the Council convene an
extraordinary meeting of the
Council at such place and time
as the chairperson may
determine.
(3) The quorum at a meetings of
the Council shall be seven
members of the Council including
the Executive Secretary.
(4) Every meeting of the Council
shall be presided over by the
chairperson and in the absence
of the chairperson, by a member
of the Council elected by the
members present from among their
number.
(5) Matters before the Council
shall be decided by a majority
of the members present and
voting and in the event of a tie
of votes, the person presiding
shall have a second or casting
vote.
(6) The Council may co-opt any
person to attend a Council
meeting but that person is not
entitled to vote on any matter
for decision by the Council.
(7) The proceedings of the
Council shall not be invalidated
because of a vacancy among the
members or a defect in the
appointment or qualification of
a member.
(8) Subject to this section the
Council shall determine the
procedure for its meetings.
Section 6—Disclosure of
Interest.
(1) A member of the Council who
has an interest in any contract,
or other transaction proposed to
be entered into with the Council
or any application before the
Council shall disclose in
writing the nature of the
interest and shall be
disqualified from participating
in any deliberations of the
Council in respect of the
contract, application or other
transaction.
(2) A member who infringes
subsection (1) is liable to be
removed from the Council.
Section 7—Committees of the
Council.
The Council may for the
discharge of its functions
appoint committees composed of
members of the Council or
non-members or both and assign
to the committees such of its
functions as it may determine
except that a committee composed
entirely of non-members may only
advise the Council.
Section 8—Health Complaint
Committee of the Council.
(1) Without limiting the scope
of section 7, there is hereby
established a committee of the
Council to be known as the
Health Complaint Committee.
(2) The composition of the
Health Complaint Committee shall
be determined by the Council
except that the chairperson
shall be a member of the
Council.
(3) The Health Complaint
Committee shall,
(a) be responsible for hearing
and resolving complaints that
may be submitted to the Council
by members of health insurance
schemes, the schemes and
healthcare providers; and
(b) perform such other functions
as the Council may determine.
(4) The Health Complaint
Committee shall be decentralized
and established in every
district office of the Council.
(5) The procedure of the
Committee and sanctions that may
be imposed by the Council upon
recommendation of the Committee
shall be prescribed by
Regulations.
Section 9—Allowances for
Members.
There shall be paid to the
members of the Council, members
of a committee of the Council
and persons co-opted to attend
meetings of the Council, such
travelling and other allowances
as may be approved by the
Minister in consultation with
the Minister responsible for
Finance.
Section 10—Ministerial
Directives.
The Minister may give to the
Council directives of a general
nature on matters of policy and
the Council shall comply with
the directives.
PART II—TYPES, REGISTRATION AND
LICENSING OF HEALTH INSURANCE
SCHEMES
Section 11—Types of Health
Insurance schemes.
The following types of health
insurance schemes may be
established and operated in the
country:
(a) district mutual health
insurance schemes;
(b) private commercial health
insurance schemes; and
(c) private mutual health
insurance schemes.
Section 12—Qualification for
Application.
A person does not qualify to
apply to operate a health
insurance scheme in this country
unless,
(a) in the case of a district
mutual or private mutual health
insurance scheme, it is
registered as a company limited
by guarantee; or
(b) in the case of a private
commercial health insurance
scheme, it is registered as a
limited liability company under
the Companies Code 1963 (Act
179).
Section 13—Application for
Registration and Licence.
(1) Application for
registration and licence to
operate any health insurance
scheme shall be made to the
Council in the prescribed form.
(2) The application shall be
submitted with the following
documents, information and
particulars as are relevant:
(a) two copies of the
constitution, bye-laws or rules
intended to govern the operation
of the scheme;
(b) the names and particulars
of members of the governing body
of the proposed scheme;
(c) the persons proposed to
manage or administer the scheme
and the qualifications of the
persons;
(d) a statement of the minimum
number of persons to be covered
by the scheme;
(e) the proposed healthcare
providers and healthcare
facilities available to or
proposed to be used by the
scheme;
(f) the healthcare benefits
available under the scheme;
(g) the proposed minimum
contribution for membership; and
(h) evidence of the
availability of any minimum
financial security, where
applicable, required in respect
of the type of scheme.
(3) The Council may require an
applicant to furnish it with
such other information as the
Council considers necessary to
determine the application.
Section 14—Registration and
Issue of Licence.
(1) The Council may register an
applicant and issue it a licence
to operate the relevant scheme
applied for, where the Council
is of the opinion that,
(a) the applicant qualifies to
be registered and licensed
having regard to the scheme to
which the application relates;
(b) the applicant has qualified
officers to manage and
administer the scheme;
(c) the applicant intends not to
carry on any other activity
except the operation of the
health insurance scheme applied
for; and
(d) the applicant has complied
with all requirements under this
Act and any other enactment
applicable to the type of health
insurance scheme applied for.
(2) A person shall not operate
a health insurance scheme of any
type in this country unless it
has been registered with the
Council and issued a licence for
the purpose.
Section 15—Further Conditions.
Notwithstanding section 14 the
Council may, as a condition for
issuing a licence, impose such
other terms and conditions as
shall be prescribed by
Regulations made under this Act.
Section 16—Fee for Issue of
Licence.
The Council in consultation with
the Minister may by Regulations
impose fees for the issue of a
licence under this Act.
Section 17—Duration and Renewal
of a Licence.
(1) A licence to operate a
health insurance scheme expires
two years from the date of issue
of the licence.
(2) The licence may on an
application be renewed for
further periods of two years at
a time.
(3) An application for renewal
of a licence shall be made not
later than three months before
the expiry of the licence.
(4) Where an application for
renewal is made and the licence
expires before the Council
determines the application, the
licence shall be deemed to be in
force until the application for
renewal is determined by the
Council.
Section 18—Variation of
Conditions of Licence.
(1) Subject to conditions
prescribed by Regulations made
under this Act, the Council may,
upon giving reasonable written
notice to a scheme,
(a) vary or revoke any condition
of a licence; or
(b) impose new conditions.
(2) A scheme may apply to the
Council in writing for a
condition of a licence to be
revoked or varied.
(3) Where, on an application
made under subsection (2), the
Council is satisfied that the
condition for a licence is no
longer necessary or should be
varied, it may revoke or vary
the condition.
(4) Where the Council revokes or
varies a condition for a licence
or imposes a new condition, the
scheme shall deliver its licence
to the Council for the licence
to be varied accordingly.
