1911. (3) A scheme made under this section shall not have any effect unless and until confirmed by the Insurance Commissioners, and the Insurance Commissioners shall not confirm any such scheme unless satisfied that the value of the additional benefits conferred by the scheme is equivalent to the value of the benefits for which they are substituted, and that, in view of the special circumstances of the members or class of members intended to come under the scheme, there is good reason for substituting the additional benefits conferred by the scheme for the benefits for which they are substituted. (4) Nothing in this section or in any scheme made thereunder shall affect the amount of any reserve value to be credited to a society in respect of a member, and such reserve values shall be calculated as if the scheme had not been made. Administration of Benefits. s. 14. 14-(1) Sickness benefit, disablement benefit, and maternity benefit Administrashall be administered, in the case of insured persons who are members of tion of benean approved society, by and through the society, or a branch thereof, fits by approved and in other cases by and through the Insurance Committees (a); medical societies or and sanatorium benefits shall in all cases be administered by and through the Insurance the Insurance Committees (b); additional benefits shall be administered Committee. by the society or branch of which the persons entitled thereto are members, except where such benefits are in the nature of medical benefits, in which case they shall be administered by and through the Insurance Committees. (2) Subject to the provisions of this Part of this Act, an approved society may, with the consent of the Insurance Commissioners, provide for the application of its existing rules or make new rules with regard to the manner and time of paying or distributing (c), and mode of calculating, benefits, suspension of benefits (d), notices and proof of disease or disablement, behaviour during disease or disablement, and the visiting of sick or disabled persons, and for the infliction and enforcement of penalties (whether by way of fines or suspension of benefits or otherwise) in the case of any member being an insured person who is guilty of any breach of any such rule, or of any imposition or attempted imposition in respect of any benefit under this Part of this Act, and may, from time to time with the like consent, alter or repeal any such rules (e); but— (a) no fine imposed under any such rules shall exceed ten shillings (c) every such rule relating to the visiting of insured persons by (a) For provisions as to the administration of the benefits of deposit contributors, see sub-section (3) of this Section and Part I. (8), (9), and (10) of the Fourth Schedule to the National Health Insurance Act, 1918 (p. 121). (b) Insurance Committees in Scotland have, in certain cases, power to modify or suspend (with the consent of the Scottish Insurance Commissioners) benefits for the administration of which they are responsible: see Section 80 (9). (c) An approved society is debarred from making any deduction from an amount payable by way of sickness, disablement or maternity benefit on account of the cost of the transmission of the benefit, except where special arrangements in that behalf are made at the request of the insured person concerned; see Section 36 of the National Health Insurance Act, 1918 (p. 114). (d) Section 12 (3) of the National Health Insurance Act, 1918 (p. 99), provides that "notwithstanding any provision to the contrary in any rule of an approved society or branch of such society, an insured unmarried woman who is pregnant shall not on the ground that her pregnancy was due to misconduct be deprived of any sickness or disablement benefit to which she would but for that provision have been entitled." (e) In Ireland, Societies and Insurance Committees may make rules for inspection of medical relief registers by their officers and for the furnishing of and payments for medical certificates for the purposes of the administration of benefits: see Section 81 (13). 1911. s. 15. Administra. tion of medical benefit. (d) every such rule relating to behaviour during disease or disablement shall be in the prescribed form; (e) no such rule shall prescribe any penalty, nor shall any insured person be subject to any penalty, whether by suspension of benefit or otherwise, on account of the refusal by any such person to submit to a surgical operation, or vaccination, or inoculation of any kind, unless such refusal in the case of a surgical operation of a minor character is considered by the society, or on appeal the Insurance Commissioners, unreasonable; no such rule shall provide for inflicting as a penalty for breach of rules or imposition or attempted imposition on the part of an insured person suspension of maternity benefit in respect of the confinement of his wife, where, his wife has not herself been guilty of any such breach, imposition, or attempted imposition. (3) The Insurance Committee shall, subject to the approval of the Insurance Commissioners, make rules in respect of any of the matters mentioned in the last preceding subsection with regard to the administration of benefits by the committee: Provided that no such rule relating to anything to be done by, to, or through the Post Office shall be made without the consent of the PostmasterGeneral. (4) Where, under any such rule as aforesaid, payment of sickness or disablement benefit is suspended on the ground that the disease or disablement has been caused by the misconduct (a) of the person claiming the benefit, such person shall not thereby become disentitled to medical benefit. (5) Where under any Act regulating the constitution of a society which becomes an approved society the rules of the society are required to be registered, any rules approved under this section by the Insurance Commissioners shall forthwith be registered, but till so registered shall have effect as if they had been duly registered. 