Act No. 60 / 1995 Coll.

Act amending and supplementing the Act of the Czech National Council No. 551 / 1991 Coll., on the General Health Insurance Company of the Czech Republic, as amended, Act of the Czech National Council No. 280 / 1992 Coll., on departmental, branch, corporate and other health insurance companies, as amended, Act No. 20 / 1966 Coll., on the care of people, as amended, and Act of the Czech National Council No. 185 / 1991 Coll., on insurance, as amended

Valid Law Effective from 01.05.1995
60
THE LAW
of 17 March 1995
amending and supplementing the Act of the Czech National Council No. 551 / 1991 Coll., on the General Health Insurance Company of the Czech Republic, as amended, Act of the Czech National Council No. 280 / 1992 Coll., on the Department, Business, and Other Health Insurance Companies, as amended, Act No. 20 / 1966 Coll., on the Care of People, as amended, and the Act of the Czech National Council No. 185 / 1991 Coll., on insurance, as amended
Parliament has decided on this law of the Czech Republic:
Čl. I
The Act of the Czech National Council No. 551 / 1991 Coll., on the General Health Insurance Company of the Czech Republic, as amended by the Act of the Czech National Council No. 592 / 1992 Coll. and the Act of the Czech National Council No. 10 / 1993 Coll., is amended as follows:
1.
"(a) payments for the payment of health care provided under general health insurance under contracts concluded with medical establishments;"
2.
"(d) the cost of the insurance undertaking's activities under an approved health insurance plan; the maximum amount of the cost of the insurance undertaking's activities shall be determined by the Ministry of Finance by law. ';
3. Paragraph 6 (2), including footnote 2, reads:
"(2) The insurance undertaking shall be required to provide through the auditor2) or a legal person who is registered in the List of Auditors (2) (hereinafter referred to as" the auditor '),
(a) verification of the insurance accounts;
(b) the verification of the insurance undertaking's annual report for the year in question.
2) Act No. 524 / 1992 Coll., on auditors and Chamber of Auditors of the Czech Republic. "
4. in Article 6, the following paragraphs 3 to 6 are inserted after paragraph 2, including footnote 3:
"(3) The insurance company is obliged to submit a draft health insurance plan for the following calendar year, financial statements and annual report for the last calendar year and audit report to the Ministry of Health, following the deadlines set by the Ministry of Finance for the submission of the draft State Budget and the State Final Account.
(4) The draft health insurance plan, the accounts and the annual report for the last year referred to in paragraph 3 shall be approved by the Chamber of Deputies of Parliament after the Government has expressed its views. The approved annual report shall be published by the insurance undertaking in an appropriate manner.
(5) If the insurance insurance plan is not approved before 1 January of the relevant calendar year, the insurance undertaking's activities shall be governed by a commission provided by the Ministry of Finance in agreement with the Ministry of Health until the insurance plan is approved. The basis for establishing a commission is the proposal for a sick insurance plan for the relevant calendar year.
(6) The health insurance plan shall include the insurance undertaking's income and expenditure plan including the breakdown by fund, the expected development of the insurance undertaking's structure, the operating cost plan, the coverage of the insurance undertaking's health care coverage, the way in which the insurance undertaking provides the availability of the services offered by the insurance undertaking, including the envisaged system of health care facilities with which the insurance undertaking enters into a contract to pay the health care.
3) § 14 paragraphs 5 and 6 of the ČNR Act No. 524 / 1992 Coll. '
Paragraph 3 shall become paragraph 7.
5. Article 7, including Notes 4), 5) and 6) shall read as follows:
„§ 7
(1) The insurance undertaking creates and manages the following funds:
(a) a basic health insurance fund which is intended to cover health care wholly or partly covered by general health insurance and consists of insurance payments;
(b) the reserve fund. The minimum reserve amount shall be 3% of the average annual expenditure of the basic health insurance fund of the insurance undertaking for the immediately preceding three calendar years. The reserve fund shall consist of the allocation of insurance premiums by transferring part of the balance of the basic fund. The insurance undertaking may use up to 30% of the funds of the reserve fund for the purchase of government securities, government-guaranteed securities, securities issued by municipalities, publicly negotiable bonds issued by companies and admitted to trading on the stock exchange, publicly marketable shares and units admitted to trading on the stock exchange and treasury orders of the Czech National Bank; these securities and treasury bills of the Czech National Bank remain part of the reserve fund. The reserve fund shall be used by the insurance undertaking to supplement the basic health insurance fund in cases of mass illness and natural disasters or by the insurance undertaking not guilty of a significant decrease in the collection of premiums; the amount of the reserve may, in such a case, fall below the minimum amount during the calendar year;
(c) other special-purpose funds as decided by the Board of Directors of the Central Insurance Corporation in accordance with the approved health insurance plan.