Section 19—Refusal to Register
and Licence a Scheme.
(1) The Council may refuse to
register and issue a licence for
a scheme and it shall notify the
applicant in writing of its
decision, stating the reasons.
(2) Where the refusal to
register and issue a licence is
as a result of a non-material
defect in the application, the
Council may in the notice
require the applicant to rectify
the application within a
specified period.
Section 20—Suspension or
Revocation of Licence of a
Scheme.
(1) The Council may suspend or
revoke the licence of a scheme
where the Council is satisfied
that the scheme
(a) has in any manner acted
fraudulently;
(b) has lost its financial
ability to continue to operate;
(c) is not operating in
accordance with good
administrative and accounting
practices and procedures; or
(d) has failed to comply with
provisions of this Act,
Regulations made under this Act
or any other enactment
applicable to the scheme.
(2) The Council shall before
suspending or revoking the
licence, give the scheme notice
of the default and provide it an
opportunity to make
representations to the Council.
(3) Where a licence expires, is
revoked or suspended, the
council may apply to a court for
an order to protect and preserve
the contribution of members and
for such orders as the court may
consider appropriate having
regard to the best interest of
members of the scheme.
Section 21—Interim Management of
a Scheme.
The Council, after consultation
with the governing body of a
scheme, may upon suspending or
revoking the licence,
(a) place the scheme under an
interim management team; or
(b) arrange for the transfer of
the activities or business of
the scheme to another scheme
subject to conditions that are
agreed upon by the parties and
approved by the Council.
Section 22—Representations to
the Minister.
(1) A person refused
registration or whose licence is
suspended or revoked by the
Council may within sixty days
after the date of receipt of
notification of refusal,
suspension or revocation make
representations to the Minister
for a determination.
(2) The Minister shall make a
determination within thirty days
of receipt of the
representations.
(3) A person dissatisfied with
the determination of the
Minister may seek such remedy as
is open to the person in the
courts.
Section 23—Prohibition of
Provision of Health Insurance
Service without Licence.
(1) A person shall not provide
health insurance service or
operate a health insurance
scheme unless the scheme is
registered with the Council and
issued with a licence for the
purpose by the Council.
(2) A person who acts contrary
to subsection (1) commits an
offence and is liable on summary
conviction to a fine of not less
than 200 penalty units or
imprisonment for a minimum term
of 6 months or both.
Section 24—Limitation to
Provision of Health Insurance.
A health insurance scheme
registered and licensed under
this Act shall not carry on any
activities other than securing
provision of healthcare to its
members.
Section 25—Prohibition in use of
Name unless Licensed.
(1) A person shall not conduct
any activity under a name which
includes "health scheme"
"medical insurance scheme",
"health insurance scheme" or
similar name which is calculated
or likely to lead people to
believe that the person operates
a health insurance scheme unless
the scheme is registered and
licensed under this Act.
(2) A person who acts contrary
to subsection (1) commits an
offence and is liable on summary
conviction to a fine not
exceeding 100 penalty units or
imprisonment not exceeding 3
months.
Section 26—Transfer and Joint
Operations.
(1) A health insurance scheme
licensed under this Act shall
not transfer its activities or
operate its activities jointly
with another scheme unless it
has the prior written approval
of the Council.
(2) An application for approval
under subsection (1) shall be
made jointly to the Council by
the schemes involved and shall
contain such information as
shall be prescribed under this
Act.
(3) Before determining an
application for approval under
subsection (1), the Council
shall cause to be conducted an
investigation into the
desirability of the change
having regard to the best
interest of the members of the
schemes.
(4) The Council may conduct a
hearing before determining an
application under this section
and may hear the representatives
of the schemes, members of the
schemes and any person the
Council considers is
sufficiently concerned in the
matter to entitle the person to
a hearing by the Council.
(5) The Council after the
hearing shall make a
determination which shall be
binding on all parties and their
members.
(6) A person dissatisfied with
the decision of the Council may
apply to the Minister for a
review of the decision.
Section 27—Gazette Notification.
Upon the licensing, suspension
or revocation of the licence of
a scheme, the Council shall
publish the name and particulars
of the scheme in the Gazette and
newspapers of national
circulation that the Council
shall determine.
Section 28—Display of Licence.
A licensed scheme must display
its licence in a prominent place
at its offices and the licence
must be visible to all members
and prospective members.
PART III—DISTRICT MUTUAL HEALTH
INSURANCE SCHEMES
Section 29—Establishment of
District Mutual Health Insurance
Scheme.
(1) There shall be established
in every district in the country
a mutual health insurance scheme
for the residents of the
district.
(2) Every District Assembly
shall identify promoters to
initiate action for the
registration of the scheme as a
company limited by guarantee
under the Companies Code 1963
(Act 179) for the relevant
district within sixty days of
the coming into force of this
Act or within such further
period as the Council may
direct.
(3) The Council may permit the
establishment of units of a
scheme within a district as it
considers necessary for the
effective management of the
scheme.
Section 30—Head Office of a
District Mutual Health Insurance
Scheme.
A district mutual health
insurance scheme shall have its
headquarters within the district
and shall notify the Council of
the addresses and other
particulars of the headquarters
as the Council may prescribe.
Section 31—Application for
Membership.
(1) Every person resident in
Ghana other than a member of the
Armed Forces of Ghana and the
Ghana Police Service shall
belong to a health insurance
scheme licensed under this Act.
(2) Any person resident in a
district, who is not a member of
a private health insurance
scheme or any other district
scheme registered under this
Act, shall apply to be enrolled
as a member of the district
mutual health insurance scheme
in the relevant district.
Section 32—Members of District
Mutual Health Insurance Schemes.
A district mutual health
insurance scheme established in
a district shall be composed of
the enrolled members and shall
be operated in accordance with
this Act and Regulations made
under this Act.
Section 33—Benefit of Members
and Subsidy.
(1) A district mutual health
insurance scheme is to be
operated exclusively for the
benefit of the members.
(2) A district mutual health
insurance scheme shall be
provided with subsidy from the
National Health Insurance Fund.
Section 34—Contribution by
Members.
(1) A person seeking membership
of a district mutual health
insurance scheme shall as a
prior condition for membership
pay the membership contribution
determined by the scheme in
accordance with guidelines
provided by the Council.
