-NA TIONA L HEALTH FUND

THE NATIONAL HEALTH FUND ACT

.- \W-\SGE\IEST OF'SECTIONS

PART I. Preliminat?'

1. Short title.

2. Interpretation.

3. Principal objects of Act.

PART 11. National Health Fund

4. Establishment of the National '~ea l th Fund.

5. Functions of the Fund.

6. ~stablishment and functibn of Board of Management.

7. Beneficiaries of the Fund.

8. Policy directions.

PART 11 1. Financial Provisions

9. Resources of the Fund.

10. Application of revenues.

1 1. Borrowing powers.

12. Power to invest moneys.

13. Guarantee by Minister of Finance for borrowing by Fund and
repayment of sums issued to meet guarantees.

14. Accounts and audit.

1 5. Annual report.

16. Exemption from income tax.

17. Estimates of revenue and expenditure.

18. Claims to be determined.

* .

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NATIONAL HEALTH FUND

PART IV. Miscellaneous

19. Appointment of inspectors.

20. Powers of inspectors.

2 1. Assault and obstruction of inspectors.

22. Refusal or neglect to give information.

23. False declaration and statement.

24. Benefits from false declaration.

25. Breaches of this Act not otherwise provided for.

25A. Minister may amend monetary penalties.

26. Regulations.

27. Act Binds the Crown.

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-.
NATIONAL HEALTH FUND

THE NATIONAL HEALTH FUND ACT ~ c t s
23 of 2003,
6 of 2011,
7 of 2011

[lst April, 2003.1 sch.

PART I. Preliminary

1. This Act may be cited as the National Health Fund Act. Short title.

2. In this Act- Interprets-
tion.

"appointed day" means the 1 st day of April, 2003;
"Board" means the ~ o a r h of ~ a n a ~ e m e n t of the Fund;
"chairman" means the chairman of the Board;
"fimctions" includes powers and duties;
"Fund" means the National Health Fund established under

section 4;
"registered medical practitioner" means a medical practi-

tioner registered under the Medical Act;
"resident" means a person who is ordinarily resident in

Jamaica for a period or periods aggregating in the
whole not less than six months in the calendar year;

"specified diseases" and "specified medical condition"
mean the diseases and medical conditions specified in
the First Schedule. First

Schedule.

3. The principal objects of this Act are to- Principal
objects of

(a) provide prescribed health benefits to all residents, Act.
regardless of age, gender, health or economic status;

(b) provide greater access to medical treatment and preven-
tative care for specified diseases and specified medical
conditions; .

(c) make pharmaceutical and medical supplies accessible 6 ~ 0 1 1
and available to government-owned health facilities; S. 3(b).

(6) secure improvement in the productivity of residents by
reducing time lost on the job that is attributable to
personal and family health care problems;

(e) reduce the Island's disease burden through health prom-
otion and protection programmes; and

J r

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4 NATIONAL HEALTH FUND

Establishment
of the National
Health Fund.

Second :
* . Schedule.

Functions of
the Fund.

V) provide support to health services and promote and
encourage-the utilization of primary health care to im-
prove the quality of lcfe of the Island's population.

PART 11. National Health Fund
4.--(1) There is hereby established for the purposes of this

Act, a body to be known as ihe National Health Fund which
shall be a body corporate toy which section 28 of the Inter-
pretation Act shall apply.

(2) The provisions of the Second Schedule shall have
effect as to the constitution of the Fund' and' otheiwise in

' , relation thereto.
5. The Fund shall perform such functions may be neces-

sary to give effect to the objects'specified in section 3 and,
without prejudice to the generality of the foregoing, such func-
tions shall include-

(a) implementing a national health insurance plan or such
other schemes' of insurance, contractual or other
arrangements or systems;

(b) administering and controlling the moneys received
from- , n

(i) the Consolidated .Fund * and . assigned . by
Parliament for the purpose;

(ii) the Special Consumption- T& for the pur-
poses of this Act; and

(iii) any other sources in accordance with the
provisions of this Act; ,

.

(c) utilizing the revenues received by the ,Fund to achieve
the objects of the ~ c t ;

(d) providing health bknefits for residents ,with specified
diseases and specified medical conditions;

(e) making prescribed drugs and other bLnefits'available to
residents at government-owned . - , and other health
facilities; h

(j) arranging and providing mechanisms for, the utilization
of benefits under the Fund;

(g) enhancing the usefulness of the Fund by promoting

improved methods and levels of efficiency in the -
delivery of health care;

(h) investing the moneys of the Fund;

(i) entering into agreements $th other persons for the
better administration of the Fund;

carrying on the businesses of chemists, druggists, manu- 6/20] I
factures, importers and distributors of and dealers in all S. 4(c).

