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Ghana Medical Trust Fund Act, 2025 (Act 1144)

From The Legal and Regulatory Framework of Ghana

ARRANGEMENT OF SECTIONS

Ghana Medical Trust Fund

1. Establishment of the Ghana Medical Trust Fund
2. Object of the Fund
3. Sources of moneys for the Fund
4. Bank account of the Fund
5. Application of moneys of the Fund

Governance of the Fund

6. Board of Trustees
7. Functions of the Board of Trustees
8. Tenure of office of members of the Board of Trustees
9. Meetings of members of the Board of Trustees
10. Disclosure of interest
11. Establishment of committees
12. Allowances
13. Policy directives

Administrative Provisions

14. Secretariat of the Fund
15. Appointment of Administrator
16. Functions of the Administrator
17. Appointment of other staff
18. Secretary to the Board of Trustees
19. Appointment of an actuary
20. Internal Audit Unit

Financial Provisions

21. Expenses of the Fund
22. Exemptions
23. Accounts and audit
24. Annual report and other reports

Beneficiaries and Services

25. Beneficiaries of the Fund
26. Application for support
27. Services
28. Quality assurance
29. Enlistment of service providers
30. Variation, suspension and revocation of enlistment
31. Medicines list and medicines tariff
32. Service list and service tariff

Claims Payable to Service Providers

33. Submission of claims by enlisted service provider
34. Vetting of claim by Fund
35. Payments to enlisted service provider
36. Payment mechanisms for enlisted service providers

Third-Party Administrators

37. Appointment of third-party administrators
38. Qualification as third-party administrator
39. Application for registration as third-party administrator
40. Consideration of application for registration as third-party administrator
41. Suspension and revocation of registration of third-party administrator

Redress Mechanism

42. Appeal
43. Redress in court

Miscellaneous Provisions

44. Data privacy and security
45. Regulations
46. Interpretation
47. Consequential amendment

SCHEDULE

Consequential Amendment

LONG TITLE

AN ACT to establish the Ghana Medical Trust Fund to mobilise resources to finance and support the provision of specialised medical care for the treatment of persons with chronic diseases; to provide for the management of the Fund and for related matters.

DATE OF ASSENT

29th July, 2025.

ACT

Ghana Medical Trust Fund

1. Establishment of the Ghana Medical Trust Fund

(1) There is established by this Act, the Ghana Medical Trust Fund as a body corporate.

(2) The Fund may, for the performance of the functions of the Fund, acquire and hold property, dispose of property and enter into a contract or any other related transaction.

(3) Where there is a hindrance to the acquisition of land, the land may be acquired for the Fund under the Land Act, 2020 (Act 1036) and the cost shall be borne by the Fund.


2. Object of the Fund

The object of the Fund is to mobilise resources to finance and support the provision of specialised medical care for the treatment of persons with chronic diseases.


3. Sources of moneys for the Fund

The sources of moneys for the Fund are

(a) twenty per cent of total moneys allocated to the National Health Insurance Fund;
(b) moneys approved by Parliament;
(c) moneys that accrue to the Fund from investments;
(d) grants, donations, gifts and any other voluntary contributions made to the Fund; and
(e) any other moneys or property that may become lawfully payable or vested in the Board of Trustees for the Fund.


4. Bank account of the Fund

The moneys for the Fund shall

(a) vest in the Board of Trustees; and
(b) be paid into a bank account opened for the Fund with the approval of the Controller and Accountant-General.


5. Application of moneys of the Fund

(1) For the purpose of achieving the object of the Fund under section 2, moneys from the Fund shall be applied to

(a) provide financial support to approved persons accessing specialised medical care for the treatment of chronic diseases;
(b) facilitate the provision or access to specialised medical care for the treatment of persons with chronic diseases;
(c) invest in programmes to promote equitable access to specialised medical care as determined by the Board of Trustees for the treatment of persons with chronic diseases;
(d) provide financial support for specialist medical training and specialised medical care research of relevance to specialised medical care as determined by the Board of Trustees for the treatment of persons with chronic diseases;
(e) investment in any other facilitating programme including medical equipment, infrastructure, human resources development and research; and
(f) any other matter necessary for the achievement of the object of the Fund.

(2) The moneys and resources of the Fund shall be disbursed in accordance with a formula to be determined by the Board of Trustees in consultation with the Minister and subject to the approval of Parliament.

(3) The Board of Trustees shall, in preparing the formula under subsection (2), take into consideration the following:

(a) the burden of the chronic disease, the cost of care and financial equity;
(b) the advancement of equitable access to specialised medical care in the country; and
(c) the reduction in the high levels of morbidity, disability and mortality and the alleviation of suffering.


