The National Health Insurance Act, 2018

THE NATIONAL HEALTH INSURANCE ACT
2018
ARRANGEMENT OF SECTIONS
PART I
PRELIMINARY PROVISIONS
1. Short title and Commencement
2. Interpretation
3. Application and power of exemption
PART II
THE NATIONAL HEALTH INSURANCE MANAGEMENT AUTHORITY
4. Establishment of National Health Insurance Management
Authority
5. Functions of Authority
6. Board of Authority
7. Functions of Board
8. Committees
9. Delegation of functions
10. Director-General and other staff of Authority
11. Provincial and district offices of Authority
PART III
NATIONAL HEALTH INSURANCE SCHEME, COVERAGE AND BENEFITS
12. Establishment of National Health Insurance Scheme
13. Membership and registration
14. Possession of health insurance by foreigners
15. Contributions and payment mechanisms
16. Persons exempt from contributions
17. Standard unit cost
18. Negotiated fees, charges and payment mechanisms
19. Scheme membership card
20. Benefits of member’s contribution
21. Death of member
22. Suspension of benefits
23. Information on change of membership status
24. Portability
25. Material modifications
National Health Insurance [No. 2 of 2018 61
Single copies of this Act may be obtained from the Government Printer,
P.O.

ity
25. Material modifications
National Health Insurance [No. 2 of 2018 61
Single copies of this Act may be obtained from the Government Printer,
P.O.

Box 30136, 10101 Lusaka, Price K120.00 each.

Box 30136, 10101 Lusaka, Price K120.00 each.

PART IV
ACCREDITATION OF HEALTH CARE PROVIDERS
26. Prohibition of provision of insured health care services without
accreditation
27. Application for accreditation to provide insured health care
services
28. Grant or rejection of application for accreditation
29. Dispensing with accreditation
30. Suspension or revocation of accreditation
31. Publication of accredited health care providers
32. Reporting requirements for accredited health care providers
33. Payment for insured health care services
34. Confidential patient record system and provider payment
system
35. Member’s enrolment with accredited health care provider
36. Duty to provide insured health care services
PART V
QUALITY ASSURANCE
37. Compliance with quality standards
38. Quality assurance
39. Contracts and monitoring mechanisms
40. Inspections
PART VI
NATIONAL HEALTH INSURANCE FUND
41. Establishment of National Health Insurance Fund
42. Administration and management of Fund
43. Fund accounts and disbursement
44. Annual report
PART VII
FINANCIAL PROVISIONS
45. Funds of Authority
46. Financial year
47. Accounts and audit
48. Annual report
62 No. 2 of 2018] National Health Insurance

II
FINANCIAL PROVISIONS
45. Funds of Authority
46. Financial year
47. Accounts and audit
48. Annual report
62 No. 2 of 2018] National Health Insurance

PART VIII
GENERAL PROVISIONS
49. Health Complaints Committee and appeals
50. Appeals
51. Immunity from execution of judgements
52. Registers
53. General offences
54. Fine in lieu of prosecution
55. Offences by body corporate
56. General penalty
57. Regulations
SCHEDULE
National Health Insurance [No. 2 of 2018 63

4. Fine in lieu of prosecution
55. Offences by body corporate
56. General penalty
57. Regulations
SCHEDULE
National Health Insurance [No. 2 of 2018 63

An Act to provide for sound financing for the national health
system; provide for a universal access to quality insured
health care services; establish the National Health
Insurance Management Authority and provide for its
functions and powers; establish the National Health
Insurance Scheme and provide for its systems, procedures
and operation; establish the National Health Insurance
Fund and provide for contributions to and payments from
the Fund; provide for accreditation criteria and conditions
in respect of insured health care services; provide for
complaints and appeals processes; provide for the
progressive establishment of provincial and district health
offices of the Authority; and provide for matters connected
with, or incidental to, the foregoing. [11th April, 2018
ENACTED by the Parliament of Zambia. PART I
PRELIMINARY PROVISIONS
1. This Act may be cited as the National Health Insurance
Act, 2018, and shall come into operation on the date appointed by
the Minister by statutory instrument. 2.

y be cited as the National Health Insurance
Act, 2018, and shall come into operation on the date appointed by
the Minister by statutory instrument. 2.

In this Act, unless the context otherwise requires—
“ accreditation ” means the process of recognition of a health
care provider as one that is allowed to provide insured
health care services for the purposes of this Act;
“ accredited health care provider ” means a health care
provider that is accredited by the Authority under section
28;
“ actuarial assessment ” means the periodic valuation of a
Scheme, made in accordance with actuarial methods;
National Health Insurance [No. 2 of 2018 65
Enactment
Short title
and
Commence-
ment
Interpretation
GOVERNMENT OF ZAMBIA
ACT
No. 2 of 2018
Date of Assent: 9th April, 2018

rance [No. 2 of 2018 65
Enactment
Short title
and
Commence-
ment
Interpretation
GOVERNMENT OF ZAMBIA
ACT
No. 2 of 2018
Date of Assent: 9th April, 2018

“ admission ” means a procedure where a person is
accommodated overnight or for such other prescribed
period by a health care provider for the purposes of
receiving necessary in-patient services and “ admitted ”
and cognate expressions shall be construed accordingly;
“ Authority ” means the National Health Insurance
Management Authority established under section 4;
“ bank ” has the meaning assigned to the word in the Banking
and Financial Services Act, 2017;
“ benefit ” means a direct insured health care service in the
form of treatment or an indirect insured health care service
consisting of a reimbursement of the expenses borne by a
member and provided by an accredited health care provider
and may include authorised tertiary health care services
or a cash benefit;
“ benefit package ” means the benefits a member is entitled
to under the Scheme;
“ billing ” means making a claim by an accredited health care
provider for insured health care service expenses;
“ Board ” means the Board of the Authority constituted under
section 6;
“ casual employee ” has the meaning assigned to the words
in the Employment Act;
“ Chairperson ” means the Chairperson of the Board,
appointed under section 6;
“ child ” has the meaning assigned to the word in the
Constitution;
“ citizen ” has the meaning assigned to the word in the
Constitution;
“ committee ” means a committee of the Board constituted
under section 8;
“ Council ” means the Health Professions Council established
under the Health Professions Act, 2009;
“ dependant ” means a person, who resides with a member,
and relies on the member’s income for survival;
“ emergency medical condition ” means the sudden, and at
the time unexpected onset of a health condition that requires
immediate medical or surgical treatment, where failure to
provide medical or surgical treatment would result in serious
impairment to bodily functions or serious dysfunction of a
body organ or part or would place the person’s life in serious
jeopardy;
Act No.

in serious
impairment to bodily functions or serious dysfunction of a
body organ or part or would place the person’s life in serious
jeopardy;
Act No.