. kinds of-

(i) pharmaceutical, medical, chemical and other
preparations, compounds and articles or things;

(ii) medical and surgical supplies, utensils and

i

implements;
I

(iii) mechanical, electrical, electionic, sonic, radio-
graphic, scopic Ad other equipment,

for use in government-owned health facilities.

(k) doing or causing to be done such other things as are
necessary or'expedient for or in connection with the
proper performance of the functions of the Fund.

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6 NA TIONA L HEALTH FUND

Establishment 6.--(I) There shall be established for the purposes of this
and functions
of Board of Act, a Board of Management of the Fund which shall, subject to
Management. the provisions of this Act, be responsible for the policy

and general administration of the affairs of the Fund.

Third (2) The provisions of the Third Schedule shall have'effect
'Schedule. as to the constitution of the Board and otherwise in relation

thereto. a t
Beneficiaries 7. Every resident who-
of the Fund.

(a) is certified by a registered medical practitioner as suf-
fering from a specified disease or specified medical
condition;

(b) presents a valid and approved me& of identification;
and

(c) otherwise satisfies the requirements of the Fund,

shall be entitled tobenefits under the Fund.

Policy 8. The Minister may, after consultation with the chairman,
directions. give to the Board such directions of a general character as to the

policy to be followed by the Board in the discharge of its

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NATIONAL HEALTH FUND 6.0 1

functions as appear to the Minister to be necessary in the public
interest; and the Board shall give effect to those directions.

PART 111. Financial Provisions
9.-41) The financial resources of the Fund shall consist Resources

of- of the Fund.

(a) such moneys as may from time to time be placed at its
disposal for the purposes of this Act by Parliament;

(b) any moneys payable to the Fund from any levy or tax,
as the case may be, on tobacco and tobacco products

. authorized under this or any other Act;

(c) 5% of the amount collected by way of Special Con-
sumption Tax or such other percentage as may be
specified by the Minister responsible for finance,
subject to affirmative resolution of the House of
Representatives;

(4 moneys received from the National Insurance Fund;

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NA TIONA L HEALTH FUND

( e ) moneys received from >loans or otherwise;
. . . , * . i

u> moneys earned by or arising from investments made by
61201 I or on behalf of the Fund;
S. 5(a).

6ROl l
s. 5(c). (g) ,moneys earned from carrying ,on any business men-

tioned in parag;-aph (j) of section 5;
a

(h) such other moneys as may lawfblly be paid to the
Fund.

(2) All moneys received or amount collected under sub-
section (I)(b), (c) and (4 shall be paid forthwith and directly to
the Fund.

. I

Application of 10. The revenue and financial resources of the Fund shall be
revenues. applied for the purposes authorized by this Act or any other

law in relation to its functions.

Borrowing 1 1 . 4 1 ) Subject to subsei3iZii (2), the Fund may borrow sums
powers. required by it for meeting by of its obligations or discharging

any of its functions.

(2) The power of the Fund to borrow shall be exercisable
only with the approval of the Minister responsible for finance,
as to the amount, as to the source of borrowing and as to the
terms on which borrowing may be effected.

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NATIONAL HlGUTH FUND

(3) An approval given in any respect for the purposes
of this section may be either general or limited to a particular
borrowing or otherwise and may be either unconditional or
subject to conditions.

12. All moneys of the Fund not immediately required to be Powat0
expended in meeting any of its obligations or discharging any rZbs,
of its fbnctions may be invested in such securities as may be
approved either generally or specifically by the Minister after
consultation with the Minister responsible for finance and the
Fund may, with the approval of the Minister after consultation
with the Minister responsible for finance, sell all or any of such
securities.

13.-(1) With the approval of the House of Representatives,
the Minister responsible for finance may guarantee, in such
manner and on such conditions as he may think fit, the
repayment of the principal and interest on any authorized
borrowings of the Fund.

(2) Where the Minister responsible for finance is
satisfied that there has been default in the repayment of any
principal moneys or interest guaranteed under the provisions of
this section, he shall direct the repayment out of the
Consolidated Fund and assets of Jamaica of the amount in
respect of which there has been such default.

(3) The Fund shall make to the Accountant-General, at
such times and in such manner as the Minister may direct,
payments of such amounts as may be so directed in or towards
repayment of any sums issued in fblfilment of any guarantee - -
given under this section, and payments of interest on what is
outstanding for the time being in respect of any sums so issued
at such rate as the Minister may direct, and different rates of
interest may be directed as respects different sums and as
respects interest for different periods.