(2) Insurance funds must be deposited at the domestic bank.4)
(3) The insurance undertaking must not set up and operate medical facilities (5) and business6) with funds resulting from general health insurance.
4) Act No. 21 / 1992 Coll., on Banks, as amended by Act No. 264 / 1992 Coll., Act No. 292 / 1993 Coll. and Act No. 156 / 1994 Coll.
5) Act No. 160 / 1992 Coll., on health care in non-state health institutions, as amended.
6) Paragraph 2 (1) of the Commercial Code. '.
6. the following Section 7a is inserted after Section 7, including footnote 7:
„§ 7a
(1) The Ministry of Finance is responsible for checking the activities of the Insurance Corporation. If this Ministry finds serious deficiencies in the insurance business, in particular non-compliance with this Act, general health insurance rules or approved health insurance plan, it shall be justified by the nature of the deficiency found.
(a) require the insurance undertaking to remedy within the prescribed period, in particular to bring its activity into line with this law, the general health insurance rules and the approved health insurance plan;
(b) establish compulsory administration for a maximum period of one year.
(2) In the case of forced administration, decisions of the insurance authorities and legal acts of the head of the insurance undertaking and of the insurer of the insurance undertaking shall be subject to the approval of the trustee, otherwise they shall not be valid.
(3) Decisions on compulsory administration shall be subject to general administrative rules, (7) unless otherwise provided for in this law. The party to proceedings shall be the insurance undertaking. The decomposition against the decision to impose a forced administration has no suspensive effect. The decision establishing the forced administration shall also include the name, surname and birth number of the administrator.
(4) The administrator is an employee of the Ministry of Finance or the Ministry of Health. The administrator shall be entitled to add additional persons to the administration. The administrator and the persons assigned to perform the forced administration shall be entitled to acquaint themselves with all the facts relating to the insurance undertaking. At the same time, they are obliged to maintain confidentiality about these matters; This obligation applies even after the end of the forced administration.
(5) The administrator may exempt the Minister of Finance from the obligation of confidentiality at the request of the criminal proceedings authority, where criminal proceedings are conducted in relation to serious deficiencies in the activities of the insurance undertaking for which forced administration has been established.
7) Act No. 71 / 1967 Coll., on Administrative Procedure (Administrative Regulations). '.
7. Article 8 (1) reads as follows:
"(1) In the event of a balance sheet imbalance, the insurance undertaking shall submit a draft measure to the government via the Minister for Health. '
8. Article 8 (3) reads as follows:
"(3) The volume of refundable financial assistance from the state budget of the Czech Republic may amount to a maximum of 50% of the proven lack of funds due to an increased range of medical services provided due to an increase in morbidity due to the proven occurrence of mass illness. Refunds may be granted only after the resources of the reserve fund have been exhausted. The basis for calculating the insolvency of the insurance undertaking is an approved health insurance plan. The Government of the Czech Republic shall decide on the granting of repayable financial assistance. '
9. In Article 14 (1), "Article 12 'is replaced by" Article 13 (2)'.
10. In Paragraph 14 (2), at the beginning of the sentence and part of the sentence behind the semicolon, the words "seat and 'shall be deleted.
11. in Article 15 (4), the words "the Czech National Council" shall be replaced by the words "Parliament's Chamber of Deputies";
12. In Paragraph 18 (1), the words "Czech and Slovak Federal Republic" shall be replaced by the words "Czech Republic," the words "resident" shall be replaced by the words "resident" and the following sentences shall be added at the end: "Member of the insurance institution and head of the head office or, where appropriate, the head of the lower organisational unit or their representative shall not be a citizen who is in employment or similar relationship with the entity with which the insurance company has entered into a health care contract. For the purposes of this Act, a citizen who has not been convicted of a criminal offence of a property nature or of an intentional offence shall be deemed to be righteous. ';
13. in Article 20 (6), the words "the Czech National Council" are replaced by the words "Parliament's Chamber of Deputies."