7
of 2017
66 No. 2 of 2018] National Health Insurance
Cap. 268
Cap. 1
Cap. 1
Act No. 24
of 2009

7
of 2017
66 No. 2 of 2018] National Health Insurance
Cap. 268
Cap. 1
Cap. 1
Act No. 24
of 2009

“ employee ” has the meaning assigned to the word in the
Employment Act;
“ employer ” has the meaning assigned to the word in the
Employment Act;
“ established resident ” has the meaning assigned to the word
in the Immigration and Deportation Act, 2010;
“ family member ” means a registered child, spouse and
dependant of a member;
“ Fund ” means the National Health Insurance Fund
established under section 41;
“ health care expense ” means an amount payable in respect
of an insured health care service provided to a member by
an accredited health care provider;
“ health care provider ” includes an institution or agency that
provides health care services;
“ health care service ” has the meaning assigned to the word
in the Health Professions Act, 2009;
“ health insurance number ” means an identification number,
assigned to a member by the Authority and stated on a
member’s membership card;
“ health practitioner ” has the meaning assigned to the words
in the Health Professions Act, 2009;
“ inpatient service ” means a health care service provided by
a patient who is admitted overnight by a health care
provider;
“ inspector ” means a person appointed as an inspector under
section 40;
“ insured health care service ” means a health care service
available under the Scheme;
“ medical doctor ” means a health practitioner registered as
such under the Health Professions Act, 2009;
“ member ” means a member of the Scheme as provided
under section 13;
“member contribution” means such amount as may be
prescribed for purposes of section 15;
“membership card” means a card issued to a person registered
under the Scheme;
“out patient service” means a health care service or procedure
provided by a health care provider to a patient who is not
admitted by a health care provider;
National Health Insurance [No.

are service or procedure
provided by a health care provider to a patient who is not
admitted by a health care provider;
National Health Insurance [No.

2 of 2018 67
Cap. 268
Cap. 268
Act No. 18
of 2010
Act No. 24
of 2009
Act No. 24
of 2009
Act No. 24
of 2009

2 of 2018 67
Cap. 268
Cap. 268
Act No. 18
of 2010
Act No. 24
of 2009
Act No. 24
of 2009
Act No. 24
of 2009

“patient” means a member who is receiving or has received
treatment from an accredited health care provider;
“pension scheme” means a pension scheme established under
any other law;
“private health insurer” means a company that provides health
insurance;
“provider payment system” means the manner of payment to
a health care provider for delivery of health services to
members;
“Scheme” means the National Health Insurance Scheme
established under section 12;
“treatment” means medical, surgical, obstetric or dental
treatment or such other medical treatment as may be
prescribed; and
“Vice-Chairperson means the Vice-Chairperson of the Board
elected under section 6. 3. (1) The provisions of this Act shall bind the Republic. (2) The Minister may prescribe health care services that are
not covered by the Scheme. (3) The Minister, by statutory instrument, may extend the
categories of individuals to whom this Act applies. PART II
THE NATIONAL HEALTH INSURANCE MANAGEMENT AUTHORITY
4.

statutory instrument, may extend the
categories of individuals to whom this Act applies. PART II
THE NATIONAL HEALTH INSURANCE MANAGEMENT AUTHORITY
4.

(1) There is established the National Health Insurance
Management Authority which is a body corporate with perpetual
succession and a common seal, capable of suing and being sued in
its corporate name and with power, subject to this Act, to do all
acts and things that a body corporate may, by law, do or perform. (2) The Schedule applies to the Authority. 5. The functions of the Authority are to—
(a) implement, operate and manage the Scheme;
(b) manage the Fund;
(c) accredit health insurance healthcare providers;
(d) develop a comprehensive benefit package to be accessed
by members;
(e) register and issue membership cards to members;
(f) facilitate—
(i) access by poor and vulnerable people to insured
health care services; and
(ii) protection of the poor and vulnerable against
deprivation of health services;
68 No. 2 of 2018] National Health Insurance
Application
and power
of exemption
Establishment
of
National
Health
Insurance
Management
Authority
Functions of
Authority

8] National Health Insurance
Application
and power
of exemption
Establishment
of
National
Health
Insurance
Management
Authority
Functions of
Authority

(g) receive, process and pay claims for services rendered by
accredited health care providers;
(h) undertake public education and awareness programmes
on health insurance;
(i) undertake research in health insurance to inform policy
formulation and implementation;
(j) advise the Minister on health insurance and health insurance
policy formulation;
(k) undertake programmes that further the sustainability of
the Scheme;
(l) develop guidelines, processes and manuals for the effective
implementation and management of the Scheme;
(m) ensure that an accredited health care provider delivers
efficient and quality insured health care services;
(n) monitor and ensure compliance with thisAct and guidelines,
policies, processes and manuals made by the Authority
in the performance of its functions under this Act;
(o) undertake, in collaboration with relevant regulatory
agencies, inspection of health facilities operated by
accredited health care providers;
(p) receive, investigate and determine complaints by members
and accredited health care providers in accordance with
section 49;
(q) collaborate with corresponding health insurance
management authorities in other countries;
(r) develop, in consultation with relevant stakeholders,
modalities of financing the coverage of indigent people
under the Scheme;
(s) cause the undertaking of actuarial valuations of the Scheme
at prescribed intervals;
(t) establish and maintain a register of members and accredited
health care providers; and
(u) do other things that are connected with, or incidental to,
the functions of the Authority under this Act.

nd accredited
health care providers; and
(u) do other things that are connected with, or incidental to,
the functions of the Authority under this Act.

6. (1) There is constituted a Board of the Authority which
consists of the following part-time members appointed by the
Minister:
(a) a representative each of the—
(i) Attorney General;
(ii) Health Professions Council of Zambia;
(iii) Ministry responsible for social services;
National Health Insurance [No. 2 of 2018 69
Board of
Authority

) Health Professions Council of Zambia;
(iii) Ministry responsible for social services;
National Health Insurance [No. 2 of 2018 69
Board of
Authority

(iv) Ministry responsible for health;
(v) Ministry responsible for finance;
(vi) Ministry responsible for labour;
(vii) associations for employees in the public sector;
(viii) associations for employees in the private sector;
(ix) associations for employers in the public sector;
(x) associations for employers in the private sector;
(xi) associations for religious groupings in Zambia;
(xii) Zambia Institute of Chartered Accountants; and
(b) two other persons, one of whom has experience in health
insurance. (2) The members of the Board referred to in subsection (1)
(a) shall be nominated by their respective institutions. (3) The Minister shall appoint the Chairperson from among
the members of the Board. (4) The members of the Board shall elect the Vice-Chairperson
from among their number.

ll appoint the Chairperson from among
the members of the Board. (4) The members of the Board shall elect the Vice-Chairperson
from among their number.