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Guarantzz by
Minister of
Finance for
borrowing by
Fund and
repayment of
sums issued
to med
guarantees.

8 NA TIONAL H U T H FUND

.iccollntsand 1 4 . 4 1 ) The Fund shall keep proper accounts and other
al~d~t records in relation to its business and shall prepare annually a

statement of accounts in a form satisfactory to the Minister
being a form which conforms with established accounting
principles.

(2) The accounts of the Fund shall be audited by an
auditor appointed annually by the Fund and approved by the
Minister.

(3) The following persons, namely-
(a) the accounting officer for the Ministry; and
( h ) officers so authorized by the Minister,

shall be allowed to have access to all the accounts and records
of the Fund and to all such information as is necessary to carry
out the audit.

(4) As soon as the accounts of the Fund have been
audited, the Board shall send the statement of its accounts
referred to in subsection (1) to the Minister, together with a
copy of any report made by the auditors on that statement or on
the accounts of the Fund.

(5) The auditor's fees and expenses of the audit shall
be paid by the Fund.

(6) The Auditor-General shall be entitled at all reason-
able times to examine the accounts and other records in relation
to the business of the Fund.

. h u a l 15.-41) The Board shall, within six months after the end of
report. each financial year, cause to be made and shall submit to the

Minister a report-

(a) dealing generally with the proceedings and activities
of the Fund during the preceding financial year; and

(b) containing-

(i) information relating to the proceedings of
the Fund; and

(ii) the operational plans within which the Fund
proposes to c&ry out its functions,

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NATIONAL H W T H FUND

as can be made public without detriment to the
interest of the Fund.

(2) The Minister shall cause a copy of the report,
together with the annual statement of accounts and the auditor's
report thereon to be laid on the Table of the House of Represen-
tatives and the Senate.

16. The Fund shall be exempt from the payment of income
tax.

17. The Fund shall, in each financial year, before a date
specified by the Minister, submit to the Minister for his
approval estimates of income and expenditure of the Fund for
the ensuing financial year.

18.-41) Any claim or question arising in connection with
benefits under the Fund shall be determined by the Board after
such inquiry as it may deem necessary.

(2) Any person aggrieved by a decision of the Board
under subsection (1) may, within twenty-one days of being
informed of such decision, appeal to a Tribunal established by
the Minister by regulations under this Act.

PART IV. Miscelluiieotrs

19. The Minister may from time to time appoint inspectors
who shall perform such duties as mav from time to time be
assigned to them under this Act or any regulation made
hereunder.

20. In carrying out the duties assigned pursuant to section
19, an inspector shall-

(a) inspect the operations of the Fund in relation to-
(i) its activities under the Act;
(ii) the efficient and effective management of

the resources of the Fund by participating
pharmacies;

Exemption
from incorr~z
tax.

tst~rnates 01
rcvcnuc and
< q m d i ~ u r <

Cln~nis lo hz
detcrmincd
h? R o a d .

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NATIONAL H W T H FUND

;Issaults and
obstruction
of inspectors.

Refusal or
neglect to
give infoma-
tion.

inspect any records or things relevant to the inspec-
tion;
require the production of records or other things
relevant to the inspection, including things that are
kept off the premises;
question an officer or other employee of the Fund on
matters relevant to the inspection, subject to that
person's right to be represented during the question-
ing by an attorney-at-law or other person;
use a data storage, processing or retrieval devices or
other systems in order to produce a record in readable
form;
if he considers necessary, remove a record or sample
or any other thing considered relevant to the inspec-
tion and shall provide a receipt for any such record,
sample or thing;
review or copy a record or other thing removed;
employ experts to render such assistance for the
purposes of the inspection as the inspector considers
necessary;
address such other matters that are required or
prescribed by the Minister; and
if he is denied access, request the assistance of a
constable to gain such access.

21. A person who willfblly delays, assaults or obstructs an
inspector in the exercise of his fimctions under this Act
commits an offence and shall be liable on summary conviction
before a Resident Magistrate to a fine not exceeding one
million dollars or to imprisonment for a term not exceeding one
year.

22. A person who, without lawhl excuse, refuses to furnish
any information or to produce any document when required to
do so by an inspector, commits an offence and shall be liable on

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NATIONAL HEALTH FUND

summary conviction before a Resident Magistrate to a fine not
exceeding two hundred thousand dollars or. to imprisonment for
a term not exceeding three months.