14. in Article 21 (5), the words "the Czech National Council" shall be replaced by the words "Parliament's Chamber of Deputies";
15. Article 24 (2) reads as follows:
"(2) The use of data from the insurance undertaking's own-account information system is its sole right. The use of data from the insurance undertaking's information system for other purposes may only be done in the manner and under the conditions laid down in this Act. '
16. Paragraphs 3 to 5 are deleted in Paragraph 24.
17. the following Section 24a is inserted after Section 24:
„§ 24a
(1) The members and alternates of the insurance undertaking's bodies, its staff and natural persons ensuring the processing of data from the information system under the contract are required to remain confidential about the facts which they have learned in the performance of their duties or employment or in the processing of data from the information system under the contract or, where appropriate, in relation to them. This obligation shall continue after their duties or employment relationship or contractual relationship with the Insurance Company have ceased. Non-disclosure obligations may be waived only in writing, indicating the extent and purpose of the obligation in the interests of them.
(2) The insurance undertaking shall establish conditions for confidentiality in accordance with paragraph 1. This also applies when using and allowing access to data registered by computer.
(3) The use of knowledge acquired in the control of, or in connection with, insurance premiums shall be regarded as a breach of the obligation to maintain confidentiality for the benefit of a person bound by this obligation or by other persons or any conduct which would harm someone. ';
18. The following Paragraph 24b is inserted after Paragraph 24a, including footnote 8:
„§ 24b
(1) The Ministry of Finance may impose a fine on Insurance up to CZK 500,000 for the breach of the obligations referred to in § 6 (3). The Ministry of Health may impose a fine on the Insurance Company up to CZK 500,000 for the breach of the obligation under the General Health Insurance Act 8).
(2) The fine referred to in paragraph 1 may be imposed within one year of the date on which the competent ministry became aware of the infringement, but no later than five years after the infringement occurred. In fixing the amount of the fine, account shall be taken of the seriousness of the infringement. Decisions on fines shall be subject to general administrative rules. 7)
(3) The fine referred to in paragraph 1 shall be the income of the Ministry which imposed it; this Ministry also collects fines.
(4) The fine referred to in paragraph 1 shall not be paid by the insurance undertaking by the basic health insurance fund or by the reserve fund.
8) Paragraph 23 (4) of Act No. 592 / 1992 Coll., on Insurance for General Health Insurance, as amended by Act No. 59 / 1995 Coll. '
Čl. II
The Act of the Czech National Council No. 280 / 1992 Coll., on departmental, branch, corporate and other health insurance companies, as amended by the Act of the Czech National Council No. 10 / 1993 Coll. and the Act of the Czech National Council No. 15 / 1993 Coll., is amended as follows:
1. Paragraph 3, including footnote 9, reads:
„§ 3
(1) An authorisation is required to establish an occupational insurance company. The Ministry of Health shall decide on the granting of the authorisation following a statement from the Ministry of Finance. (9) Unless otherwise specified below.
(2) The authorisation referred to in paragraph 1 shall be granted after an assessment of:
(a) the information given in the application for authorisation (§ 4 (2));
(b) factual, financial and organisational assumptions for the activities of the occupational insurance undertaking;
(c) the reality of the expected income and expenditure of the occupational insurance undertaking.
9) Act No. 71 / 1967 Coll., on Administrative Procedure (Administrative Regulations). '
2.
„§ 4
Application for authorisation
(1) An applicant for an authorisation pursuant to Article 3 may be a legal person established in the Czech Republic.
(2) The applicant shall indicate in the application for authorisation:
(a) the expected name and registered office of the occupational insurance undertaking; it must be clear from the name that it is an occupational insurance undertaking,
(b) an analysis of the expected income and expenditure of the occupational insurance undertaking;
(c) an undertaking by the applicant to pay the costs associated with the setting-up of an occupational insurance undertaking, indicating how the undertaking is to be fulfilled;
(d) the factual, financial and organisational conditions for the activities of the occupational insurance undertaking;
(e) the bank which will raise funds for the employee insurance undertaking;
(f) an undertaking that the occupational insurance undertaking shall reach at least 50 000 insured persons within one year of the establishment of the number;
(g) the method of liquidation in the event of non-compliance with the obligations referred to in (c), (d) or (f).
