NATIONAL HEALTH INSURANCE ACT, 1924.

Provided that—

(a) no rule shall provide for the imposition of a fine exceeding ten shillings or, in the case of repeated breaches of rules, twenty shillings:

(b) no rule shall provide for the suspension of any benefit for a period exceeding one year:

(c) every rule relating to the visiting of insured persons by visitors appointed by the society shall provide that women shall not be visited otherwise than by women:

(d) every rule relating to behaviour during disease or disablement shall be in the prescribed form :

(e) no rule shall provide, nor have effect so as to subject any insured person to, any penalty, whether by way of suspension of benefits or otherwise, on account of his refusal to submit to a surgical operation, vaccination or inoculation of any kind, unless the refusal is a refusal to submit to a surgical operation of a minor character and is considered by the society, or by the Minister on appeal to him, unreasonable :

(f) no rule shall provide for inflicting suspension of maternity benefit in respect of the confinement of the wife of an insured person as a penalty for breach of rules or imposition or attempted imposition on his part except where the wife has herself been guilty of any such breach, imposition or attempted imposition.

(2) Notwithstanding any provision to the contrary in any rule of an approved society or branch of an approved 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.

(3) Except where special arrangements in that behalf are made at the request of an insured person, no deduction may be made by an approved society as on account of the cost of the transmission of the benefit from the amount payable by way of sickness, disablement or maternity benefit.

(4) 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 Minister shall forthwith be registered, but till so registered shall have effect as if they had been duly registered.

23. RULES OF INSURANCE COMMITTEES WITH RESPECT TO ADMINISTRATION OF BENEFITS.-Every insurance committee shall, subject to the approval of the Minister, make rules in respect of the matters mentioned in subsection (1) of the last preceding section in relation 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 except with the consent of the PostmasterGeneral.

24. ADMINISTRATION OF MEDICAL BENEFIT.—(1) Every insurance committee shall, for the purpose of administering medical benefit, make arrangements with duly qualified medical practitioners in accordance with regulations.

(2) Provision shall be made by regulations for the arrangements under this section being subject to the approval of the Minister and being such as to secure that insured persons shall, subject to the provisions of this Act, receive adequate medical treatment and attendance 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 of being so included;

(c) a right on the part of any insured person of selecting, at such periods as may be prescribed, from the appropriate list the practitioner by whom he wishes

14 & 15 GEORGE 5, CHAPTER 38.

to be attended and treated, and, subject to the consent of the practitioner so selected, of being attended and treated by him;

(d) the distribution among the several practitioners whose names are on the lists so far as practicable, under arrangements made by them, of the insured persons who after due notice have failed to make any selection, or who have been refused by the practitioner whom they have selected;

(e) the provision, on the same terms as to remuneration as those arranged with respect to insured persons, of medical treatment and attendance, to such members of any friendly or other society which, or a separate section of which, is or becomes an approved society as were members thereof on the sixteenth day of December, nineteen hundred and eleven, and who are not entitled to medical benefit under this Act by reason that being subject to permanent disablement on the fifteenth day of July, nineteen hundred and twelve, they were not qualified to become insured persons:

Provided that—

(i) If the Minister, after such inquiry as may be prescribed, is satisfied that the continued inclusion in the list of any medical practitioner would be prejudicial to the efficiency of the medical service of the insured, the Minister may remove his name from the list :

(ii) If the Minister is satisfied after inquiry that the medical practitioners included in any list are not such as to secure an adequate medical service in any area, or part of an area, he may dispense with the necessity of the adoption of such system as aforesaid as respects that area or part, and authorise the committee to make such other arrangements as he may approve, or may himself make such arrangements as he thinks fit, or may suspend the right to medical benefit in respect of any insured persons in the area or part for such period as he thinks fit, and pay to each such person a sum bearing the same proportion to nine shillings and sixpence as that period bears to a whole year, and where the Minister takes any such action himself, he shall retain and apply for the purpose such part of the sums payable to the insurance committee in respect of medical benefit as may be required:

(iii) If the Minister is satisfied that the insured persons or any considerable proportion of the insured persons within any area or part of an area are not receiving satisfactory medical treatment under the panel system, he may authorise the insurance committee to make, or may himself make, such other arrangements as will secure to insured persons within that area or that part of the area such better medical service as is practicable having regard to the funds available for the purpose, or arrangements whereunder insured persons within that area or that part of the area may be required to make their own arrangements for receiving medical treatment and attendance (including medicines and appliances) and whereunder the insurance committee or the Minister undertake to pay the cost of that medical treatment and attendance upon such scale as the insurance committee with the approval of the Minister or as the Minister, as the case may be, may determine. (3) The regulations made for the purposes of this section shall authorise the insurance committee by which medical benefit is administered to require any person 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 treatment and attendance (including medicines and appliances) and in such case the committee shall, subject to the regulations, out of the funds out of which medical benefit is payable, contribute towards the cost of medical treatment and attendance (including medicines and appliances) for those persons sums not exceeding in the aggregate the amounts which the committee would otherwise have expended in providing medical benefit for them.