23. A person who knowingly makes any false declaration or False declara-
tion and state- false statement of a material nature in any application made ,,,,

under this Act, commits an offence and shall be liable on sum-
mary conviction before a Resident Magistrate to a fine not
exceeding one million dollars or to imprisonment for a term not
exceeding one yea.

24. A person who obtains benefits under this Act by means Benefits
from false of false declarations commits an offence and shall be liable on declaration,

summary conviction before a Resident Magistrate to a fine not
exceeding one million dollars or to imprisonment for a term not
exceeding one year.

25. A person who commits an offence against this Act for
which no penalty is otherwise provided shall be liable on
summary conviction before a Resident Magistrate to a fine not
exceeding five hundred thousand dollars and in default of
payment, for a term of imprisonment not exceeding six months.
25A. The Minister may, by order subject to affirmative reso-

lution, amend the monetary penalties specified in this Act.

26.-(1) The Minister may, after consultation with the
Board, make regulations for the proper administration of and
giving effect to this Act and, without prejudice to the generality
of the foregoing, may make regulations prescribing-

(a) a national health insurance plan, benefit schedules or
other schemes of insurance, arrangements or systems
for Jamaica;

(b) the health benefits to be administered by the Fund
and the illnesses to be monitored by the Fund; .

(c) the records to be kept by persons liable to pay moneys
under any levy or tax established by or pursuant to
this Act;

(4 the drugs and other benefits to be made available by the
Fund, at government-owned and other health facilities;

Breaches of
this Act not
otherwise
provided for.

Minister
may amend
monetary
penalties.
7\20] 1
Sch.

Regulations.

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4

NA TIONA L HEAL TH FUND

(e ) any other matter relevant to the operation of this Act;

(2) The ~ i n i s t e i may from time, to time, by order,
~ i A t Schedule. amend the First Schedule.

.

(3) Regulations and any 'order made bnder this section
shall be subject to a f f i~a t ive . . resolution. ,

~ R O I I (4) Notwithstanding section 29(b) of the Interpretation
Sch. Act, regulations made under subsection (1) may provide in

respect of a breach of the provisions thereof for the imposition
- of penalties on summary conviction in a Resident Magistrate's

Court of a fine not exceeding one million dollars or imprison-
ment for a term not exceeding twelve months or both such fine
and imprisonment.

Actjbinds the 27. This Act binds the Crown.
Crown.

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NATIONAL HEALTH F W D

c2RST SCHEDULE (Section 2)

Specified Diseases and Specified Medical Conditions
Arthritis
Asthma
Cancer of the breast
Cancer of the prostate
Diabetes

Epilepsy
Glaucoma
High Cholesterol
Hypertension
Ischaemic Heart Disease
Major Depression
Psychosis
Rheumatic Fever Heart Disease
Vascular Disease

SECOND SCHEDULE (Section 4)

The National Health Fund

1.-(1) The seal of the Fund shall be kept in the custody of the chainnan seal md
or of any officer of the Fund authorized by the Board in that behalf, and executionof
shall be affixed to instruments pursuant to a resolution of the Board in the
presence of the chairman or any other member duly authorized to act in that
behalf, and the secretary.

(2) The seal of the Fund shall be authenticated by the signature of the
secretary or any other member of the Board duly authorized to act in that
behalf.

2 . 4 ) Subject to sub-paragraph (2) the Fund shall appoint and employ Power to
at such remuneration and on such terms and conditions as it thinks fit an appoint
Executive Director, a Secretary and such other officers and servants as it O f f i C = %

agents, a.
thinks necessary for the proper carrying out of the provisions of this Act.

(2) The Minister shall give prior approval to-

(a) any salary in excess of the prescribed rate per annum assigned to
any post;

(6) any appointment made to any post to which a salary in excess of
the prescribed rate is assigned;

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NATIONAL HEALTH FUND

Authentic-
ation of
documents.

Expznses
of the Fund.

Constitution
of Board.

Chairman
and deputy
drainnan.

Term of
office.

appoint-

Resigna-
tion

(c) payments under any pension scheme or for the payment of any
gratuity or other like benefit to. or in respect of the semice of. any
officer or servant.

(3) In sub-paragraph (2). the prescribed rate means a rate of two
million dollars or such hgher rate as the Minister may. by order. prescribe.

3. All documents, other that those required by law to be under seal. made
by. and all decisions of. the Fund may be signified under the hand of the
chauman or any member of the Board authorized to act in that behalf or an
officer of the Fund so authorized.

4. The expenses of the Fund (including the remuneration of the staff
thereof and members of the Board) shall be defrayed out of the income of
the Fund or from sums provided for the purpose by Parliament.