(3) The application shall be accompanied by proposals for the instrument of incorporation and the status of the occupational insurance undertaking and the first health insurance plan.
(4) The application will be decided by the Ministry of Health, after a statement from the Ministry of Finance, within 180 days of its receipt. The authorisation provided for in Section 3 shall include the approval of the draft employment insurance scheme. The draft of the first health insurance plan is decided by the Ministry of Finance after the opinion of the Ministry of Health.
(5) The authorisation provided for in Article 3 shall be granted for an indefinite period; the permit is not transferable to another person. Changes in the facts referred to in paragraph 2 (a), (e) or (g) and changes in the status of the occupational insurance undertaking shall be subject to approval by the Ministry of Health. ';
3. The following Section 4a is inserted after Section 4:
„§ 4a
Bail
(1) Before applying for permission to establish an employee insurance company, the applicant is obliged to deposit in a separate account in the domestic bank (hereinafter referred to as "bail") of CZK 50 000 000.
(2) The date of registration of the employee insurance company in the Commercial Register transfers bail rights to the employee insurance company. The employee insurance company transfers bail to the reserve fund.
(3) A legal decision of the Ministry of Health rejecting an application for authorisation to establish an occupational insurance company is released to the applicant. "
4. The following Section 4b is inserted after Section 4a:
„§ 4b
The status of the employee insurance undertaking shall include in particular the scope of the activity of the employee insurance undertaking, the general focus of health policy, the principles of management and the manner in which the annual report of the employee insurance undertaking is published. ';
5.
"(a) the merger with the General Health Insurance Company of the Czech Republic or the merger with another occupational insurance company. A permit to merge or merge employee insurance companies shall be issued by the Ministry of Health after a statement from the Ministry of Finance. A new health insurance plan shall be submitted with the application. Employers' insurance undertakings shall be required to demonstrate that they fulfil the conditions required for the authorisation to establish an occupational insurance undertaking, with the exception of the condition set out in § 4a. '
6. Paragraph 6 is renumbered paragraph 1 and the following paragraph 2 is added:
"(2) Failure to comply with the obligation under Article 4 (2) (f) shall result in the employee insurance being cancelled and entered into liquidation. The Ministry of Health may decide, in the event of repeated non-approval of the draft health insurance plan, the accounts or the annual report of the employee insurance company, to cancel the employee insurance undertaking and enter into liquidation. The resources of the basic health insurance fund [Paragraph 16 (1) (a)] shall be transferred to the General Health Insurance Corporation of the Czech Republic for reallocation. The capital balance resulting from the liquidation (liquidation balance), 10) shall be transferred to the applicant for authorisation pursuant to § 3 or to his legal successor. If there is no applicant for authorisation under § 3 or his successor in title, the General Health Insurance Company of the Czech Republic shall be transferred. The general health insurance company of the Czech Republic shall allocate the liquidation balance in proportion to the number of insured persons to individual health insurance companies and transfer the relevant amount to them.
10) § 75 (1) of the Commercial Code. '
7.
„§ 7
Forced administration
(1) The Ministry of Finance shall carry out an audit of the activities of the occupational insurance company. If this Ministry finds serious deficiencies in the activities of an occupational insurance company, in particular non-compliance with this Act, general health insurance rules or approved health insurance plan, it shall be justified by the nature of the deficiency found.
(a) require the employee insurance undertaking to remedy within the prescribed period, in particular to bring its activity into line with this law, the general health insurance rules and the approved health insurance plan;
(b) establish compulsory administration for a maximum period of one year.
(2) In the case of forced administration, the decision of the institution of the employee insurance undertaking and the legal acts of the director of the employee insurance undertaking shall be subject to the approval of the AIFM, otherwise they shall be invalid.
(3) Decisions on compulsory administration shall be subject to general administrative provisions, unless otherwise provided for in this law. The party to proceedings shall be the employee insurance company. The decomposition against the decision to impose a forced administration has no suspensive effect. The decision establishing the forced administration shall also include the name, surname and birth number of the administrator.