(5) A person shall not be nominated or appointed as a member
of the Board if that person—
(a) is an undischarged bankrupt;
(b) has a mental disability that renders that person incapable
of performing the functions of a member of the Board;
(c) has been convicted of an offence involving fraud or
dishonesty;
(d) has been convicted of an offence under any law and
sentenced to imprisonment for a period exceeding six
months without the option of a fine; or
(e) is an employee of the Authority. (6) The Schedule applies to the Board. 7. Subject to the provisions of this Act, the functions of the
Board are to—
(a) review the policy and strategic plan of the Authority;
(b) provide strategic direction to the Authority, oversee the
implementation and successful operation of the policy
and functions of the Authority;
(c) approve the annual plans and budget of the Authority;
(d) monitor and evaluate the performance of the Authority
against the plans and budget;
(e) approve the acquisition of property, movable and
immovable, which may be necessary or expedient for
the attainment of the purposes of this Act; and
70 No. 2 of 2018] National Health Insurance
Functions of
Board

which may be necessary or expedient for
the attainment of the purposes of this Act; and
70 No. 2 of 2018] National Health Insurance
Functions of
Board

(f) approve the business plans of the Authority. 8. (1) The Board may constitute committees that it considers
necessary and delegate any of its functions to these committees. (2) The Board may appoint as members of a committee,
persons who are, or are not members of the Board, except that at
least one member of a committee shall be a member of the Board. (3) A person serving as a member of a committee shall hold
office for such period as the Board may determine. (4) Subject to any specific or general direction of the Board, a
committee may regulate its own procedure. 9. The Board may, by direction in writing, and subject to the
terms and conditions that it considers necessary, delegate to the
Director-General, any of its functions under this Act. 10. (1) The Board shall, appoint a Director-General on the
terms and conditions that the Emoluments Commission may
determine. (2) The Director-General shall be the chief executive officer
of the Authority and shall, subject to the control of the Board, be
responsible for the day-to-day administration of the Authority.

executive officer
of the Authority and shall, subject to the control of the Board, be
responsible for the day-to-day administration of the Authority.

(3) A person shall not be appointed as Director-General unless
that person has relevant qualifications or management experience
in health economics, health care financing, medical care, health
care, insurance or actuarial assessments and evaluations. (4) The Director-General may attend meetings of the Board
and of any committee and may address such meetings, but shall
have no vote. (5) The Board shall appoint a Board Secretary on the terms
and conditions that the Emoluments Commission may determine. (6) The Board may, whenever the Director-General is for any
reason unable to discharge the functions of the Director-General’s
office, appoint an Acting Director-General to discharge the Director-
General’s functions. (7) The Board may appoint, on the terms and conditions that
the Emoluments Commission may determine, other staff of the
Authority that it considers necessary for the performance of its
functions under this Act. 11. The Authority shall, with approval of the Board,
progressively establish and maintain provincial and district offices
of the Authority. National Health Insurance [No.

all, with approval of the Board,
progressively establish and maintain provincial and district offices
of the Authority. National Health Insurance [No.

2 of 2018 71
Committees
Delegation
of
functions
Director-
General
and other
staff
of Authority
Provincial
and
district
offices of
Authority

2 of 2018 71
Committees
Delegation
of
functions
Director-
General
and other
staff
of Authority
Provincial
and
district
offices of
Authority

PART III
NATIONAL HEALTH INSURANCE SCHEME, COVERAGE AND BENEFITS
12. (1) There is established the National Health Insurance
Scheme into which shall be paid all contributions authorised under
this Act and out of which shall be met all payments authorised to
be paid under this Act. (2) The objective of the Scheme is to provide universal access
to quality insured health care services in accordance with this Act. 13. (1) A citizen or established resident who is above eighteen
years shall be registered as a member of the Scheme in the
prescribed manner and form. (2) The Minister may prescribe conditions and procedures
under which a person who is not eligible to become a member of
the Scheme under the Act may access insured health care services. (3) Subject to subsections (1) and (2), an employer shall register
an employee with the Authority within thirty days of the
commencement date of the contract of employment in the
prescribed manner and form. (4) A manager of a pension scheme shall ensure that a retiree
is registered by the Authority in accordance with this Act. (5) A self-employed citizen and established resident shall
register as a member of the Scheme in accordance with this Act.

n accordance with this Act. (5) A self-employed citizen and established resident shall
register as a member of the Scheme in accordance with this Act.

(6) The Authority shall, in accordance with subsection (1),
register a person as a member of the Scheme and issue a
membership card in accordance with section 19. 14. (1) A foreigner who enters the Republic shall have valid
health insurance for the period that the foreigner stays in the
Republic. (2) A foreigner who enters the Republic without valid health
insurance shall register and pay for health insurance with a health
insurer on arrival in the Republic, in the prescribed manner and
form. 15. (1) An employer shall pay to the Scheme an employee’s
contribution consisting of the employer’s contribution and the
employee’s contribution at a prescribed percentage. (2) The employer shall pay contributions to the Scheme at the
end of each month. 72 No. 2 of 2018] National Health Insurance
Establishment
of National
Health
Insurance
Scheme
Membership
and
registration
Possession
of health
insurance by
foreigners
Contributions
and payment
mechanisms

ment
of National
Health
Insurance
Scheme
Membership
and
registration
Possession
of health
insurance by
foreigners
Contributions
and payment
mechanisms

(3) A manager of a pension scheme shall pay to the Scheme a
retiree’s contribution, as prescribed. (4) A self-employed citizen or established resident shall pay a
contribution to the scheme, as prescribed. (5) The Minister shall, in consultation with the Authority,
prescribe rates of contribution for different benefit packages and
payment mechanisms available to the member. 16. A citizen or established resident that may be exempted
from payment of contributions under the Scheme include—
(a) a mentally or physically disabled person who is unable to
work;
(b) an elderly person above the age of 65;
(c) a person classified as poor and vunerable by the Ministry
responsible for social welfare; and
(e) any other person as may be prescribed by the Minister. 17. The Authority shall for each year establish and update a
uniform national standard schedule of the fees and charges for
items and services provided by accredited health care providers. 18. (1) The Authority shall negotiate with accredited health
care providers, a schedule of fees and charges for insured health
care services that are fair and optimal.

rity shall negotiate with accredited health
care providers, a schedule of fees and charges for insured health
care services that are fair and optimal.

