Advanced Search

Amending Act, With Respect To Contracts Of Insurance, The Law Of 25 June 1992 On Terrestrial Insurance Contract And The Law Of 20 July 2007 Amending, With Regard To Private Insurance, The Law Of 25 June 1992 Contracts On

Original Language Title: Loi modifiant, en ce qui concerne les contrats d'assurance maladie, la loi du 25 juin 1992 sur le contrat d'assurance terrestre et la loi du 20 juillet 2007 modifiant, en ce qui concerne les contrats privés d'assurance maladie, la loi du 25 juin 1992 sur

Subscribe to a Global-Regulation Premium Membership Today!

Key Benefits:

Subscribe Now for only USD$40 per month.
belgiquelex.be - Carrefour Bank of Legislation

17 JUNE 2009. - An Act to amend, with respect to health insurance contracts, the Act of 25 June 1992 on the land insurance contract and the Act of 20 July 2007 to amend, with respect to private health insurance contracts, the Act of 25 June 1992 on the land insurance contract (1)



ALBERT II, King of the Belgians,
To all, present and to come, Hi.
The Chambers adopted and We sanction the following:
CHAPTER 1er. - Preliminary provision
Article 1er. This Act regulates a matter referred to in Article 78 of the Constitution.
CHAPTER 2. - Amendments to the Act of 25 June 1992 on the land insurance contract
Art. 2. Section 138bis -1 of the Act of 25 June 1992 on the land insurance contract, inserted by the Act of 20 July 2007, are amended as follows:
Paragraph 2 is replaced by the following:
“§2. A health insurance contract related to occupational activity means any health insurance contract entered into by one or more insurance takers for the benefit of one or more persons professionally related to the insurance taker(s) at the time of affiliation. »;
2° the article is supplemented by paragraphs 3 and 4 as follows:
Ҥ3. The primary insured is the person for whom the health insurance contract is entered into.
§ 4. Secondary insured persons are defined as family members of the principal insured person affiliated with the health insurance contract. »
Art. 3. In title III, chapter IV, section II, of the same Act, inserted by the Act of 20 July 2007, the word "individuals" is replaced by the words "not related to professional activity".
Art. 4. ÷ section 138bis -2 of the Act, inserted by the Act of 20 July 2007, are made the following amendments:
1° in paragraph 1erthe word "individuals" is replaced by the words "not related to professional activity";
2° in paragraph 2, the words "and members of his family who are affiliated with his health insurance" are replaced by the words ", the principal insured and the secondary insured."
Art. 5. In article 138bis -3, § 2, of the same law, inserted by the law of 20 July 2007, the words "of the insurance owner" are replaced by the words "of the principal insured".
Art. 6. Section 138bis -4 of the Act, inserted by the Act of 20 July 2007, is replaced by the following:
« § 1er. Unless mutually agreed by the parties and the exclusive request of the principal insured, as well as in the cases referred to in §§ 2, 3 and 4, the insurer may no longer make changes to the technical bases of the premium or to the conditions of coverage after the health insurance contract has been concluded.
The modification of the technical bases of the premium and/or the conditions of coverage, with the mutual agreement of the parties, provided for in paragraph 1er, can only be performed in the interest of insured persons.
§ 2. The premium, deductible and benefit can be adapted to the annual premium maturity date based on the Consumer Price Index.
§ 3. The premium, the deductible and the benefit may be adapted to the cost of the services covered by private health insurance contracts on the annual expiry date of the premium and on the basis of one or more specific indices if and to the extent that the changes in this or more indices exceed that of the consumer price index.
The King, on a joint proposal by Ministers who have Insurance and Social Affairs in their responsibilities and after consultation with the Federal Centre for Health Care Expertise (hereinafter "the Centre of Expertise"), determines the method of building these indices. ÷ this effect, It:
- select a set of objective and representative parameters;
- determines the method of calculating the values of these parameters;
- determines the respective weights of these parameters in the index(s).
This method can be evaluated by the Centre of Expertise, at the joint request of Ministers who have Social Affairs and Insurance in their responsibilities.
On the basis of the method fixed by the King, the SPF Economy calculates and publishes annually to the Belgian Monitor the value of the index or indices, based on the figures known as 30 June. Publication of the result is done no later than 1er September. The modalities of collaboration between the Centre of Expertise and the SPF Economie are the subject of a protocol signed between these two institutions.
The King may increase the frequency of calculating and publishing the value of the index or indices.
Individuals and institutions that have the information necessary for the calculation are required to communicate to the Centre of Expertise and the SPF Economie at the request of the Centre.
§ 4. The application of this section does not prejudice section 21octies of the Act of 9 July 1975 on the control of insurance companies.
§ 5. The premium, period of deficiency and coverage may be appropriately and proportionally:
1. changes in the insurance profession, in respect of non-mandatory health insurance, incapacity for work, disability insurance and care insurance and/or
2. changes in the insured's income with respect to incapacity for work insurance and disability insurance and/or
3. where the latter changes status in the social security system, with respect to health care insurance and incapacity for work insurance, provided that these modii cations have a significant impact on the risk and/or the cost or extent of guaranteed benefits. »
Art. 7. ÷ section 138bis -6 of the Act, inserted by the Act of 20 July 2007, are made the following amendments:
1° in paragraph 1er, the words "For a period of two years from the entry into force of this section" are replaced by the words "÷ from 1er July 2007 until June 30, 2011 included and the words "the insurance applicant" are replaced by the words "the primary insured candidate";
2° Paragraph 4 is replaced by the following:
"The obligation to provide health care insurance to key insured candidates who are chronically ill or disabled will be subject to, by 1er January 2011, an evaluation involving the Centre of Expertise, the Professional Union of Insurance Companies (Assuralia) and patient associations. The King determines before 1er July 2011, by deliberation in the Council of Ministers, if this obligation is maintained beyond 30 June 2011 when the results of the assessment demonstrate a continuing and important demand for health care insurance referred to in this article. »
Art. 8. In section 138bis -7 of the same Act, inserted by the Act of July 20, 2007, the words "The insurance owner" are replaced by the words "The principal insured" and the words "member of the insured family" and "insured" are replaced by the words "secondary insured".
Art. 9. In title III, chapter IV, section III, of the same law, inserted by the Act of 20 July 2007, the word "collective" is replaced by the words "related to professional activity".
Art. 10. In sections 138bis -8 to 138bis -11 of the same law, inserted by the law of 20 July 2007, the word "collective" is replaced each time by the words "related to professional activity" and the word "collective" is replaced each time by the words "related to professional activity".
Art. 11. ÷ article 138bis -8, § 2, paragraph 2, of the same law, inserted by the law of 20 July 2007, the following sentences are inserted between the second and the third sentence:
"The principal insured person and, where applicable, the co-insured person shall have the right to extend the 30-day period, provided that the insurer is notified in writing or electronically. This right must be served by the employer in accordance with paragraph 1er. "
CHAPTER 3. - Miscellaneous amendments
Art. 12. Article 21octies, § 2, of the Act of 9 July 1975 on the control of insurance companies, inserted by the Royal Decree of 12 August 1994 and amended by the Royal Decree of 25 March 2003, is replaced as follows:
Ҥ2. CBFA may require a company to balance a tariff if it finds that the application of this tariff results in losses.
Without prejudice to paragraph 1er, the CBFA, at the request of a company and if it finds that the application of this tariff, notwithstanding the application of section 138bis -4, §§ 2 and 3, of the law of June 25, 1992 on the land insurance contract, gives the person or risk of giving rise to losses, in the case of a health insurance contract other than professional in the sense of section 138bis - These measures may include adaptation of coverage conditions.
The raising of a tariff applies to contracts entered into on the basis of the notification of the CBFA decision and, without prejudice to the right to termination of the insurance licensee, it also applies to premiums and premiums of existing contracts, which expire on the first day of the second month following the notification of the CBFA decision.
The raising of a tariff is not subject to the obligation to report price increases under the Act of 22 January 1945 on economic regulation and prices and its enforcement orders. The CBFA informs the Price Commission of the tariff recovery decision. This decision takes effect only fifteen days after this notifi- cation and is only valid for a period determined by the CBFA. »
Art. 13. Section 3 of the Act of 20 July 2007 amending, with respect to private health insurance contracts, the Land Insurance Contract Act of 25 June 1992 is replaced by the following:
« § 1er. This Act comes into force on 1er July 2007. It is applicable both to new health insurance contracts and to health insurance contracts entered into before it comes into force.
§ 2. For existing health insurance contracts not related to professional activity, a two-year transitional period is applicable from 1er July 2007 with respect to the application of section 138bis -4 of the Act of 25 June 1992 on the land insurance contract.
With respect to existing health insurance contracts not related to professional activity that, at the time of the coming into force of this Act, do not meet the requirements of section 138bis-3 of the Act of 25 June 1992 on the land insurance contract, the insurance company proposes to the principal insured, no later than two years from 1er July 2007, a new health insurance contract complies with these requirements. The principal insured person decides, within thirty days of receipt of the proposal, to subscribe to the proposal or to maintain its current health insurance contract for its remaining duration.
Existing health insurance contracts not related to professional activity that have been entered into by one or more insurance licensees of one or more principal insured persons and/or one or more secondary insured persons are subject to the end of the transitional period referred to in paragraph 1erthe provisions of Chapter IV, Section III, of the Act of 25 June 1992 on the land insurance contract. New principal insured persons can no longer join these insurances.
§ 3. For existing health insurance contracts related to occupational activity, a two-year transitional period is applicable from 1er July 2007 to adapt these contracts to the requirements of Part III, Chapter IV, Section III, of the Act of 25 June 1992 on the land insurance contract.
§ 4. Existing health insurance contracts must have been formally adjusted by 1er July 2009. »
Art. 14. Section 4 of the Act is repealed.
CHAPTER 4. - Final provision
Art. 15. This Act produces its effects from 1er July 2007.
Promulgation of this law, let us order that it be clothed with the seal of the State and published by the Belgian Monitor.
Given in Brussels on 17 June 2009.
ALBERT
By the King:
Minister of Finance,
D. REYNDERS
Minister of Justice,
S. DE CLERCK
Minister of Social Affairs and Public Health,
Ms. L. ONKELINX
Seal of the state seal:
Minister of Justice,
S. DE CLERCK
____
Note
(1) Parliamentary references:
Documents of the House of Representatives - K.52-1662.
Deposit: December 11, 2008.
Adoption en commission (amendé) : 27 février 2009.
Review, Full record: 12 March 2009.
Overall vote: does not vary (unanimity)
Full report: 19 March 2009.
Adoption with amendment to the Commission: 19 March 2009.
Senate documents: S-4-1235
Transmission to the Senate for the first time: March 20, 2009.
Overall vote: no change (+35/-22/o1): 28 May 2009.
Adoption without amendment: 28 May 2009.
Transmission to the Chamber for Penalty: May 28, 2009.
Board submission for sanction: June 2, 2009.