Recovery of benefit paid in excess and short payment of premium
22.—(1)  If, on account of any material change to the information available to the Board or the correction of any error relating to an insured person or in other prescribed circumstances (if prescribed), the Board finds that any premium paid in respect of any insurance period by or for any person insured or to be insured under the CSHL Scheme or ESH Scheme is less than an amount which ought to have been paid under this Act, the amount of the shortfall is payable, by all or any of the following persons, and in such proportion, as the Board may require:
(a)the insured person;
(b)a person by whom the premium is payable under section 14(4)(b).
(2)  If, on account of any material change to the information available to the Board or the Administrator, or the correction of any error relating to an insured person or in any other circumstances prescribed, the Board or the Administrator finds that any benefit or payment under the CSHL Scheme or ESH Scheme has been paid in excess of the amount that ought to have been paid under the CSHL Scheme or ESH Scheme (as the case may be), the Board or the Administrator (as the case may be) may direct that the excess payment be repaid to the Fund in accordance with the regulations by the insured person or approved payee who received the excess payment.
(3)  The Board may charge an insured person, a person by whom the premium is payable or an approved payee (as the case may be) an administrative fee of such amount as may be prescribed and (if applicable) interest on the excess payment at such rate as may be prescribed, if any material change, error or prescribed circumstances referred to in subsection (1) or (2) arise from incorrect information which is —
(a)provided by —
(i)the insured person, or the authorised applicant or claim applicant acting on behalf of the insured person;
(ii)the person by whom the premium is payable;
(iii)the approved payee,
as the case may be; and
(b)included in a health declaration, means declaration, claim or any other application made under or used for the CSHL Scheme or ESH Scheme in relation to the insured person.
(4)  Sections 14(4), 23 to 30, 35, 59(2) and 64(2)(g) apply, with such modifications as may be prescribed, to any amount payable under this section as they apply to a premium.
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Last updated 29 May 2025
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