(2) In negotiating a schedule of fees and charges, under
subsection (1), the Authority shall take into consideration the—
(a) need for a uniform national standard of fees and charges;
(b) objective of ensuring that accredited health care providers
are compensated at a rate which reflects their health
practitioner’s expertise and the value of their service,
regardless of geographic region and past fees and
charges;
(c) need to establish a prescription drug formulary system,
including medical interventions, which encourages best-
practices in prescribing and discourages the use of
ineffective, dangerous, or excessively costly medications
where better alternatives are available; and
(d) need to use generic medications where such are available
while allowing the use of brand-names and off-formulary
medications as prescribed in the benefit package. 19. (1) The Authority shall, on registration of a member, issue
a membership card as prescribed. National Health Insurance [No. 2 of 2018 73
Persons
exempt from
contributions
Standard
unit cost
Negotiated
fees, charges
and payment
mechanisms
Scheme
membership
card

nsurance [No. 2 of 2018 73
Persons
exempt from
contributions
Standard
unit cost
Negotiated
fees, charges
and payment
mechanisms
Scheme
membership
card

(2) Where a membership card is lost or defaced or otherwise
destroyed, the Authority shall replace the membership card on
payment of a prescribed fee. (3) The issuance of the membership card shall be accompanied
by adequate information on the benefits, rights and privileges of
the member, including the list of accredited health care providers. 20. (1) A member and a family member shall access the
benefits package under the Scheme as prescribed. (2) Subject to this Act, insured health care services, in whole
or in part, shall be provided at national, provincial and district levels,
as prescribed. 21. (1) Membership to the Scheme shall cease on the death
of a member. (2) A family member is entitled to continued benefits for a
period of four months following the death of the member. (3) The mechanisms for the continuation of benefits of a family
member after the period referred to in subsection (2) shall be as
prescribed. 22. (1) The benefits of a member other than a member whose
contribution is paid in accordance with section 15 (1), (2) and (3)
under the Scheme may be suspended where a contribution in respect
of that member is not paid to the Scheme.

ccordance with section 15 (1), (2) and (3)
under the Scheme may be suspended where a contribution in respect
of that member is not paid to the Scheme.

(2) The Authority shall suspend a member where that member
presents a false claim, makes material misrepresentation or fails
to disclose factual information required for the purposes of the
Act. (3) The period of suspension shall be for a month during which
the amount remains unpaid or such longer period. (4) The provisions of this section are without prejudice to any
other remedy available to the Authority. 23. (1) A member shall provide to the Authority updated
information in case of—
(a) an employment status shift resulting from change of
employment, termination of employment, or retirement;
(b) modification of the family membership resulting from the
death of a member, birth of a child, or arrival or departure
of a family member;
74 No. 2 of 2018] National Health Insurance
Benefits of
member’s
contribution
Death of
member
Suspension
of benefits
Information
on change of
membership
status

of 2018] National Health Insurance
Benefits of
member’s
contribution
Death of
member
Suspension
of benefits
Information
on change of
membership
status

(c) modification of financial status;
(d) geographic relocation; and
(e) any other change that impacts membership status. (2) A member shall provide an update under subsection (1),
within a month after the change occurs. (3) Despite subsection (2), updated information in case of death
shall be provided as soon as practicable but not later than four
months. 24. (1) A member may access an insured health care service
offered by an accredited health care provider anywhere within
the Republic. (2) The Authority shall develop and enforce mechanisms and
procedures which shall ensure benefits are portable across the
areas of work within the Republic. 25. The Authority shall, where there is any material
modification in any benefit package or coverage that is not reflected
in the most recently provided summary of benefits or coverage,
provide notice of that modification to a member, not later than sixty
days prior to the date on which the modification is to come into
operation. PART IV
ACCREDITATION OF HEALTH CARE PROVIDERS
26.

r, not later than sixty
days prior to the date on which the modification is to come into
operation. PART IV
ACCREDITATION OF HEALTH CARE PROVIDERS
26.

(1) A health care provider shall not provide a health care
service under the Scheme to a member if that health care provider
is not accredited in accordance with this Act. (2) TheAuthority shall not pay for an insured health care service
provided by a health care provider that is not accredited. (3) Despite subsection (2), a health care provider that is not
accredited in accordance with this Act may provide an insured
health care service to a member in case of an emergency where
an accredited health care provider is not immediately accessible or
under the circumstances of the case it is not practicable to the
member to attend before an accredited health care provider. (4) The Authority shall pay for an insured health care service
provided under subsection (3) by a health care provider that is not
accredited in accordance with this Act. National Health Insurance [No. 2 of 2018 75
Portability
Material
modifications
Prohibition
of provision
of insured
health care
services
without
accreditation

l Health Insurance [No. 2 of 2018 75
Portability
Material
modifications
Prohibition
of provision
of insured
health care
services
without
accreditation

27. (1) A health care provider that wishes to provide an insured
health care service to a member shall apply to the Authority for
accreditation in the prescribed manner and form on payment of a
prescribed fee. (2) The Authority shall, on receipt of an application made under
subsection (1), cause to be undertaken an assessment of the
application in order to determine whether the applicant meets the
requirements for accreditation, as prescribed. 28. (1) The Authority shall, within ninety days of receipt of
an application for accreditation, under section 27—
(a) grant accreditation where the applicant meets the
requirements; or
(b) reject the application where the applicant does not meet
the requirements. (2) The Authority shall, where it rejects an application in
accordance with subsection (1) (b), inform the applicant of the
reasons for the rejection. (3) Where the Authority does not make a determination or
communicate its decision on an application within the period
specified in subsection (1),accreditation shall be considered to have
been granted. 29.

r
communicate its decision on an application within the period
specified in subsection (1),accreditation shall be considered to have
been granted. 29.

(1) An accredited health care provider that is wound up
or decides to dispense with accreditation shall within sixty days of
such winding up or dispensing with accreditation notify theAuthority,
in writing, of the decision and surrender the accreditation. (2) The Authority shall cancel an accreditation surrendered in
accordance with subsection (1), subject to the conditions that the
Authority may impose in the interest of the member enrolled with
the accredited health care provider. (3) A health care provider that dispenses with that provider’s
accreditation shall, within thirty days of the Authority’s direction to
do so, transfer the medical records of members in that provider’s
possession to the Authority. (4) The Authority shall, before directing a health care provider
to transfer medical records in accordance with subsection (3),
consult the affected members on the alternative accredited health
care providers that the members may wish to be enrolled with. Application
for
accreditation
to provide
insured
health care
services
76 No. 2 of 2018] National Health Insurance
Grant or
rejection of
application
for
accreditation
Dispensing
with
accreditation

red
health care
services
76 No. 2 of 2018] National Health Insurance
Grant or
rejection of
application
for
accreditation
Dispensing
with
accreditation

30. (1) The Authority may suspend or revoke a health care
provider’s accreditation if that accredited health care provider—
(a) obtained the accreditation by fraud or submission of false
information or statements;
(b) does not comply with a term or condition of the
accreditation; or
(c) operates in contravention of this Act or any other law
relating to the provision of a health care service. (2) The Authority shall, before suspending or revoking a health
care provider’s accreditation in accordance with subsection (1),
notify the health care provider of the intention to suspend or revoke
the accreditation and shall—
(a) give reasons for the intended suspension or revocation;
and
(b) require the health care provider to—
(i) show cause, within such reasonable period as the
Authority may specify in the notice, why the
accreditation should not be suspended or
revoked; or
(ii) remedy the default. (3) The Authority shall not suspend or revoke a health care
provider’s accreditation if the health care provider takes remedial
measures to the satisfaction of the Authority within the period
specified in accordance with subsection (2).

f the health care provider takes remedial
measures to the satisfaction of the Authority within the period
specified in accordance with subsection (2).