15. (1) Every Insurance Committee shall, for the purpose of administering medical benefit, make arrangements with duly qualified medical practitioners in accordance with regulations made by the Insurance Commissioners (b). (2) The regulations made by the Insurance Commissioners shall provide for the arrangements made being subject to the approval of the Insurance Commissioners and being such as to secure that insured persons shall, save as hereinafter provided, receive adequate medical attendance and treatment from the medical practitioners with whom arrangements are so made, and shall require the adoption by every Insurance Committee of such system as will secure (a) the preparation and publication of lists of medical practitioners who have agreed to attend and treat insured persons whose medical benefit is administered by the committee; (b) a right on the part of any duly qualified medical practitioner who is desirous of being included in any such list as aforesaid (a) See footnote (d) on preceding page. (b) Part I. (6) of the Fourth Schedule to the National Health Insurance Act, 1918 (p. 120), provides for regulations to be made by the Insurance Commissioners with respect to the issue of certificates for the purposes of Part I. of the principal Act by medical practitioners under agreement with Insurance Committees; and Part II. of that Schedule (p. 121) provides for the making of regulations with respect to the adminis tration of medical benefit or treatment, the cost of which may be defrayed out of the additional sums provided by Parliament under Section 1 of the National Insurance Act, 1913 (p. 74). of being so included, but, where the Insurance Commissioners, (c) a right on the part of any insured person of selecting, at such (d) the distribution amongst, and, so far as practicable, under (e) the provision of medical attendance and treatment, on the Provided that, if the Insurance Commissioners are satisfied after inquiry that the practitioners included in any list are not such as to secure an adequate medical service in any area, they may dispense with the necessity of the adoption of such system as aforesaid as respects that area, and authorise the Committee to make such other arrangements as the Commissioners may approve; or the Commissioners may themselves make such arrangements as they think fit, or may suspend the right to medical benefit in respect of any insured persons in the area for such period as they think fit, and pay to each such person a sum equal to the estimated cost of his medical benefit during that period, and, where the Commissioners take any such action themselves, they shall retain and apply for the purpose (a) Where, in exercise of their powers under this paragraph, the Insurance Commissioners remove the name of a medical practitioner from any list of medical practitioners prepared under this Section, they are empowered by Section 32 (1) of the National Health Insurance Act, 1918 (p. 113), to remove his name from all or any other lists so prepared in which it is at the time included, and to disqualify him, for so long as they think fit, for inclusion in any other list, whether in England, Scotland or Wales, in which his name was not then included or from which it was then removed. (b) Section 32 (2) and (3) of the National Health Insurance Act, 1918 (p. 114), provides that :- (i) As regards the administration of medical benefit in England and Wales, the regulations made under Section 15 may provide for the application, with any necessary modifications, to inquiries held under this paragraph of any of the provisions of the Arbitration Act, 1889, relating to the costs of an arbitration, the attendance of witnesses, and the production of documents, and for the costs of any such inquiry and of the finding thereon being in the discretion of the Commissioners instead of in the discretion of the person holding the inquiry; (ii) As regards the administration of medical benefit in Scotland, the regulations made under Section 15 may provide that, in the case of any such inquiry held in Scotland, the Scottish Insurance Commissioners may make such award as seems to them proper in regard to the expenses of the inquiry and the finding thereon. (c) By Section 10 (2) of the National Insurance Act, 1913 (p. 76), this paragraph was extended to members of other societies who were at the date of the passing of the principal Act (i.e., 16th December, 1911) entitled as such members to medical attendance and treatment. 1911. s. 15. 1911. s. 15. such part of the sums payable to the Insurance Committee in respect of medical benefit as may be required (a). (3) The regulations made by the Insurance Commissioners shall authorise the Insurance Committee by which medical benefit is administered to require any persons whose income exceeds a limit to be fixed by the Committee, and to allow any other persons, in lieu of receiving medical benefit under such arrangements as aforesaid, to make their own arrangements for receiving medical attendance and treatment (including medicines and appliances) (b) and in such case the Committee shall, subject to the regulations, contribute from the funds out of which medical benefit is payable towards the cost of medical attendance and treatment (including medicines and appliances) for such persons sums not exceeding in the aggregate the amounts which the Committee would otherwise