Governance of the Fund

6. Board of Trustees

(1) The governing body of the Fund is a Board of Trustees consisting

(a) the chairperson;
(b) the Administrator;
(c) a representative each of the following:
(i) the Ministry responsible for Health not below the rank of a Director nominated by the Minister;
(ii) the Ministry responsible for Finance not below the rank of a Director nominated by the Minister responsible for Finance; and
(iii) the Ministry responsible for Social Welfare not below the rank of a Director nominated by the Minister responsible for Social Welfare;
(d) the Chief Executive Officer of the National Health Insurance Authority;
(e) one representative each from
(i) the health sector nominated by the Minister; and
(ii) the pharmaceutical industry nominated by the Minister;
(f) a health professional with
(i) not less than ten years' experience; and
(ii) expertise in chronic diseases;
nominated by the Minister;
(g) a legal practitioner with not less than ten years' experience nominated by the Attorney-General and Minister for Justice; and
(h) three other persons nominated by the President, at least one of whom is a woman.

(2) The President shall, in accordance with article 70 of the Constitution, appoint the members of the Board of Trustees.

(3) The President shall, in appointing the members of the Board of Trustees under subsection (1), have regard to the integrity, knowledge, expertise and experience of the persons in matters relevant to the object of the Fund.


7. Functions of the Board of Trustees

(1) The Board of Trustees is responsible for the management of the Fund.

(2) For the purpose of subsection (1), the Board of Trustees shall

(a) have oversight responsibility for the collection and accounting for resources mobilised for the Fund;
(b) approve expenditure charged on the Fund;
(c) subject to the Public Financial Management Act, 2016 (Act 921), appoint a fund manager to invest moneys of the Fund that are not required for immediate use in financial

instruments and ventures that are financially beneficial to the Fund;

(d) organise fund-raising activities to raise money for the Fund; and
(e) perform any other function incidental to the achievement of the object of the Fund.


8. Tenure of office of members of the Board of Trustees

(1) A member of the Board of Trustees shall hold office for a period of four years and is eligible for re-appointment for another term only.

(2) Subsection (1) does not apply to the Administrator and a person who is a member of the Board of Trustees by reason of the office of that person.

(3) A member of the Board of Trustees may at any time resign from office in writing addressed to the President through the Minister.

(4) A member of the Board of Trustees, other than the Administrator, who is absent from three consecutive meetings of the Board of Trustees without sufficient cause ceases to be a member of the Board of Trustees.

(5) The President may by a letter addressed to a member revoke the appointment of that member.

(6) Where a member of the Board of Trustees is for a sufficient reason, unable to act as a member, the Minister shall determine whether the inability may result in the declaration of a vacancy.

(7) Where there is a vacancy

(a) under subsection (3), (4) or (5) or subsection (2) of section 10;
(b) as a result of a declaration under subsection ( 6), or
(c) by reason of the death of a member,

the Minister shall notify the President of the vacancy and the President shall appoint a person to fill the vacancy for the unexpired term.


9. Meetings of members of the Board of Trustees

(1) The Board of Trustees shall meet at least once every three months for the despatch of business at the place and time determined by the chairperson.

(2) The chairperson shall, at the request in writing of not less than one-third of the membership of the Board of Trustees, convene an extraordinary meeting of the Board of Trustees at the place and time determined by the chairperson.

(3) The quorum at a meeting of the Board of Trustees is seven members including the Administrator.

(4) The chairperson shall preside at meetings of the Board of Trustees and in the absence of the chairperson, a member of the Board of Trustees, other than the Administrator, elected by the members present from among their number shall preside.

(5) Matters before the Board of Trustees shall be decided by a majority of the members present and voting and in the event of an equality of votes, the person presiding shall have a casting vote.

(6) The Board of Trustees may co-opt a person to attend a meeting of the Board of Trustees but that person shall not vote on a matter for decision at the meeting.

(7) The validity of proceedings of the Board of Trustees shall not be affected by any vacancy among the members or by any defect in the appointment of a member.


10. Disclosure of interest

(1) A member of the Board of Trustees who has an interest in a matter for consideration

(a) shall disclose in writing the nature of the interest and the disclosure shall form part of the record of the consideration of the matter; and
(b) is disqualified from being present at or participating in the deliberations of the Board of Trustees in respect of that matter.

(2) A member ceases to be a member of the Board of Trustees, if that member has an interest in a matter before the Board of Trustees and

(a) fails to disclose that interest; or
(b) is present at or participates in the deliberations of the Board of Trustees in respect of that matter.

(3) Without limiting any further cause of action that may be instituted against the member, the Board of Trustees shall recover any benefit derived by a member who contravenes subsection (1), in addition to the revocation of the appointment of the member.


11. Establishment of committees

(1) The Board of Trustees may establish committees consisting of members and non-members of the Board of Trustees to perform a function of the Board of Trustees.

(2) A committee composed of members and non-members of the Board of Trustees shall be chaired by a member of the Board of Trustees.

(3) Without limiting subsection (1), the Board of Trustees shall establish the following committees:

(a) Resource Mobilisation and Fund-Raising Committee;
(b) Finance and Investment Committee; and
(c) Technical Oversight Committee.

(4) The Board of Trustees shall determine the composition and functions of the committees established under subsection (3).