(4) The Authority shall, in making the final determination on
the suspension or revocation of a health care provider’s accreditation
consider the remedial measures made by the health care provider
in accordance with subsection (3). (5) The Authority shall, where a health care provider’s
accreditation is suspended or revoked in accordance with this
section, publish the suspension or revocation, as the case may be,
in a daily newspaper of general circulation in the Republic. (6) The revocation of a health care provider’s accreditation in
accordance with this section does not affect any liability incurred
by the health care provider before the revocation, and any legal
proceedings commenced or continued against the health care
provider before the revocation may be continued against that health
care provider. (7) A health care provider whose accreditation is suspended
or revoked shall, within thirty days of the Authority’s direction to
do so, transfer the medical records of members in its possession to
an accredited health care provider that the Authority may direct. National Health Insurance [No. 2 of 2018 77
Suspension
or revocation
of
accreditation

n accredited health care provider that the Authority may direct. National Health Insurance [No. 2 of 2018 77
Suspension
or revocation
of
accreditation

(8) The Authority shall, before directing a health care provider
to transfer medical records in accordance with subsection (7),
consult the affected members on the alternative accredited health
care providers they wish to be enrolled with. 31. The Authority shall publish annually in the Gazette and a
daily newspaper of general circulation in the Republic the names
of accredited health care providers. 32.

shall publish annually in the Gazette and a
daily newspaper of general circulation in the Republic the names
of accredited health care providers. 32.

(1) The Minister shall, in consultation with relevant
stakeholders, prescribe the reporting requirements for accredited
health care providers in respect of insured health care services
provided by the accredited health care providers, including the periods
for reporting the following:
(a) statistical data on members enrolled with the health care
provider;
(b) the insured health care services provided during the
reporting period and the conditions under which the
services were provided;
(c) the number and skills of staff of the health care provider;
(d) the type and state of equipment and infrastructure of the
health care provider;
(e) the inventory of medicines including stock levels available;
(f) the relationship with other accredited health care providers
and the details thereof; and
(g) such other administrative, financial or medical information
relevant to the provision of quality insured health care
services.

etails thereof; and
(g) such other administrative, financial or medical information
relevant to the provision of quality insured health care
services.

(2) The Authority may request, from an accredited health care
provider, information and documents, including medical records and
explanations, which are in the possession of the health care provider,
relating to the provision of insured health care services and that
health care provider shall disclose the information or submit the
documents to the Authority. (3) An accredited health care provider that fails to comply
with this section commits an offence. 33. An accredited health care provider that provides a health
care service to a member, shall submit a claim in the prescribed
manner and form. (2) The Authority shall process a claim for payment in respect
of insured health care services rendered by an accredited health
care provider within such period as the Authority may agree on
with the accredited health care provider. 78 No. 2 of 2018] National Health Insurance
Publication
of accredited
health care
providers
Reporting
requirements
for
accredited
health care
providers
Payment for
insured
health care
services

e
Publication
of accredited
health care
providers
Reporting
requirements
for
accredited
health care
providers
Payment for
insured
health care
services

(3) An accredited health care provider that receives payment
from the Fund shall not bill a member directly for any insured health
care service. 34. (1) An accredited health care provider shall, implement a
standardised and confidential patient record system to maintain
accurate patient records and simplify the provider payment system
as prescribed by the Minister, in consultation with the Authority. (2) A member shall, on request, submit to the Authority, an
employer, an accredited health care provider or any other authorised
person information required for the better carrying out of the
provisions of this Act. (3) A person who receives information under this section, in
the course of that person’s functions under this Act, shall keep
such information confidential and shall not disclose or make use of
the information, except as authorised by law. (4) An accredited health care provider shall implement a
prescribed provider payment system. (5) A person who contravenes subsection (4) commits an
offence and is liable, on conviction to a fine not exceeding five
hundred thousand penalty units or to imprisonment for a term not
exceeding five years, or to both. 35.

ble, on conviction to a fine not exceeding five
hundred thousand penalty units or to imprisonment for a term not
exceeding five years, or to both. 35.

The Minister may prescribe the processes and procedures
for enrolment, or removal of a member from an accredited health
care provider. 36. An accredited health care provider shall provide to a
member, the insured health care services specified in the benefits
package. PART V
QUALITY ASSURANCE
37. (1) An accredited health care provider shall comply with
national quality assurance systems set by the Authority or other
relevant regulatory agencies. (2) The Authority shall liaise with appropriate authorities to
ensure that national quality assurance systems developed by
regulatory agencies are relevant to current developments in the
provision of national health insurance and have a positive impact
on the delivery of health care services. National Health Insurance [No. 2 of 2018 79
Confidential
patient
record
system and
provider
payment
system
Member’s
enrolment
with
accredited
health care
provider
Duty to
provide
insured
health
care services
Compliance
with quality
standards

payment
system
Member’s
enrolment
with
accredited
health care
provider
Duty to
provide
insured
health
care services
Compliance
with quality
standards

38. (1) An accredited health care provider shall take part in
programmes for quality assurance and performance review to
ensure that they provide quality health care services. (2) An accredited health care provider shall appoint persons,
on their personnel establishment, whose responsibility is to—
(a) ensure quality and cost effective health care service
delivery in conformity with national standards;
(b) manage the patient record system; and
(c) ensure accurate and expedient, submission of claims in
accordance with prescribed procedures. 39. (1) The Authority shall enter into a contract with each
accredited health care provider for provision of insured health care
services under the Scheme.

1) The Authority shall enter into a contract with each
accredited health care provider for provision of insured health care
services under the Scheme.

(2) The Authority and accredited health care provider shall
ensure that monitoring mechanisms are put in place to safeguard
against—
(a) overutilisation of insured health care services;
(b) underutilisation of insured health care services;
(c) unnecessary diagnostic and therapeutic procedures and
interventions;
(d) irrational and inappropriate prescription of medicines;
(e) inappropriate referral practices;
(f) inappropriate or unnecessary healthcare service being
continued as part of insured health care services;
(g) fraud; and
(h) any other circumstances that are likely to arise. 40. (1) The Authority shall, in consultation with the Council,
and the Registrar responsible for Pensions and Insurance, appoint
inspectors for purposes of this Act. (2) An inspector may, at all reasonable times, enter and inspect
any premises, which is being used by an accredited health care
provider to ensure compliance with this Act and regulations issued
under this Act. (3) An inspector shall, on entering the premises of an accredited
health care provider, present that inspectors’identity card to a person
in charge.

. (3) An inspector shall, on entering the premises of an accredited
health care provider, present that inspectors’identity card to a person
in charge.