THIRD SCHEDULE (Section 6)

The Board of hiianagement of the Fund

1 . 4 1 ) The Board shall consist of such number of members not being
less than seven nor more than nine as the M s t e r may from time to time
appoint by instnunent in writing.

(2) The Chief Executive Officer of the Fund shall be an ex oflcio
member of the Board.

2 .41) The Minister shall appoint a chairman and a deputy chainnan
from among the members of the Board.

(2) In case of the absence or inability to act of the chamm, the
deputy chairman shall exercise the functions of the chainnan

3. A member of the Board shall, subject to the provisions of this
Schedule, hold office for a period not exceeding three years and each such
member shall be eligible for re-appointment.

4. The Minister may appoint any person to act in the place of any
member of the Board in the case of the absence or inability to act of such
member.

5 .41) Any member of the Board other than the chairman may at any
time resign his office by instrument in writing addressed to the chainnan
who shall forthwith cause it to be forwarded to the Minister and upon the
date of the receipt by the Minister of such instrument the member shall
cease to hold office.

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(2) Thc chairman may at any time rcsign h ~ s office by instrument in
writing addressed to the Minister and such resignation shall lake elTcct as
from thc date of thc rcccipt of such instrument.

6. The Minister may at any time rcvokc thc appointment of any member .
of the Board if he thinks it cxpcdicnt so to do.

7. The names of all members of the Board as first constituted and every
change in membership thereof shall be published in the Gazette.

%-(I) Thc Minister may. on the application of any member of the
Board, grant leave of absence to such member.

(2) The appointment of a member referrcd to in paragraph 3 shall be
rcgarded as terminated if. without the grant of leave of absence. that member
is absent from three consecutive meetings of the Board.

9.-41) The Board shall meet as often as may be necessary or expedient
for the trrlnsaction of its business (but at least six meetings shall be held
within each financial year) and such meetings shall be held at such places
and times and on such days as the Board may determine.

(2) The chairman may at any time call a special meeting to be held
withm seven days of a written request for the purpose addressed to h m by
any two members of the Board.

(3) The chairman shall preside at meetings of the Board and if the
chairman and the deputy chairman are absent from a meeting, the members
present shall elect one of their number to preside at that meeting.

(4) The quorum of the Board shall be five.
(5) The decisions of the Board shall be by a majority of votes and. in

addition to an original vote. the chairman or other member presiding at the
meeting shall have a casting vote in any case in whch the voting is equal.

(6) Minutes in proper form of each meeting of the Board shall be
kept.

(7) Subject to the provisions of this Schedule the Board may
regulate its own proceedings.

10. A member of the Board who is duectly or indirectly interested in any
matter which is being dealt with by the Board-

(a) shall dsclose the nature of his interest at a meeting of the Board;
and

(b) shall not take part in any deliberation or decision of the Board
with respect to that matter.

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Ixaw of
absence.

Roce+rz
and mekings.

Disclosure
of intetest.

16

Appoint-
ment of
committee.

Remunera-
tion of
membas.

Rotedim
of office.

Rotedim
of Board
members.

Office of

NATIONAL HEALTH FUND

11.--(I) The Board shall appoint-

(a) a medical Review Committee to monitor benefit schedules and
illnesses to be covered by the Fund; and

(b) an Operations Review Committee to monitor the operational and
financial operations of the Fund and to recommend changes
thereto, where necessary,

and may appoint such other committees as it thinks fit, consisting wholly or
partly of members of the Board and may delegate to such committees such
of the Board's functions as it thinks fit.

(2) A delegation under sub-paragraph (1) shall not prevent the
exercise by the Board of any function so delegated.

12. There shall be paid to the chairman and each member of the Board
such remuneration (whether by way of honorarium, salary or fees) and such
allowances as the Minister may determine.

13. No act done or proceeding taken under this Act shall be questioned
on the ground-

(a) of the existence of any vacancy in the chairmanship of, or any
defect in the constitution of, the Board; or

(b) of any omission, defect or irregularity not affecting the merits of
the case.

14.-41) No action, suit or other proceeding of the Board shall be
brought or instituted personally against any member of the Board in respect
of any act done bonaPde in the course of carrying out the provisions of this
Act.

(2) Where any member of the Board is exempt from liability
by reason only of the provisions of this paragraph, the Fund shall be liable to
the extent that it would be if that member were an employee or agent of the
Fund.

15. The office of a member of the Board shall not be a public
member other office for the purposes of Chapter V of the Constitution of Jamaica.
than
chairman not
public office.

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