(2) The mode and time of
payment of the contribution
shall be prescribed in
Regulations.
(3) Notwithstanding subsection
(1), Regulations shall prescribe
for exemptions of certain
categories of persons from the
payment of contributions.
(4) Where the monthly
contribution of a contributor to
the Social Security Pensions
Scheme Fund amounts to or
exceeds the minimum monthly
contribution required under a
district mutual health insurance
scheme, the contributor shall be
entitled to the minimum health
care benefits under the district
mutual health insurance scheme
without any further contribution
to the district mutual health
insurance scheme.
(5) Without prejudice to
subsection (3), a pensioner
under the Social Security
Pension Scheme shall be entitled
to the minimum health care
benefit under this Act without
the payment of contribution to
the district mutual health
insurance scheme.
Section 35—Investments and
Management of Funds of a
District Mutual Health Insurance
scheme.
(1) A district mutual health
insurance scheme shall not
invest the funds of the scheme
unless the investment is made
with the prior authorisation of
the Council.
(2) The Council shall determine
the rules and procedures that
govern the management of the
funds of a district mutual
health insurance scheme.
Section 36—Minimum Membership.
(1) A district mutual health
insurance scheme shall at all
times have such minimum members
as the Council may determine.
(2) Notwithstanding subsection
(1) a district mutual health
insurance scheme may be licensed
on the condition that the number
of its members shall reach the
minimum determined by the
Council within a specified
period and upon failure the
Council may revoke its licence.
(3) Every licensed district
mutual health insurance scheme
shall provide a clear method of
enrolment of members and give
such assistance as may be
necessary to non-literate or
other disadvantaged applicants.
(4) Membership takes effect
within six months from the date
of enrolment of the applicant
upon the payment of the initial
contribution.
Section 37—Transfer of
Residence.
A member of a district mutual
health insurance scheme who
moves to reside in an area other
than the area where the scheme
on which the member is enrolled,
is entitled to have the
membership transferred to the
district mutual health insurance
scheme in the new area of
residence.
Section 38—Indigent Members.
(1) The Minister on the advice
of the Council shall prescribe a
means test for determining
persons who are indigent.
(2) A district mutual health
insurance scheme shall on the
basis of the means test,
identify and keep a list of
members registered with it who
are indigent.
(3) The list shall be submitted
to the Council at such time as
the Council shall determine.
(4) The Council shall in
consultation with the managers
of district mutual health
insurance schemes determine the
method to secure the provision
of the minimum health care
benefits to indigents.
(5) The Minister responsible for
Finance shall in consultation
with the Council determine at
least six months in advance the
Budget for the support of
indigents.
PART IV—PRIVATE HEALTH INSURANCE
SCHEMES
Sub Part I—Private Commercial
Health Insurance Schemes
Section 39—Establishment of
Private Commercial Health
Insurance Schemes.
A body corporate registered as a
limited liability company under
the Companies Code 1973 (Act
179) may operate as a private
commercial health insurance
scheme.
Section 40—Membership.
Any person may enrol to be a
member of a private commercial
health insurance scheme.
Section 41—Business Venture.
A private commercial health
insurance scheme is a business
venture.
Section 42—Contribution of
Members.
The contribution of members to a
private commercial health
insurance scheme shall be
determined by the governing body
of the scheme and shall be paid
in such manner and at such time
as the governing body of the
scheme shall determine.
Section 43—Provision of
Security.
(1) A private commercial health
insurance scheme shall be
required as a condition for
registration and licensing by
the Council to deposit with the
Bank of Ghana such amount of
money as the Council shall
prescribe as security for its
members.
(2) The security referred to
under subsection (1) shall be
maintained throughout the period
that the business of private
commercial health insurance is
carried on.
(3) The Council may review the
level of the security deposit.
Section 44—Withdrawal from the
Security Deposit.
(1) Where a private commercial
health insurance scheme suffers
a substantial loss, arising from
liability to members and the
loss is such that it cannot
reasonably be met from its
available resources, the Council
may, after ascertaining the
nature of the claim, and upon
application made to it by the
scheme, approve the withdrawal
from the security deposit of the
scheme of an amount of not more
than ten per cent of the
security deposit, and any amount
withdrawn shall be replaced by
the scheme not later than ninety
days after the date of the
withdrawal.
(2) The security deposit is the
assets of the private commercial
health insurance scheme, but
except as provided in subsection
(1), it shall be available to
the scheme only in event of the
closure or winding up of the
health insurance business for
the discharge of any liabilities
arising out of policies
transacted by the Insurer and
remaining undischarged at the
time of the closure or winding
up of the insurance business.
Section 45—Application of
Insurance Law 1989 (P.N.D.C.L.
227).
(1) Subject to the provisions of
this Act, the following
provisions of the Insurance Law
1989 (P.N.D.C.L. 227) shall
apply to private commercial
health insurance schemes:
(a) section 21 (1)(b) (relating
to margin of solvency);
(b) section 23 (1) and (2)
(relating to reserves);
(c) section 24 (relating to
payment of dividend);
(d) section 25 (relating to
credit on payment of premium);
(e) section 26 (1) and (2) (b)
(relating to investments);
(f) section 35 (relating to
standards of principal
officers);
(g) section 38 (relating to
records of business transacted
in and outside the country);
(h) section 45 (relating to
payment of commission to
unregistered intermediaries);
(i) section 48 (relating to
winding up of insurance
companies);
(j) Part V (relating to
insurance intermediaries);
(k) section 57 (relating to duty
to disclose material facts);
(l) sections 58 and 59 (relating
to test of materiality and
effect of misstatements); and
(m) sections 65 and 66 (relating
to avoidance of conflict of
interest and inspection of
documents in custody of the
Council).
(2) A reference to the National
Insurance Commission in any of
the provisions of the Insurance
Law 1989 (PNDCL 227) applied by
this Act, shall be read as a
reference to the Council
established under section 1 of
this Act.
Sub-Part II—Private Mutual
Health Insurance Scheme
Section 46—Establishment of
Private Mutual Health Insurance
Scheme.
Any group of persons resident in
the country may form and operate
a private mutual health
insurance scheme.
Section 47—Headquarters of a
Private Mutual Health Insurance
Scheme.
A private mutual health
insurance scheme shall have its
headquarters at such place as
the governing body of the scheme
shall determine and the address
and other particulars of the
headquarters shall be notified
in writing to the Council.