(4) An inspector may inspect a patient’s records, treatment,
diagnosis and fees sheet to ascertain the validity of any billing,
except that an inspector shall, in so doing, pay particular regard to
ethical procedures, privacy and confidentiality. 80 No. 2 of 2018] National Health Insurance
Quality
assurance
Contracts
and
monitoring
mechanisms
Inspections

procedures, privacy and confidentiality. 80 No. 2 of 2018] National Health Insurance
Quality
assurance
Contracts
and
monitoring
mechanisms
Inspections

(5) A person shall not—
(a) delay or obstruct an inspector in the performance of the
inspectors’ functions;
(b) refuse to give an inspector such reasonable assistance as
the inspector may require for the purpose of executing
the inspectors’ duties and powers under this Act; or
(c) give an inspector false or misleading information in answer
to an inquiry made by the inspector. (6) A person who contravenes subsection (4), commits an
offence and is liable, on conviction, to a fine not exceeding two
hundred thousand penalty units or imprisonment for a term not
exceeding two years, or to both. (7) An inspector shall submit to the Authority a written report
relating to an inspection conducted under this Act. (8) Where the Authority receives a report, submitted under
subsection (5), indicating that the accredited health care provider
is not complying with a provision of this Act, the Authority shall
serve the accredited health care provider with a written notice
specifying the violation and stating that the Board may suspend or
revoke the accreditation of the health care provider if the
counteracting responses do not offer sufficient grounds exculpating
the accredited health care provider.

reditation of the health care provider if the
counteracting responses do not offer sufficient grounds exculpating
the accredited health care provider.

PART VI
NATIONAL HEALTH INSURANCE FUND
41. (1) There is established the National Health Insurance
Fund for the purpose of the Scheme. (2) Despite the generality of subsection (1), the Fund shall be
held and applied for the purposes of—
(a) paying for the cost of insured health care services accessed
by members of the Scheme;
(b) paying administrative and management expenses; and
(c) programmes for the promotion of access to insured health
care services that the Minister may, in consultation with
the Authority, determine. (3) The Fund shall consist of—
(a) contributions paid into the Fund in accordance with this
Act;
(b) monies as may be appropriated by Parliament for the
purpose of the Scheme;
National Health Insurance [No. 2 of 2018 81
Establishment
of
National
Health
Insurance
Fund

appropriated by Parliament for the
purpose of the Scheme;
National Health Insurance [No. 2 of 2018 81
Establishment
of
National
Health
Insurance
Fund

(c) monies as may be paid to the Fund by way of loans, grants
or donations;
(d) such monies as may, by or under any other law, be payable
to the Fund;
(e) interest arising out of any investment of the Fund; and
(f) such other monies as may vest or accrue to the Fund. (4) Subject to the approval of the Minister, the Authority may—
(a) accept monies by way of grants or donations from a source
within or outside Zambia;
(b) raise by way of loans or otherwise, such monies as it may
require for the discharge of its functions; and
(c) charge and collect fees for services provided by the
Authority. (5) The Authority shall not, in any year, expend on activities or
programmes referred to in subsection 2(b) and (c) more than a
prescribed percentage of the monies held by the Fund in that year. 42. (1) The Authority shall administer and manage the Fund
for the purposes specified in section 41(2). (2) The Authority may invest any monies of the Fund that are
not immediately required for the purposes of the Fund in the manner
authorised by the Board.

The Authority may invest any monies of the Fund that are
not immediately required for the purposes of the Fund in the manner
authorised by the Board.

(3) The Authority shall ensure that prudent controls are
established for the Fund relating to—
(a) fiscal controls and accounting procedures governing the
Fund;
(b) actuarial correctness of the Fund;
(c) reporting procedures for matters relating to the Fund; and
(d) investment of the monies of the Fund. (4) The Authority shall cause to be kept proper books of
accounts and other records relating to the accounts of the Fund. 43. (1) The Authority shall, for purposes of the Fund, operate
an account in respect of the Scheme at a bank as the Board may
determine. (2) Monies paid into the Fund for the purpose of the Scheme
shall be deposited in the Fund account designated for the Scheme. (3) TheAuthority shall not disburse from a Fund account monies
to be applied for the purposes of a Scheme other than the Scheme
in respect of which the Fund account is operated. 82 No. of 2018] National Health Insurance
Administra-
tion and
management
of Fund
Fund
accounts and
disbursement

f which the Fund account is operated. 82 No. of 2018] National Health Insurance
Administra-
tion and
management
of Fund
Fund
accounts and
disbursement

44. (1) As soon as practicable, but not later than ninety days
after end of the financial year, the Authority shall submit to the
Minister a report concerning the activities relating to the Fund during
the financial year. (2) The report referred to in subsection (1) shall include
information on the financial affairs relating to the Fund and there
shall be appended to the report—
(a) an audited statement of financial position;
(b) an audited statement of comprehensive income; and
(c) such other information as the Minister may require. (3) The Fund shall be audited by the Auditor-General or an
auditor appointed by the Board and approved by the Auditor-
General. (4) The Board may order any other audit in addition to the
annual audit specified under subsection (3). (5) The Minister shall cause to be prepared an annual statement
of the income and expenditure of the Authority to be laid before
the National Assembly. PART VII
FINANCIAL PROVISIONS
45.

prepared an annual statement
of the income and expenditure of the Authority to be laid before
the National Assembly. PART VII
FINANCIAL PROVISIONS
45.

(1) The funds of the Authority shall consist of such monies
as may—
(a) be appropriated to the Authority by Parliament for the
purposes of the Authority;
(b) be paid to the Authority by way of fees, loans, grants or
donations; and
(c) otherwise vest in or accrue to the Authority. (2) TheAuthority may, subject to the approval of the Minister—
(a) accept monies by way of grants or donations from any
source within or outside the Republic; and
(b) raise by way of loans or otherwise, such monies as it may
require for the discharge of its functions. (3) There shall be paid from the funds of the Authority—
(a) the emoluments of the Members and staff of the Authority;
(b) such traveling and other allowances for the members of
the Board, members of committees of the Board and
staff of the Authority when engaged on the business of
the Authority at such rates as the members of the Board
may approve; and
National Health Insurance [No. of 2018 83
Annual
report
Funds of
Authority

of
the Authority at such rates as the members of the Board
may approve; and
National Health Insurance [No. of 2018 83
Annual
report
Funds of
Authority

(c) any other expenses incurred by the Authority in the
performance of its functions under this Act. (4) The Authority may, with the approval of the Board, invest
in a manner that it considers appropriate such of its funds as it does
not immediately require for the discharge of its functions. 46. The financial year of the Authority shall be the period of
twelve months ending on 31st December in each year. 47. (1) The Authority shall cause to be kept proper books of
account and other records relating to its accounts. (2) The accounts of the Authority shall be audited annually by
the Auditor-General or an auditor appointed by the Auditor-General. (3) The auditor’s fees shall be paid by the Authority. 48. (1) As soon as practicable, but not later than ninety days
after the end of the financial year, the Authority shall submit to the
Minister a report concerning the Authority’s activities during the
financial year.

er the end of the financial year, the Authority shall submit to the
Minister a report concerning the Authority’s activities during the
financial year.