have expended in providing medical benefit for them. (4) The regulations shall provide that, in the case of persons who are entitled to receive medical attendance and treatment under any system or through any institution existing at the time of the passing of this Act and approved by the Insurance Committee and the Insurance Commissioners, such medical attendance and treatment may be treated as, or as part of, their medical benefit under this Part of this Act, and may provide for the Committee contributing towards the expenses thereof the whole or any part of the sums which would be contributed in the case of persons who have made their own arrangements as aforesaid, so, however, that such regulations shall secure that no person be deprived of his right, if he so elects, of selecting the duly qualified medical practitioner by whom he wishes to be attended and treated, in accordance with the foregoing provisions of this section. (5) Every such Committee shall also make provision for the supply of proper and sufficient drugs and medicines and prescribed appliances to insured persons in accordance with regulations made by the Insurance Commissioners, which shall provide for the arrangements made being subject to the approval of the Insurance Commissioners and being such as to enable insured persons to obtain from any persons, firms, or bodies corporate with whom arrangements have been made such drugs, medicines, and appliances if ordered by the medical practitioner by whom they are attended, and shall require the adoption by every Insurance Committee of such a system as will secure (a) The preparation and publication of lists of persons, firms, and bodies corporate who have agreed to supply drugs, medicines, and appliances to insured persons whose medical benefit is administered by the Committee, according to such scale of prices as may be fixed by the Committee; (b) A right on the part of any person, firm, or body corporate desirous of being included in any such list as aforesaid of being so included, for the purpose of supplying such drugs, medicines, and appliances as such person, firm, or body corporate is entitled (a) Section 11 of the National Insurance Act, 1913 (p. 76), provides that "if the Insurance Commissioners are satisfied that the insured persons or any considerable proportion of them within an area, or part of an area, are not receiving satisfactory medical treatment under the panel system, the Commissioners may authorise the Insurance Committee to make, or may themselves make, such other arrangements as will secure to insured persons within the area or part such better medical service as is practicable having regard to the funds available for the purpose, or arrangements whereunder insured persons within the area, or part of the area, may be required to make their own arrangements for receiving medical attendance and treatment, including medicines and appliances, and whereunder the Insurance Committee or the Insurance Commissioners undertake to pay the cost of such medical attendance and treatment upon such scale as they may determine with the approval of the Commissioners so calculated that the medical attendance and treatment so secured shall be of a quality not inferior to that provided under the panel system." (b) Proviso (b) tô Section 9 (1) of the National Insurance Act, 1913 (p. 76), provides that where the total income of any exempt person exceeds £160 a year, he shall be required to make his own arrangements for medical attendance and treatment. by law and authorised by the Committee to supply, except in Provided that— (i) If the Insurance Commissioners are satisfied that the scale of 1911. s. 15. (iii) Subject to the regulations made by the last foregoing proviso (iv) Nothing in this Act shall interfere with the rights and privileges (6) There shall in each year be paid to the Insurance Committee for each county (b) or county borough (c) out of moneys credited to a society which has members resident in the county or county borough such sum in respect of the medical benefit of such members and the cost of administration thereof as may be agreed between the society and the committee or, in default of agreement, may be determined by the Insurance Commissioners. (7) If in any year the amount payable to an Insurance Committee in respect of all persons for the administration of whose medical benefit it is responsible is insufficient to meet the estimated expenditure thereon, the Committee may, through the Insurance Commissioners, transmit to the Treasury and to the council of the county or county borough (c) an account showing the amount so payable and the estimated expenditure, and the Treasury and the county council or the council of the county borough may, if they think fit and if satisfied that the amounts so payable and the (a) Footnotes (a) and (b) on p. 11 apply also, mutatis mutandis, to inquiries held under this paragraph for the removal of any person, firm, or body corporate undertaking the supply of drugs, medicines or appliances from any list of such persons, firms and bodies corporate, and to subsequent action taken by the Commissioners as the result of such inquiries. (b) In Scotland, the counties of Kinross and Clackmannan and the counties of Elgin and Nairn shall in each case be regarded as a single county see Section 80 (5). (c) In Scotland, a burgh or police burgh within the meaning of the Local Government (Scotland) Act, 1889, containing within the police boundaries thereof according to the census a population of 20,000 or upwards, and including the burgh of Dumfries and the police burgh of Maxwelltown as if they were a single burgh: see Section 80 (4). c. 121. 55 Geo. 3, c. 194. |