Section 48—Management of a
Private Mutual Health Insurance
Scheme.
(1) A private mutual health
insurance scheme may be managed
by an independent manager
appointed by its governing body
and approved by the Council.
(2) The manager of a private
mutual health insurance scheme
may be a body corporate
registered by guarantee under
the Companies Code, 1963 (Act
179).
Section 49—Security deposit.
(1) The Council may require a
private mutual health insurance
scheme to maintain a reserve
fund equivalent to six months
operational income as the
Council may determine.
(2) The reserve fund shall be
constituted within three years
after the commencement of the
scheme.
Section 50—Benefit of Members.
A private mutual health
insurance scheme is to be
operated exclusively for the
benefit of the members and shall
provide the members with such
health benefits as the governing
body of the scheme shall
determine.
Section 51—Contribution by
Members.
(1) Contribution of members
shall be determined by the
governing body of the scheme.
(2) The contribution shall be
paid in such manner as the
governing body of the scheme
shall direct.
Section 52—Minimum Membership.
(1) A private mutual health
insurance scheme shall have such
minimum membership as the
governing body of the scheme
shall determine.
(2) Every private mutual health
insurance scheme shall provide a
clear method of enrolment of
members.
(3) Membership takes effect from
such date as the governing body
may determine upon the payment
of the initial contribution.
Section 53—No Subsidy for
Private Mutual Health Insurance
Scheme.
A private mutual health
insurance scheme is not entitled
to receive subsidy from the
National Health Insurance Fund
established under Part VI of
this Act.
PART V—GENERAL PROVISIONS
APPLICABLE TO OPERATION OF
HEALTH INSURANCE SCHEMES
Section 54—Governing Body,
Appointment of Scheme Managers
and other Employees.
(1) Every scheme shall have a
governing body which shall be
responsible for the direction of
the policies of the scheme and
appointment of employees.
(2) Every scheme shall have a
scheme manager who shall be
responsible for the management
of the scheme.
(3) A scheme manager may be an
independent body corporate or
committee.
(4) Every scheme shall in
addition to the scheme manager,
appoint other officers and
employees for the effective
management of the scheme.
(5) Where a scheme manager or
any person on the management
team of a scheme ceases to be
employed by the scheme, the
governing body of the scheme
shall inform the Council in
writing and take immediate steps
to appoint a new manager or
other person for the scheme.
(6) The Minister may by
legislative instrument provide
further for the qualifications
of directors, scheme managers
and other principal employees of
schemes.
Section 55—Participation by
Dependants.
The dependants of a member may,
in accordance with the
constitution of the scheme,
participate in the scheme and
receive the same benefits as the
member subject to such
reasonable variation in the
level of contribution by the
member, based on the number of
the dependants.
Section 56—Financial Obligation
of Schemes.
(1) The Council shall determine
the financial security deposit,
if any, that should be deposited
by a scheme as security to meet
any liabilities of the scheme.
(2) Regulations may provide
further in respect of financial
security deposit of schemes.
Section 57—Annual Reports,
Accounts and Audit of Schemes.
(1) A licensed scheme shall
keep books of account and proper
record in respect of the
accounts.
(2) Notwithstanding the
provisions in the Companies
Code, a licensed scheme shall
submit an annual report in a
prescribed form to the Council
covering its activities for the
period from 1st January and
ending on 31st December within
three months after the 31st
December of the preceding year.
(3) A licensed scheme shall have
its accounts audited by its
auditors and a copy of the audit
report shall be submitted with
its annual report to the
Council.
(4) An auditor shall not be an
employee, manager, or director
of the scheme.
(5) The Council may without
notice cause to be audited the
accounts of a scheme which
receives subsidy from the
National Health Insurance Fund.
Section 58—Amendment of Annual
Report.
(1) Where in the opinion of the
Council an annual report
furnished by a scheme to the
Council is incorrect or is not
prepared as prescribed, the
Council may, by notice in
writing call upon the scheme to
amend the report or to furnish a
correct report.
(2) Where the scheme fails to
comply with a notice referred to
in subsection (1) to the
satisfaction of the Council, the
Council may itself either amend
the report and give the scheme
particulars of the amendment or
it may reject the report.
(3) A report amended by a scheme
or the Council under this
section shall be treated as if
it had been originally submitted
in its amended form.
(4) Where the Council amends a
report under this section, the
scheme if dissatisfied with the
amendment may appeal to the
Minister.
(5) The appeal shall be lodged
with the Minister within thirty
days after receipt by the scheme
of the amended report.
Section 59—Standards of
Principal Officers of Scheme.
(1) A scheme shall have at all
times high calibre directions,
principal officers and expert
technical and professional staff
and shall maintain such
standards as may from time to
time be prescribed or as may be
directed by the Council.
(2) Without prejudice to
subsection (1) a person does not
qualify to be a director,
manager, secretary or other
officer of a health insurance
scheme if the person
(a) is certified by a medical
practitioner to be a person
suffering from mental disorder;
(b) is adjudged or otherwise
declared bankrupt by a court;
(c) compounds with his or her
creditors; or
(d) is convicted by a court of
an offence involving fraud or
dishonesty.
(3) Except with the express
authority of the Council, a
person who has participated in
the management or direction of
an insurance company which has
been wound up pursuant to an
order of a court, shall not
participate in the management or
direction of a health insurance
scheme.
Section 60—Notification of
Certain Changes.
A scheme shall, within two
months after the end of each
financial year notify the
Council in writing of any change
in the senior executive
personnel or technical operation
of the scheme which occurred in
that financial year and of any
particulars relating to the
change.
Section 61—Furnishing of
Information to Council.
A scheme shall furnish the
Council with all essential
information concerning its
capitalization, its reserves,
and such other information as
the Council may require.
Section 62—Inspection of Annual
Report.
(1) A member of a scheme may
inspect a copy of the annual
report of the scheme at any time
during normal business hours at
the principal office of the
scheme.
(2) No fee shall be paid to the
scheme for an inspection under
subsection (1).
(3) Upon a request by a member
for a copy of the annual report
and on payment to the scheme of
any fee, the scheme shall supply
a copy of the report to the
member.
Section 63—Financial Year of
Schemes.
The financial year of a scheme
shall be from 1st January to
31st December.
Section 64—Minimum Health Care
Benefits.
Every licensed scheme shall
provide to its members such
minimum healthcare benefits as
the Minister may on the advice
of the Council by legislative
instrument prescribe.