(2) The report referred to in subparagraph (1) shall include
information on the financial affairs of the Authority and there shall
be appended to the report—
(a) an audited statement of financial position;
(b) an audited statement of comprehensive income; and
(c) such other information as the Minister may require. (3) The Minister shall cause to be prepared an annual statement
of the income and expenditure of the Authority to be laid before
the National Assembly. PART VIII
GENERAL PROVISIONS
49. (1) There is constituted the Health Complaints Committee
of the Board. (2) The Board shall appoint persons as members of the
Committee who have experience in health, legal or financial matters. (3) The Committee shall—
(a) hear and resolve complaints that may be submitted to the
Authority by members, accredited health care providers
and members of the health profession;
(b) hear and determine matters relating to accredited health
care providers; and
84 No. of 2018] National Health Insurance
Financial
year
Accounts
and
audit
Annual
report
Health
Complaints
Committee
and
appeals

care providers; and
84 No. of 2018] National Health Insurance
Financial
year
Accounts
and
audit
Annual
report
Health
Complaints
Committee
and
appeals

(c) perform any other functions relating to the management
of the welfare of members as may be determined by
the Board. (4) The Authority shall develop an awareness process to ensure
that members and accredited health care providers are aware of
their right to lodge complaints to the Committee where there is
failure to settle a complaint internally. (5) A person aggrieved with a decision of the Committee may,
within thirty days of receiving the decision, appeal to the Board. 50. A person who is aggrieved by a decision of the Board
may appeal to the High Court. 51. Where a judgment order is obtained against the Authority,
execution, attachment or process of any nature shall not be issued
against the Authority or against any property of the Authority, but
the Authority shall cause to be paid out of its revenues an amount
that may, by the judgment or order, be awarded against the Authority
to the person entitled to that amount. 52. (1) The Authority shall establish and maintain a register
in the prescribed manner and form of—
(a) members;
(b) employers, pensions schemes and self employed citizens
or established residents; and
(c) accredited health care providers.

d form of—
(a) members;
(b) employers, pensions schemes and self employed citizens
or established residents; and
(c) accredited health care providers.

(2) An accredited health care provider shall establish and
maintain a register of members enrolled with that provider. 53. (1) A person shall not—
(a) make a false statement or representation in connection
with registration for membership;
(b) obtain or procure a prescribed health care service by
knowingly making a false or fraudulent statement or
uttering a false document;
(c) make a claim for payment in respect of prescribed health
care services that the person has not rendered;
(d) fail to pay to the Scheme within the period specified any
contribution which the person is liable to pay under the
Act;
(e) where required to pay contributions to the Scheme, evade
payment of a contribution;
National Health Insurance [No. of 2018 85
Appeals
Immunity
from
execution of
judgments
Registers
General
offences

me, evade
payment of a contribution;
National Health Insurance [No. of 2018 85
Appeals
Immunity
from
execution of
judgments
Registers
General
offences

(f) when required to register as a member or to ensure the
registration of another person as a member, fail to do so
within the period specified by or under this Act;
(g) when required by or under this Act to furnish any
information, without lawful excuse, fail or refuse to
furnish that information;
(h) obstruct any officer of the Authority in the discharge of
the officer’s duties; or
(i) without lawful excuse, fail to produce documents which
the person is required by or under this Act to produce. (2) A person who contravenes subsection (1) commits an
offence and is liable, on conviction, to a fine not exceeding two
hundred thousand penalty units or imprisonment to a term not
exceeding two years or to both. 54. (1) Where a person commits an offence under this Act
agrees to pay a specified fine proposed by the Authority which
does not exceed the maximum penalty provided by this Act for the
offence in question, the Authority may impose that fine on that
person, except that where criminal proceedings have been instituted
against that person for the offence, the power conferred by this
subsection shall not be exercised without the written consent of
the Director of Public Prosecutions.

son for the offence, the power conferred by this
subsection shall not be exercised without the written consent of
the Director of Public Prosecutions.

(2) The Authority shall furnish the person with a certificate
setting out the nature of the offence, the date of its occurrence,
and the fine imposed under subsection (1), and such certificate
may be used by that person as prima facie proof of the facts stated
in the certificate. (3) Where a fine imposed in terms of subsection (1) is not paid
on demand, the Authority may take steps for, or towards, its
recovery in any manner permitted by this Act with respect to the
recovery of unpaid contribution. (4) The imposition of a fine under subsection (1), shall not be
treated as a conviction of the person of a criminal offence, but no
prosecution for the offence in question shall thereafter be instituted
or maintained. (5) This section shall not in any way affect liability for the
payment of contributions due under this Act. 86 No. 2 of 2018] National Health Insurance
Fine in lieu
of
prosecution

any way affect liability for the
payment of contributions due under this Act. 86 No. 2 of 2018] National Health Insurance
Fine in lieu
of
prosecution

55. Where an offence under this Act is committed by a body
corporate or unincorporate body, and the director, manager or
shareholder of that body is suspected to have committed the offence
and is charged of that offence, that director, manager or shareholder
of the body corporate or unincorporate body is liable, on conviction,
to the penalty specified for the offence, unless the director, manager
or shareholder proves to the satisfaction of the court that the act
constituting the offence was done without the knowledge, consent
or connivance of the director, manager or shareholder or that the
director, manager or shareholder took reasonable steps to prevent
the commission of the offence. 56. A person who commits an offence under this Act for which
a penalty is not provided is liable, on conviction, to a fine not
exceeding two hundred thousand penalty units or to imprisonment
for a term not exceeding two years, or to both. 57. (1) The Minister may, by statutory instrument, prescribe
anything which by this Act is required to be prescribed or is
necessary for the carrying out of the provisions of this Act.

tory instrument, prescribe
anything which by this Act is required to be prescribed or is
necessary for the carrying out of the provisions of this Act.

(2) Without prejudice to the generality of subsection (1),
regulations made under that subsection may provide for—
(a) the procedure for applying for and registration as a member;
(b) the manner and form of applying for accreditation as a
health care provider for purposes of the Scheme;
(c) different rate of contributions for different benefit
packages;
(d) the procedure for replacing a defaced, damaged, lost or
expired membership card;
(e) a standard schedule of fees for items and services provided
by accredited health care providers;
(f) payment of a prescribed fee in respect of such replacement;
and
(g) investment guidelines for the Scheme. National Health Insurance [No. 2 of 2018 87
Offences by
body
corporate
General
penalty
Regulations

ment;
and
(g) investment guidelines for the Scheme. National Health Insurance [No. 2 of 2018 87
Offences by
body
corporate
General
penalty
Regulations

SCHEDULE
(Sections 4 (2) and 6(6))
1. (1) The seal of the Authority shall be such device as may
be determined by the Board and shall be kept by the Secretary. (2) The affixing of the seal shall be authenticated by the
Chairperson or Vice-Chairperson and the Director-General or one
other person authorised in that behalf by a resolution of the Board. (3) A contract or instrument which, if entered into or executed
by a person, not being a body corporate, is not required to be under
seal, may be entered into or executed without seal on behalf of the
Board, the Director-General or by any other person generally or
specifically authorised by the Board in that behalf. (4) A document purporting to be a document under the seal of
the Authority or issued on behalf of the Authority shall be received
in evidence and shall be deemed to be so executed or issued, as the
case may be, without further proof, unless the contrary is proved. 2. (1) Subject to the other provisions of this Act, the Board
may regulate its own procedure. (2) The Board shall meet for the transaction of business at
least once every three months at such places and times as the
Board may determine.

cedure. (2) The Board shall meet for the transaction of business at
least once every three months at such places and times as the
Board may determine.