NATIONAL HEALTH INSURANCE ACT, 1924.

(4) The regulations made for the purposes of this section shall provide that, in the case of persons who are entitled to receive medical treatment and attendance under any system or through any institution existing on the sixteenth day of December, nineteen hundred and eleven, and approved by the insurance committee and the Minister, medical treatment and attendance so received may be treated as, or as part of, their medical benefit under 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 under the last preceding subsection, but the regulations shall secure that no person shall be deprived of his right of selecting, if he desires so to do, in accordance with the foregoing provisions of this section, the duly qualified medical practitioner by whom he wishes to be attended and treated.

(5) Every insurance committee shall make arrangements for the supply of proper and sufficient drugs and medicines and prescribed appliances to insured persons in accordance with regulations, and the regulations made for the purposes of this subsection shall provide for the arrangements made being subject to the approval of the Minister and being such as to enable insured persons to obtain such drugs, medicines and appliances, if ordered by the medical practitioner by whom the insured persons are attended, from any persons with whom arrangements have been made, 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, 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 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 that person is entitled by law and authorised by the committee to supply, except in cases where the Minister after inquiry is satisfied that the inclusion or continuance of that person in the list would be prejudicial to the efficiency of the service :

Provided that

(i) If the Minister is satisfied as respects any area that the scale of prices fixed by the committee is reasonable, but that the persons included in any list are not such as to secure an adequate and convenient supply of drugs, medicines and appliances in that area, he 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 he may approve :

(ii) Except as may be provided by regulations, no arrangement shall be made by the insurance committee with a medical practitioner under which he is bound or agrees to supply drugs or medicine to any insured persons: (iii) Subject to the provisions of the last foregoing proviso, the regulations shall prohibit arrangements for the dispensing of medicines being made with persons other than persons who are entitled to carry on the business of a chemist and druggist under the provisions of the Pharmacy Act, 1868 (31 & 32 Vict. c. 121), as amended by any other enactment, and who undertake that all medicines supplied by them to insured persons shall be dispensed either by or under the direct supervision of a registered pharmacist or by a person who for three years immediately before the sixteenth day of December nineteen hundred and eleven, acted as a dispenser to a duly qualified medical practitioner or a public institution : (iv) Nothing in this Act shall interfere with the rights and privileges conferred by the Apothecaries Act, 1815 (55 Geo. 3, c. 194), upon any person qualified under that Act to act as an assistant to any apothecary in compounding and dispensing medicines.

(6) Where the Minister in pursuance of his powers under this section removes

14 & 15 GEORGE 5, CHAPTER 38.

the name of any medical practitioner from any list of medical practitioners prepared under this section, or the name of any person undertaking the supply of drugs, medicines or appliances from any list so prepared of persons undertaking such supply, he may, if he thinks fit so to do, remove the name of that practitioner or person from any of the other lists so prepared in which it is at the time included, and, until such time as the Minister directs to the contrary, that practitioner or person shall be disqualified for inclusion in any list prepared under this section, whether in England, Scotland or Wales, of medical practitioners or of persons undertaking such supply as aforesaid.

(7) Provision for any of the following matters may be included in regulations made for the purposes of this section

(a) The issue of certificates for the purposes of this Act by medical practitioners under agreement with insurance committees ;

(b) The application to inquiries held under this section, subject to such modifications as may be prescribed (including a modification providing that the costs of any inquiry and of the finding thereon shall be in the discretion of the Minister instead of in the discretion of the person holding the inquiry), of any of the provisions of the Arbitration Act, 1889 (52 & 53 Vict. c. 49), relating to the costs of an arbitration, the attendance of witnesses and the production of documents;

(c) The procedure on any appeal to the Minister against a decision of an insurance committee given under the regulations, and the application to any such appeal, subject to such modifications as may be prescribed, of any of the provisions of the Arbitration Act, 1889.

25. REINSURANCE FOR THE PURPOSES OF MATERNITY BENEFIT.-For the purposes of the administration of maternity benefit, the Minister may, if he thinks fit, by special order provide for the reinsurance with him of the liabilities of all approved societies in respect of maternity benefit, and the order may provide for the method of calculating the premiums to be charged against the several societies in respect of any such reinsurance and may contain such other incidental, consequential and supplemental provisions as may appear necessary for the purpose.