Section 65—Health Insurance
Identity Card.
(1) Upon the registration by a
scheme of any individual as a
member, the scheme shall issue
to the member a health insurance
identity card referred to in
this Act as Health ID Card
within such period as shall be
prescribed.
(2) The following shall be
issued with the Health ID Card:
(a) a booklet containing
membership rights, obligations
and privileges;
(b) a list of the healthcare
benefits available under the
scheme; and
(c) a list of heaalthcare
providers and health
institutions accredited by the
Council to the scheme and the
periods or time of their
availability.
(3) The Health ID Card shall
have a number which shall be
unique to the member and shall
be assigned permanently to the
member notwithstanding that the
member may change his or her
place of residence.
(4) In the event of loss, the
Health ID Card shall be replaced
upon payment of a prescribed
fee.
(5) A member who applies for
the replacement of a Health ID
Card for a reason other than the
expiration or loss of the card
shall be required to surrender
the unexpired card.
(6) Notwithstanding any
provision of this section, the
Council may accept the use of
any identity card authorised
under any enactment to be used
for all purposes of
identification in this country.
Section 66—Termination or
Suspension of Membership.
A scheme may terminate or
suspend a member on any of the
following grounds only:
(a) failure to pay contribution
within the stipulated time;
(b) submission of false or
fraudulent claim;
(c) commission of any act of
fraud in relation to the scheme;
or
(d) non-disclosure of material
information requested by the
scheme;
(2) A district mutual health
insurance scheme shall not
suspend the membership of an
indigent without the scheme
first informing the Council
within such period as the
Council may direct.
(3) Where a member dies, any
dependant of the deceased member
may, subject to the payment of
the deceased member's
contribution, continue to
receive the benefits available
to the deceased member until the
marriage or attainment of the
age of eighteen years of the
dependant and subject to such
other conditions as are provided
in the constitution of the
scheme.
(4) Regulation may provide
further for matters relating to
termination or suspension of
members of schemes.
Section 67—Settlement of
Complaints.
Every scheme shall provide a
procedure for settlement of
complaints from its members and
its healthcare providers and
ensure that the members and
healthcare providers are aware
of their right to submit
complaint to the Council where
there is failure to settle any
complaint raised with the
scheme.
Section 68—Quality Assurance.
(1) The Council shall endeavour
though such means as the Council
may determine, including
accreditation, that healthcare
providers put in place
programmes that secure quality
assurance, utilization review
and technology assessment to
ensure that
(a) the quality of healthcare
services delivered are of
reasonably good quality and high
standard;
(b) the basic healthcare
services are of standards that
are uniform throughout the
country;
(c) the use of medical
technology and equipments are
consistent with actual need and
standards of medical practice;
(d) medical procedures and the
administration of drugs are
appropriate, necessary and
comply with accepted medical
practice and ethics; and
(e) drugs and medication used
for the provision of healthcare
in the country are those
included in the National Health
Insurance Drug List of the
Ministry of Health.
Section 69—Safeguards to Prevent
over or under use of Healthcare
Services.
Every scheme must comply with
the National Health Insurance
Drug List to prevent
(a) over or under use of
healthcare services;
(b) unnecessary diagnostic and
therapeutic procedures and
intervention;
(c) irrational medication and
prescriptions; and
(d) inappropriate referral
practices.
Section 70—Accreditation of
Healthcare Providers and Health
Facilities.
(1) A scheme shall not use the
services of any healthcare
provider or any health facility
in the operation of the scheme
unless the healthcare provider
or the health facility has been
approved and accredited to the
scheme by the Council.
(2) Regulations may prescribe
the qualifications, requirements
and such other matters as the
Council considers necessary in
respect of healthcare providers
and healthcare facilities that
operate under the schemes.
Section 71—Tariffs Payable to
Healthcare Providers.
(1) Tariffs payable to
healthcare providers shall be
paid within four weeks by
schemes to the healthcare
providers directly.
(2) Regulations may prescribe
further for matters relating to
the payment of tariffs to
healthcare providers.
(3) A scheme may deny or reduce
the tariff claim of a healthcare
provider where,
(a) the scheme considers that
the claim is false, incorrect or
there is provision of
insufficient information; or
(b) the healthcare provider
without just cause fails to
comply with any provision of
this Act or Regulations made
under this Act.
Section 72—Actuary.
The Council may
(a) where it has reasonable
grounds to believe that a
licensed health insurance scheme
or a manager of such a scheme
has contravened a provision of
this Act or Regulations made
under this Act and the
contravention is such as to
adversely affect the interest of
the members; or
(b) at the request of a health
insurance scheme appoint an
actuary to investigate and
report to the Council the
activities and affairs of the
scheme.
Section 73—Powers of Actuary.
An actuary appointed under
section 72
(a) shall have access to any
information or document in the
possession, or under the
control, of the scheme where the
actuary reasonably requires
access for the proper
performance of the actuary's
functions and duties;
(b) may require any manager or
employee of the scheme to answer
questions or produce documents
for the purpose of enabling the
actuary perform properly the
actuary's functions and duties;
(c) may attend meetings of the
governing body of the scheme on
matters that relate or affect
the financial affairs of the
scheme; and
(d) shall have and exercise
other powers necessary for the
effective performance of the
actuary's duties and functions.
Section 74—Inspection of
Schemes.
(1) The Council may, at any
time, for the purposes of
supervision of health insurance
schemes,
(a) inspect the premises,
business and affairs, including
the procedures and systems of a
scheme;
(b) inspect the assets,
including cash, belonging to or
in the possession or control of
any person who has any relation
with the scheme;
(c) examine and make copies of
documents, including accounting
records, that belong to or are
in the possession or control of
a person who in the opinion of
the Council has activities that
relate to the activities of a
scheme.
(2) The Council may employ
suitably qualified and
experienced persons to assist it
or carry out any inspection on
its behalf.
(3) Without limiting subsection
(1), the Council shall ensure
that an inspection is carried
out in respect of a licensed
health insurance scheme at least
once in every twelve months.
(4) The Council shall after any
inspection compile a report
stating the status of the scheme
and shall submit a copy of the
report including its
recommendations to the scheme
for compliance where applicable.
Section 75—Directives of
Council.
The Council may direct a scheme
or an officer of a scheme to
comply with such directions as
the Council may specify in
writing and where there is
failure to comply, the Council
may seek an order from the High
Court to order the person to
comply.