(3) A meeting of the Board may be called by the Chairperson
upon giving notice of not less than fourteen days and shall be called
if not less than one-third of the members of the Board so request,
in writing, except that if the urgency of a particular matter does not
permit the giving of such notice, a special meeting may be called
upon giving a shorter notice. (4) Seven members of the Board shall constitute a quorum at
a meeting of the Board. (5) There shall preside at a meeting of the Board—
(a) the Chairperson;
(b) in the absence of the Chairperson, the Vice-Chairperson;
and
(c) in the absence of the Chairperson and the Vice-
Chairperson, a member of the Board as the members
of the Board present may elect from amongst
themselves for the purpose of that meeting. National Health Insurance [No. 2 of 2018 89
Seal of
Authority
Proceedings
of
Board

may elect from amongst
themselves for the purpose of that meeting. National Health Insurance [No. 2 of 2018 89
Seal of
Authority
Proceedings
of
Board

(6) A decision of the Board on any question shall be determined
by a majority of the votes of the members of the Board present
and voting at the meeting and, in the event of an equality of votes,
the person presiding at the meeting shall have, in addition to a
deliberative vote, a casting vote. (7) Where a member of the Board is, for any reason unable to
attend the meeting of the Board, that member of the Board may, in
writing, nominate another person from the same organisation to
attend the meeting in that member of the Board’s stead and that
person shall be considered to be a member of the Board for purposes
of that meeting. (8) The Board may invite any person whose presence is, in its
opinion desirable, to attend and to participate in the deliberation of
a meeting of the Board, but that person shall have no vote. (9) The validity of any proceedings, act or decision of the Board
shall not be affected by any vacancy in the membership of the
Board or any defect in the appointment of any member of the
Board or by reason that any person not entitled to do so, took part
in the proceedings.

he
Board or any defect in the appointment of any member of the
Board or by reason that any person not entitled to do so, took part
in the proceedings.

(10) The Board shall cause minutes to be kept of the
proceedings of every meeting of the Board and of every committee
of the Board. 3. (1) Subject to the other provisions of this Act, a member of
the Board shall hold office for a period of three years from the
date of appointment and may be reappointed for a further like period
but shall not successively hold office for more than two terms. (2) The office of a member of the Board becomes vacant if
the member of the Board—
(a) dies;
(b) is adjudged bankrupt;
(c) is absent from three consecutive meetings of the Board
of which the member of the Board has had notice,
without the prior approval of the Board;
(d) resigns from office;
(e) becomes mentally incapable of performing the duties of
a member of the Board;
(f) is convicted of an offence under this Act or any other law;
or
(g) ceases to represent the institution that nominated that
member of the Board. 90 No. of 2018] National Health Insurance
Tenure of
office of
Member and
vacancy

to represent the institution that nominated that
member of the Board. 90 No. of 2018] National Health Insurance
Tenure of
office of
Member and
vacancy

(3) Subject to the other provisions of this Act, a member of the
Board shall, on the expiration of the period for which the member
of the Board is appointed, continue to hold office until another
member of the Board, is appointed to succeed that member of the
Board, but in no case shall the member of the Board hold office for
more than three month after the expiration of the member of the
Board’s term. (4) A member of the Board may resign from office by giving
not less than one month’s notice, in writing, to the Chairperson and
the Minister. (5) The Minister shall, where the office of a member of the
Board becomes vacant, appoint another person in place of the
member of the Board who vacates office, and such member of the
Board shall hold office for the remainder of the term. 4. A member of the Board or committee of the Board, shall be
paid such allowances as the Emoluments Commission may, on the
recommendation of the Board, determine. 5.

the Board or committee of the Board, shall be
paid such allowances as the Emoluments Commission may, on the
recommendation of the Board, determine. 5.

(1) A person who is present at a meeting of the Board or a
committee of the Board at which any matter is the subject of
consideration, and in which that person or that person’s relative or
associate, is directly or indirectly interested in a private capacity
shall, as soon as practicable after the commencement of the
meeting, disclose that interest and shall not, unless the Board or the
committee otherwise directs, take part in any consideration or
discussion of, or vote on, any question relating to that matter. (2) A disclosure of interest made under this paragraph shall be
recorded in the minutes of the meeting at which the disclosure is
made. (3) A person who contravenes subparagraph (1) commits an
offence and is liable, upon conviction, to a fine not exceeding two
hundred thousand penalty units or to imprisonment for a period not
exceeding two years, or to both. 6.

e, upon conviction, to a fine not exceeding two
hundred thousand penalty units or to imprisonment for a period not
exceeding two years, or to both. 6.

(1) A person shall not, without the consent in writing, given
by or on behalf of the Board, publish or disclose to an unauthorised
person, otherwise than in the course of that person’s duties, the
contents of any document, communication or information
whatsoever, which relates to, and which has come to that person’s
knowledge in the course of that person’s duties under this Act. National Health Insurance [No. of 2018 91
Allowances
of member
Disclosure
of
interest
Prohibition
of
publication
of, or
disclosure of
information
to,
unauthorised
person

urance [No. of 2018 91
Allowances
of member
Disclosure
of
interest
Prohibition
of
publication
of, or
disclosure of
information
to,
unauthorised
person

92 No. 2 of 2018] National Health Insurance
(2) A person who contravenes subparagraph (1) commits an
offence and is liable, on conviction, to a fine not exceeding two
hundred thousand penalty units or to imprisonment for a period not
exceeding two years, or to both.
(3) A person who, having information which to that person’s
knowledge has been published or disclosed in contravention of
subparagraph (1), unlawfully publishes or communicates that
information to another person, commits an offence and is liable, on
conviction, to a fine not exceeding two hundred thousand penalty
units or to imprisonment for a period not exceeding two years, or to
both.
7. An action or other proceeding shall not lie or be instituted
against a member of the Board or committee of the Board or a
member of staff of the Authority for, or in respect of, an act or
thing done or omitted to be done in good faith in the exercise or
performance, of any of the powers, functions or duties conferred
under this Act.
Immunity