(4) The administrator is an employee of the Ministry of Finance or the Ministry of Health. The administrator shall be entitled to add additional persons to the administration. The administrator and the persons assigned to perform the compulsory administration shall be entitled to acquaint themselves with all the facts relating to the employee insurance undertaking. At the same time, they are obliged to maintain confidentiality about these facts. This obligation applies even after the end of the forced administration.
(5) The administrator may waive the obligation of secrecy of the Minister of Finance at the request of the law enforcement authority, where criminal proceedings are conducted in connection with serious deficiencies in the activities of the occupational insurance undertaking for which forced administration has been established.
(6) If the compulsory administration fails to meet its purpose, the procedure laid down in Paragraph 6 (1) (b) of this Act shall be applied mutatis mutandis. '
8. In Paragraph 8 (1), the word "insurance 'is replaced by" health insurance'.
9. In Section 9, the word "founder 'is replaced by" Ministry of Health'.
Article 10 (3) reads as follows:
"(3) The representative of the State shall appoint and withdraw the Ministry of Health."
11. Article 10 (4) shall be added as follows:
"(4) Only an upstanding citizen of the Czech Republic with a permanent residence in its territory who has reached the age of at least 25 may be a member of the institution of the employee insurance company or its alternate. The member of the institution of the occupational insurance undertaking and the head of the head office or, where appropriate, the head of the lower organisational unit or their representative shall not be a citizen who is in an employment or similar relationship with the entity with which the occupational insurance undertaking has concluded a health care contract. For the purposes of this Act, a citizen who has not been convicted of a criminal offence of a property nature or of an intentional offence shall be deemed to be righteous. ';
12. Article 13 (1) (a) reads as follows:
"(a) payments for the payment of health care provided under general health insurance under contracts concluded with medical establishments;"
13. In Paragraph 13 (1) (c), the words "to the minimum, to the extent that the General Health Insurance Company of the Czech Republic will pay."
14. Paragraph 13 (1) (d) reads as follows:
"(d) the cost of the activities of the occupational insurance undertaking under the approved health insurance plan; the maximum amount of the cost of the employment insurance company's activities shall be determined by the Ministry of Finance by law. ';
15.
„§ 15
(1) Employee insurance undertaking is obliged to provide through auditora11) or a legal person registered in the list of auditors, 11) (hereinafter referred to as "auditor")
(a) verification of the accounts of the employee insurance undertaking;
(b) verification of the annual report of the occupational insurance undertaking for the year in question.
(2) The Employee Insurance Corporation is required to submit to that Ministry, through the Ministry of Health, a draft health insurance plan for the following calendar year, financial statements and an annual report for the previous calendar year and an auditor's report, following the deadlines laid down by the Ministry of Finance for the submission of a draft State Budget and State Final Account. 12) The approved annual report shall be published by the employee insurance undertaking in an appropriate manner.
(3) The draft health insurance plan, the accounts and the annual report for the last year referred to in paragraph 2 are approved by the Chamber of Deputies of Parliament following the Government's observations.
(4) The health insurance plan of an occupational insurance undertaking shall include an income and expenditure plan, including breakdown by fund, anticipated development of the structure of the insured person, operational cost plan, data on the extent of the health care paid by the occupational insurance undertaking, how to ensure the availability of the services offered by the occupational insurance undertaking, including the envisaged system of health facilities with which the occupational insurance undertaking enters into a contract to pay the health care.
11) Act ČNR No. 524 / 1992 Coll., on auditors and Chamber of Auditors of the Czech Republic.
12) § 14, paragraphs 5 and 6 of the ČNR Act No. 524 / 1992 Coll. '
16. In Article 16 (2), the words "and supplementary insurance funds' shall be deleted and the following words shall be added at the end:" and in accordance with the approved health insurance scheme of the occupational insurance undertaking '.
17. In the first sentence of Paragraph 17 (1), the word "needed" is deleted and the following words are added at the end: "fully or partly covered by general health insurance."