PART VI—NATIONAL HEALTH
INSURANCE FUND
Section 76—Establishment of a
National Health Insurance Fund.
There is established by this Act
a National Health Insurance
Fund, referred to in this Act as
the "Fund".
Section 77—Object of the Fund.
(1) The object of the Fund is to
provide finance to subsidize the
cost of provision of healthcare
services to members of district
mutual health insurance schemes
licensed by the Council.
(2) For the purpose of
implementing the object, the
monies from the Fund shall be
expended as follows:
(a) to provide subsidy of such
level as the Council shall
determine to district mutual
health insurance schemes;
(b) to reinsure district mutual
health insurance schemes against
random fluctuations on cost
under conditions to be
determined by the Council;
(c) to set aside some monies
from the Fund to provide for the
health care cost of indigents;
(d) to provide support to
facilitate provision of or
access to health service;
(e) to invest in any other
facilitating programme to
promote access to health service
as may be determined by the
Minister in consultation with
the council.
Section 78—Sources of Money for
the Fund.
(1) The sources of money for
the Fund are as follows:
(a) the health insurance levy
provided for under section 86;
(b) two and one half percent of
each person's seventeen and one
half percent contribution to the
Social Security and Pensions
Scheme Fund;
(c) such money that may be
allocated to the Fund by
Parliament;
(d) money that accrues to the
Fund from investments made by
the Council; and
(e) grants, donations, gifts and
any other voluntary contribution
made to the Fund.
(2) The Director-General of the
Social Security and National
Insurance Trust shall at the end
of each month cause to be
transferred to the Fund two and
one half percent of each
person's seventeen and one half
percent of social security
contributions for the preceding
month.
(3) The contribution under
subsection (1) shall be without
prejudice to the benefits due
the contributors under the
Social Security Pensions Scheme.
(4) Where there is a default in
the payment of benefits by
Social Security and National
Insurance Trust to contributors
arising from the payment of the
contribution into the Fund under
Subsection (1) (b), there shall
be paid by Government into the
Social Security Trust Fund such
amount of money as may be
required to enable the benefits
to be paid to the contributor.
(5) The Council may by
Regulations review the sources
of funding to keep pace with
developments in the health
insurance industry.
Section 79—Formula for
Disbursement from the Fund.
(1) The Council shall annually
submit to Parliament for
approval, the formula for
distribution of subsidies to be
paid to licensed district mutual
health insurance schemes.
(2) The Council shall in the
disbursement of monies from the
Fund make specific provision
annually towards the health
needs of indigents and prescribe
the method for distributing the
monies involved.
Section 80—Bank Account for the
Fund.
(1) Monies of the Fund shall be
paid into such bank accounts as
the Council may determine with
the approval of the
Accountant-General.
Section 81—Conditions for
Provision of Subsidy to District
Mutual Health Insurance Schemes.
(1) Subject to subsection (2),
the Council shall provides
subsidies from the Fund to
licensed district mutual health
insurance schemes that offer the
minimum healthcare benefits
prescribed by the Minister.
(2) Subsidy shall not be granted
under subsection (1) unless the
Council is satisfied that,
(a) the district mutual health
insurance scheme is open to the
residents in the geographical
area of the relevant District
Assembly;
(b) the scheme is operated in
such a manner that it is
answerable to its members;
(c) the annual report and
financial accounts submitted to
its governing body and copied to
the Council are acceptable to
the Council;
(d) no person is excluded from
enrolment on the scheme because
of physical disability, social,
economic or health status;
(e) the scheme allows for
portability, namely,
availability of the benefits to
a member who moves outside the
geographical area of the scheme
of which the person is a member;
and
(f) the tariff payable to
healthcare providers under the
scheme are in accordance with
guidelines set by the Council.
(3) A district mutual health
insurance scheme must apply for
subsidy from the Fund in a form
and at a time directed by the
Council.
Section 82—Management of the
Fund.
(1) The Fund shall be managed by
the Council.
(2) The Council in the
management of the Fund shall
have the following powers and
functions;
(a) formulate and implement
policies towards achieving the
object of the Fund;
(b) collect or arrange to be
collected monies lawfully due to
the Fund;
(c) account for the money in the
Fund;
(d) provide a formula for the
distribution of monies from the
Fund;
(e) approve any other
expenditure charged on the Fund
under this Act or any other
enactment;
(f) set aside an amount for
indigents; and
(g) perform any other function
ancillary to the object of the
Fund.
Section 83—Investment of the
Fund.
The Council may invest such part
of the Fund as it considers
appropriate in such securities
as the Minister for Finance may
approve.
Section 84—Expenses of the Fund.
The expenses attendant to the
management of the Fund shall be
charged on the Fund.
Section 85—Accounts, Auditing
and Annual Report.
The provisions in sections 99
and 100 on accounts, auditing
and annual report to Parliament
apply to the Fund.
PART VII—NATIONAL HEALTH
INSURANCE LEVY
Section 86—Imposition of
National Health Insurance Levy.
(1) There is imposed by this Act
a national health insurance levy
charge at the rate of two and
one half percent calculated on
(a) every supply of goods and
services made or provided in
Ghana;
(b) every importation of goods;
and
(c) supply of any imported
service
unless otherwise exempted in
this Act or under Regulations
made under it.
(2) The levy is payable at the
time the goods and services are
supplied or imported.
(3) For the purposes of this
Part the provisions on supply of
goods and services in the
enactment that establishes the
revenue or collection agency
charged with responsibility for
the collection of this levy by
the Minister shall apply.
Section 87—Exempt Supply.
A supply in respect of any of
the matters set out in Schedule
I Part I is exempt from the levy
imposed under section 86(1).
Section 88—Zero-Rated Supply.
A supply in respect of any of
the matters specified in
Schedule I Part II is
zero-rated.
Section 89—Relief from Levy.
There is hereby granted relief
from the payment of the levy to
the individuals, organisations
and in respect of the matters
specified in Schedule I Part
III.
Section 90—Collection of the
Levy.
(1) The levy shall be collected
by such revenue or collection
agency as the Minister
responsible for Finance shall
determine.
(2) Upon the determination by
the Minister responsible for
Finance of the revenue or
collection agency to collect the
levy, the enactment of the
relevant revenue agency for the
collection of tax or levy shall
apply, with such modifications
as are necessary for the
collection of the levy imposed
under this Act.