26. POWER TO SUBSCRIBE TO HOSPITALS, &c.—An approved society or insurance committee may make such subscriptions or donations as it thinks fit to hospitals, dispensaries and other charitable institutions, or for the support of district nurses, and may appoint nurses for the purpose of visiting and nursing insured persons, and any sums expended under this section shall be treated as expenditure on such benefits as may be prescribed.

27. REPAYMENT of Benefits IMPROPERLY PAID.-—(1) If it is found at any time that a person has been in receipt of any benefit or any payment under this Act without being lawfully entitled thereto, he, or in the case of his death his personal representatives, shall be liable to repay to the Minister the amount of that benefit or payment, and any such amount may be recovered as a debt due to the Crown, and when so recovered shall be carried to the credit of the society of which that person was a member, or, if he was not a member of an approved society, to the credit of the Deposit Contributors Fund.

(2) Subject to the consent of the Treasury, regulations may be made for authorising any sums paid by an approved society or branch of an approved society as on account of benefits to or on behalf of persons not lawfully entitled thereto, so far as not recovered, to be treated, to such extent and subject to such conditions as may be prescribed, as expenditure on benefits, and providing for charging to the administration account of societies any sums so improperly paid as aforesaid, and neither authorised to be treated as expenditure on benefits as aforesaid nor recovered. 28. DISPOSAL OF SUMS ARISING FROM BENEFITS FORMING PART OF ESTATE OF DECEASED PERSONS.-Regulations may be made :

(a) Providing for the nomination by an insured person of the persons to whom any sum payable to him by way of benefit and unpaid at the date of his death, or any other sum payable under this Act and forming part of his

NATIONAL HEALTH INSURANCE ACT, 1924.

estate, is to be paid at his death, for the revocation of any such nomination, for the payment of the specified amount to any nominee so nominated, and providing that any such nomination shall take effect as if it were a will of the deceased duly executed, and that notwithstanding the want of due execution, minority or marriage;

(b) Providing that, subject to the regulations, probate or other proof of the title of the personal representatives of the deceased person may be dispensed with in the case of any such sum as aforesaid, and that any such sum may be paid or distributed to or among the persons appearing in manner provided by the regulations to be beneficially entitled to the personal estate of the deceased person, whether under any such nomination as aforesaid or by law, or as next of kin or as creditors, or otherwise, or to or among any one or more of such persons exclusive of the others, or in the case of any illegitimacy of the deceased person or his children to or among such person or persons as may be directed by the regulations, and that any society or committee making a payment in accordance with the regulations shall be discharged from all liability in respect of the sum so paid.

PART II.-APPROVED SOCIETIES AND INSURANCE COMMITTEES.

Constitution, Government, &c., of Approved Societies.

29. CONSTITUTION OF APPROVED SOCIETIES.-(1) Any society, that is to say, any body of persons corporate or unincorporate (not being a branch of another such body), registered or established under any Act of Parliament or by Royal Charter or, if not so registered or established, having a constitution of such a character as may be prescribed, may, if it complies with the requirements of this Act relating to approved societies, be approved by the Minister, and, if so approved, shall be an approved society for the purposes of this Act:

Provided that where any society establishes for the purposes of this Act a separate section consisting of insured persons, whether with or without honorary members not being insured persons, and so constituted as to comply with the requirements of this Act relating to approved societies, that separate section may be approved by the Minister, and, if so approved, shall be an approved society, and the provisions of this Act relating to the conditions of approval of societies and to approved societies shall apply only to the separate section of the society.

(2) No society shall be approved by the Minister unless it satisfies the following

conditions:

(a) It must not be a society carried on for profit: (b) Its constitution must provide to the satisfaction of the Minister for its affairs being subject to the absolute control of its members being insured persons or, if the rules of the society so provide, of its members whether insured persons or not, and for the election and removal of the committee of management or other governing body of the society, in case of a society whose affairs are managed by delegates elected by members, by those delegates, and in other cases in such manner as will secure absolute control by its members:

(c) If the society has honorary members, its constitution must provide for excluding the honorary members from the right of voting in their capacity of members of the society on all questions and matters arising under this Act.

(3) The Minister may grant approval either unconditionally or subject to the condition that the society shall within such time as the Minister may allow take such steps as may be necessary to make the society comply with the requirements of this Act relating to approved societies.

30. PROVISIONS AS TO SOCIETIES HAVING MEMBERS IN MORE THAN ONE NATIONAL AREA. (1) A society shall not be required to be approved in respect of any national