Paragraph 18 (1) reads as follows:
"(1) The minimum amount of the reserve shall be 3% of the average annual expenditure of the basic health insurance fund of the occupational insurance undertaking over the immediately preceding three calendar years. The reserve fund shall consist of the allocation of insurance premiums by transferring part of the balance of the basic fund. The Employee Insurance Corporation may use up to 30% of the funds of the reserve fund to purchase government securities, government-guaranteed securities, securities issued by municipalities, publicly negotiable bonds issued by companies and admitted to trading on the stock exchange, publicly marketable shares and units admitted to trading on the stock exchange and treasury orders of the Czech National Bank; these securities and treasury bills of the Czech National Bank remain part of the reserve fund. The reserve fund shall be used by the employee insurance undertaking to supplement the basic fund in cases of mass illness and natural disasters; the amount of the reserve may in such a case fall below the minimum amount during the calendar year. The employer's insurance undertaking shall complete the reserve within two years of the date of establishment. '
19. In Paragraph 18 (2), the word "the founder 'is replaced by" the Ministry of Health'.
20. In Paragraph 18 (3), the word "founder 'is replaced by" Ministry of Health'.
21. Article 19 (2) and (3), including Notes 7, 13 and 14, read:
"(2) The funds of the employee insurance undertaking must be deposited in the domestic bank. 7)
(3) Employee insurance undertakings must not set up and operate healthcare facilities (13) and business14) with funds resulting from general health insurance.
7) Act No. 21 / 1992 Coll., on Banks, as amended by Act No. 264 / 1992 Coll., Act No. 292 / 1993 Coll. and Act No. 156 / 1994 Coll.
13) Act ČNR No. 160 / 1992 Coll., on health care in non-state health institutions, as amended.
14) Paragraph 2 (1) of the Commercial Code. '.
22.
„§ 21
(1) The Employee Insurance Corporation manages, updates and develops the information system of the Employee Insurance Corporation.
(2) The use of data from the information system of an occupational insurance undertaking for its own use is its sole right. Data from the information system of an occupational insurance undertaking for other purposes may be used only in the manner and under the conditions laid down in this Act. ';
23.
„§ 22
(1) The members and alternates of the occupational insurance undertaking's bodies, its employees and natural persons ensuring the processing of data from the information system under the contract are required to remain confidential about the facts which they have learned in the performance of their duties or employment or in the processing of data from the information system under the contract or in connection with them, where appropriate. This obligation shall continue after their duties or employment relationship or contractual relationship with an occupational insurance undertaking have ceased. Non-disclosure obligations may be waived only in writing, indicating the extent and purpose of the obligation in the interests of them.
(2) The use of knowledge acquired in the control of, or in connection with, payments of insurance premiums shall be regarded as a breach of the obligation to remain confidential for the benefit of a person obliged to do so or to other persons or any conduct which would cause harm to someone.
(3) The employment insurance undertaking is obliged to establish the conditions for confidentiality laid down in paragraph 1. This shall also apply when using and allowing access to data registered by computer. ';
24. in Paragraph 23 (1), the word "necessary" shall be deleted.
25. The following Section 23a is inserted after Section 23, including Notes 15) and 16):
„§ 23a
(1) The Ministry of Finance may fine the employee insurance company up to CZK 500,000 for the breach of the obligations referred to in § 15 (2). The Ministry of Health may impose a fine on the occupational insurance company up to CZK 500,000 for the breach of the obligations under the General Health Insurance Act 15.
(2) The fine referred to in paragraph 1 may be imposed within one year of the date on which the competent Ministry became aware of the infringement, but no later than five years after the infringement occurred. In fixing the amount of the fine, account shall be taken of the seriousness of the infringement.
(3) The fine referred to in paragraph 1 shall be the income of the general health insurance special account. 16)
(4) The fine referred to in paragraph 1 shall not be paid by the employee insurance undertaking from the resources of the basic health insurance fund or from the resources of the reserve fund.
15) Paragraph 23 (4) of Act No. 592 / 1992 Coll., on Insurance for General Health Insurance, as amended by Act No. 59 / 1995 Coll.

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Regulation Information

CitationAct No. 60 / 1995 Coll., amending and supplementing the Act of the Czech National Council No. 551 / 1991 Coll., on the General Health Insurance Company of the Czech Republic, as amended, Act of the Czech National Council No. 280 / 1992 Coll., on departmental, branch, business and other health insurance companies, as amended, Act No. 20 / 1966 Coll., on the care of people, as amended, and Act No. 185 / 1991 Coll., on insurance, as amended
Regulation TypeLaw
Author-
CollectionCode of Laws
Date of Promulgation24.04.1995
Effective from01.05.1995
Effective until-
Status Valid
The regulation text is for informational purposes only.
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