Section 91—Payment of Levy into
the Fund.
The revenue or collection agency
charged with the collection of
the levy shall within thirty
days of collection of the levy,
pay the levy directly into the
Fund.
PART VIII—ADMINISTRATIVE,
FINANCIAL AND MISCELLANEOUS
PROVISIONS
Section 92—Executive Secretary
of the Council.
(1) There shall be appointed for
the Council by the President in
accordance with the advice of
the Council given in
consultation with the Public
Services Commission, an
Executive Secretary of the
Council who shall be the chief
executive of the Council.
(2) The Executive Secretary
shall hold office on terms and
conditions specified in his or
her letter of appointment.
(3) Subject to the directions of
the Council, the Executive
Secretary shall be responsible
for the day to day
administration of the Council
and implementation of the
decisions of the Council.
(4) The Executive Secretary may
delegate some functions of his
or her office to any other
officer of the secretariat of
the Council except that the
Executive Secretary shall not be
relieved from ultimate
responsibility for the discharge
of the delegated function.
Section 93—Units of the Council.
(1) For the purposes of
implementing its functions under
this Act, the Council may
establish such units or
divisions of the Council as it
considers necessary.
(2) Without limiting the effect
of subsection (1), the following
are hereby established as units
of the Council;
(a) Registration and Licensing
Unit;
(b) Planning, Monitoring and
Evaluation Unit;
(c) Administration, Management
Support and Training Unit; and
(d) Fund Management and
investment Unit
(3) Each unit shall have as its
head a technical director who
shall, subject to the direction
of the Executive Secretary, be
responsible for overseeing and
implementing the functions
assigned to the unit.
(4) The staff strength and the
detailed functions of each unit
shall be determined by the
Council.
Section 94—Appointment of
Internal Auditor.
(1) There shall be appointed an
internal auditor for the Council
who shall be responsible to the
Executive Secretary in the
performance of his or her
duties.
(2) The internal auditor shall
at the end of every three months
submit a report of the audit of
the Fund carried out by the
internal auditor in respect of
that period to the Council.
(3) The chairperson of the
Council shall submit a copy of
the report to the Minister and
the Minister responsible for
Finance.
Section 95—Appointment of other
Staff.
(1) The President shall in
accordance with the advice of
the Council given in
consultation with the Public
Services Commission and on such
terms and conditions as the
President may determine appoint
other staff for the Council.
(2) Other public officers may be
transferred or seconded to the
Council or may otherwise give
assistance to it.
Section 96—Delegation of
Appointment.
The President may in accordance
with article 195(2) of the
Constitution delegate the power
of appointment of public
officers under this Act.
Section 97—District Offices of
the Council.
(1) The Council may establish
such district offices as it
considers necessary.
(2) A district office of the
Council shall be provided with
such public officers as the
President acting in accordance
with the advice of the Council
given in consultation with the
Public Services Commission shall
determine.
(3) A district office of the
Council shall perform such
functions of the Council in the
district as the Council may
direct.
Section 98—Expenses of the
Council.
(1) The salaries of employees of
the Council shall be the same as
those applicable to employees of
equivalent status in the Public
Service and shall be paid out of
such monies as may be allocated
by Parliament from the Fund on
the recommendation of the
Minister for Finance.
(2) All administrative expenses
of the Council shall be paid out
of the Fund subject to the
approval of the Minister acting
in consultation with the
Minister for Finance.
Section 99—Accounts and Audit.
(1) The Council shall keep books
of account and proper records in
relation to them and the
accounts and records of the
Council shall be in a form
approved by the Auditor-General.
(2) The accounts of the Council
shall be audited within six
months after the end of each
financial year by the
Auditor-General or an auditor
appointed by the
Auditor-General.
(3) The Auditor-General shall,
not later than six months after
the end of each financial year,
forward to the Minister a copy
of the audited accounts of the
Council for the preceding
financial year.
(4) The financial year of the
Council shall be the same as the
financial year of the
Government.
Section 100—Annual Report and
other Reports of the Council.
(1) The Council shall as soon as
practicable after the expiry of
each financial year but within
eight months after the end of
the year submit to the Minister
an annual report covering the
activities of the Council for
the year to which the report
relates.
(2) The annual report submitted
under subsection (1) shall
include,
(a) the report of the
Auditor-General;
(b) a report of the effect of
the implementation of the
national health insurance policy
on the nation; and
(c) a report on the Fund
specifying the total
disbursement, reserve and the
average cost provided from the
Fund to beneficiaries under the
schemes.
(3) The Minister shall within
two months of the receipt of the
annual report submit the report
to Parliament with such
statement as the Minister
considers necessary.
(4) The Council shall also
submit to the Minister such
other reports as the Minister
may in writing require.
Section 101—No Cancellation of a
Scheme Registered with Registrar
of Companies.
The registration of a scheme
licensed under this Act shall
not be cancelled or altered by
the Registrar of companies
without the prior written
authorisation of the Council.
Section 102—Offences.
Any licensed scheme which
(a) carries on any other
activity other than the
provision of healthcare services
to its members contrary to
section 24;
(b) without the prior approval
of the Council transfers or
jointly operates the scheme with
another scheme contrary to
section 26;
(c) operates a mutual health
scheme for profit except for its
members;
(d) fails to keep books of
account and proper records in
respect of the accounts;
(e) fails to provide the minimum
healthcare benefits specified by
or Regulations made under this
Act;
(f) falsifies or connives with
any person to falsify tariffs
payable to any healthcare
provider; or
(g) obstructs an actuary, an
inspector or any person
authorised by the Council or
this Act in the performance of a
function under this Act;
commits an offence and is liable
on summary conviction to a fine
of not less than 200 penalty
units and not exceeding 15,000
penalty units or a term of
imprisonment of not less than 12
months and not exceeding 10
years; and every principal
officer or manager of the scheme
shall be deemed to have
committed the offence unless it
is proved that the offence was
committed without the knowledge
or connivance of the principal
officer or manager.
(2) Where a contributor to a
scheme cheats or attempts to
cheat the scheme by conniving
with a healthcare provider or a
non-contributor to make a claim
for
(a) a service which has not been
provided;
(b) a service which the
contributor does not need but
which the healthcare provider
purports to have provided; or
(c) drug prescriptions which the
contributor does not require or
which is far in excess of what
the contributor requires,
the contributor commits an
offence and is liable on summary
conviction to a fine not
exceeding 1,000 penalty units or
a term of imprisonment not
exceeding 5 years or to both.
(3) A health care provider who
cheats or attempts to cheat a
scheme by presenting to a scheme
for payment tariffs for
(a) a service which the
healthcare provider has not
provided;
(b) a service which the
contributor, in respect of whom
the tariff claim is made, does
not need but which the
healthcare provider purports to
have provided; or
(c) drug prescriptions which the
contributor, in respect of whom
the tariff claim is made, does
not require or which is far in
excess of what the contributor
requires
commits an offence and in
addition to any other
disciplinary measure which the
Council may adopt, is liable on
summary conviction to a fine not
exceeding 5000 penalty units or
to imprisonment not exceeding 10
years or to both.
Section 103—Regulations.
(1) The Minister on the advice
of the Council may by
legislative instrument make
Regulations for the effective
implementation of this Act.
(2) Without limiting the scope
of subsection (1), Regulations
may:
(a) provide further for
registration and licensing of
schemes;
(b) prescribe reports to be
submitted to the Council;
(c) prescribe matters relating
to health ID cards;
(d) prescribe the mode of
payment of contributions by
members of district mutual
health insurance schemes;
(e) prescribe the qualification
of managers and principal
officers of schemes;
(f) prescribe financial deposit
or other financial security, if
any, to be paid by schemes;
(g) provide for matters relating
to healthcare benefits;
(h) prescribe the means test for
indigents;
(i) prescribe accreditation of
healthcare providers and health
facilities;
(j) provide procedure for
resolution of disputes and
complaints by the Council;
(k) provide further for matters
relating to suspension and
termination of a member from a
scheme;
(l) prescribe matters relating
to quality assurance;
(m) provide for matters relating
to the payment of tariffs to
healthcare providers and health
institutions within the schemes;
(n) prescribe further conditions
for grant of subsidy from the
Fund;
(o) provide for matters relating
to accounts of district mutual
health insurance schemes;
(p) prescribe the minimum
healthcare benefits;
(q) provide for forms;
(r) provide for the imposition
of fees for a licence;
(s) provide conditions for
variation and recovation of
conditions of a licence;
(t) provide for terms and
conditions for the issue of a
licence; and
(u) provide for the exemption
from the payment of the national
health insurance levy payable
under this Act.
Section 104—Interpretation.
In this Act unless the context
otherwise requires,
"actuary" means an insurance
risk analyst;
"accreditation" means a process
by which the qualification and
capability of a healthcare
provider is verified for the
purpose of enabling the person
provide healthcare services
under a scheme;
"beneficiary" means a person
entitled to healthcare services
under this Act;
"contribution" means the amount
of money paid by or on behalf of
a member to a scheme for
membership of the scheme;
"dependant" in relation to a
beneficiary or member means:
(a) a spouse of a member;
(b) unmarried and unemployed
child below eighteen years;
(c) a child who is eighteen
years or above but suffering
from congenital disability,
either physical or mental, or
any disability that renders the
person totally dependent on the
member for support or is still
in school or learning a trade;
(d) a parent of sixty years old
or above and whose monthly
income if any, is below an
amount determined by the
Council;
"district" means the
geographical area of one or more
District Assemblies;
"District Assembly" includes a
Metropolitan and Municipal
Assembly;
"healthcare facility" includes a
hospital, nursing home,
laboratory, maternity home,
dental clinic, polyclinic,
clinic and pharmacy and other
facilities that the Council may
determine;
"healthcare provider" means a
healthcare professional or
practitioner licensed to
practice in Ghana in accordance
with any enactment in force;
"indigent" means a person who
has no visible or adequate means
of income or who has nobody to
support him or her and by the
means test qualifies as an
indigent;
"means test" means the process
by which a mutual health
insurance scheme determines the
ability of individuals or
households to pay varying levels
of contributions to the scheme
ranging from contributions that
would be fully paid by
Government, through
contributions that are
subsidised by Government to
contributions that do not
require subsidy;
"member" means a person
registered by a scheme as a
beneficiary of the scheme;
"Minister" means the Minister
responsible for health;
"mutual health insurance scheme"
means a community based health
insurance scheme composed of
members of the community in the
relevant district and operated
exclusively for the benefit of
the members;
"quality assurance" means a
formal set of activities to
review and ensure the quality of
healthcare services provided to
members of health insurance
schemes;
"resident" means a person who
lives in this country for six
months or more in any period of
twelve months;
"scheme" means a district
mutual, a private mutual or a
private commercial health
insurance scheme or a body
registered and licensed under
this Act.
Section 105—Disapplication of
P.N.D.C.L. 227 to Health
Insurance Schemes.
Except as otherwise expressly
provided in this Act under
section 45 in respect of private
commercial health insurance
schemes, the Insurance Law, 1989
(P.N.D.C.L. 227) shall not apply
to health insurance schemes.
Section 106—Transitional
Provision.
Upon the coming into force of
this Act, any group of persons
operating a health insurance
scheme who desires to continue
the operation of the scheme,
shall within six month of the
appointment of the Council,
apply to the Council for the
registration and licensing of
the scheme in compliance with
the provisions of this Act.
Section 107—Commencement of
Payment of Levy.
The national health insurance
levy imposed under section 86 of
this Act shall become payable on
such date as the Minister may by
legislative instrument
prescribe.
SCHEDULE
PART 1
(Section 87)
EXEMPT SUPPLIES
PART II
ZERO-RATED SUPPLIES
(section 88)
1. Export of taxable goods and
services.
2. Goods shipped as stores on
vessels and aircrafts leaving
the territories of Ghana.
PART III
RELIEF
(section 89)
1. President of the Republic of
Ghana.
2. For the official use of any
Commonwealth or Foreign Embassy,
Mission or Consulate (relief
applies only to Levy on imported
goods).
3. For use of a permanent member
of the Diplomatic Service of any
Commonwealth or Foreign Embassy,
Mission or Consulate (relief
applies only to Levy on imported
goods).
Note: Provided that with regard
to items 2 and 3 of this Part a
similar privilege is accorded by
such Commonwealth or Foreign
Country to the Ghana
representative in that country.
4. For use of an international
agency or technical assistance
scheme where the terms of the
agreement made with the
Government include exemption
from domestic taxes.
5. Emergency relief items
approved by Parliament.
Date of Gazette Notification:
12th September, 2003.
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