(5) Section 10 applies to a member of a committee of the Board of Trustees.


12. Allowances

Members of the Board of Trustees and members of a committee of the Board of Trustees shall be paid allowances approved by the Minister in consultation with the Minister responsible for Finance.


13. Policy directives

The Minister may give policy directives consistent with the object of this Act to the Board of Trustees and the Board of Trustees shall comply.


Administrative Provisions

14. Secretariat of the Fund

The Fund shall have a secretariat with the headquarters in Accra.


15. Appointment of Administrator

(1) The President shall, in accordance with article 195 of the Constitution, appoint an Administrator for the Fund.

(2) The Administrator shall hold office on the terms and conditions specified in the letter of appointment.


16. Functions of the Administrator

(1) The Administrator

(a) is the head of the secretariat of the Fund;
(b) is responsible for the day-to-day administration of the Fund;
(c) is responsible for ensuring the implementation of the decisions of the Board of Trustees;
(d) is answerable to the Board of Trustees for the performance of the functions under this Act; and
(e) shall perform any other function assigned by the Board of Trustees.

(2) The Administrator may delegate a function to an officer of the Fund but shall not be relieved of the ultimate responsibility for the performance of the delegated function.


17. Appointment of other staff

(1) The President shall, in accordance with article 195 of the Constitution, appoint other staff of the Fund that are necessary for the effective and efficient performance of the functions of the Fund.

(2) The President may, in writing, delegate the power of appointment under subsection (1) to the Board of Trustees.

(3) Other public officers may be transferred or seconded to the Fund.

(4) The Board of Trustees may, on the recommendation of the Administrator, engage the services of advisors and consultants.


18. Secretary to the Board of Trustees

(1) The Administrator shall designate a staff of the Fund as Secretary to the Board of Trustees.

(2) The Secretary shall, subject to the directives of the Board of Trustees,

(a) ensure that the business of the Board of Trustees is arranged;
(b) ensure that the minutes of the meetings and decisions of the Board of Trustees are kept in the form approved by the Board of Trustees; and
(c) perform any other function that the Board of Trustees or the Administrator may direct.


19. Appointment of an actuary

(1) There shall be appointed an actuary for the Fund who shall be responsible to the Administrator.

(2) The actuary shall, at the end of every three months, submit an actuarial report of the Fund carried out by the actuary in respect of that period to the Administrator and the chairperson of the Board of Trustees.

(3) For the purpose of paragraph (b) of subsection (2), "non-core activities" mean activities other than activities specified in subsection (1) of section 5.


20. Internal Audit Unit

(1) The Fund shall have an Internal Audit Unit in accordance with section 83 of the Public Financial Management Act, 2016 (Act 921).

(2) The Internal Audit Unit shall be headed by an Internal Auditor who shall be appointed in accordance with the Internal Audit Agency Act, 2003 (Act 658).

(3) The Internal Auditor is responsible for the internal audit of the Fund.

(4) The Internal Auditor shall, subject to subsections (3) and (4) of section 16 of the Internal Audit Agency Act, 2003 (Act658), at intervals of three months

(a) prepare and submit to the Board of Trustees a report on the internal audit carried out during the period of three months immediately preceding the preparation of the report; and
(b) make recommendations in each report with respect to matters which appear to the Internal Auditor as necessary for the conduct of the affairs of the Fund.

(5) The Internal Auditor shall in accordance with subsection (4) of section 16 of the Internal Audit Agency Act, 2003 (Act 658), submit a copy of each report prepared under this section to

(a) the Minister;
(b) the Auditor-General; and
(c) the chairperson of the Board of Trustees.


Financial Provisions

21. Expenses of the Fund

(1) The expenses of the Fund, including the salaries of employees and administrative expenses of the Fund, shall be a charge on the Fund.

(2) The Fund shall not spend

(a) more money than the Fund raised in any financial year; and
(b) more than ten per cent of the annual funding amount on non-core activities.

(3) The Minister shall, within thirty days after the receipt of the annual report, submit the report to Parliament with a statement that the Minister considers necessary.

(4) The Board of Trustees shall submit to the Minister any other report that the Minister may require in writing.


22. Exemptions

(1) Subject to article 174 of the Constitution and the Exemptions Act, 2022 (Act 1083),

(a) the Fund is exempt from the payment of taxes that the Minister responsible for Finance may, in writing, determine with the prior approval of Parliament; and
(b) the importation of selected medicines, technologies and non-medical consumables recommended by the Board of Trustees through the Minister, is exempt from the taxes that the Minister responsible for Finance may, in writing, determine with the prior approval of Parliament.

(2) A person who donates to the Fund is, in accordance with section 100 of the Income Tax Act, 2015 (Act 896), entitled to claim a deduction that is equal to the donation made to the Fund.


23. Accounts and audit

(1) The Fund shall keep books, records, returns of account and other documents relevant to the accounts in the form approved by the Auditor-General.

(2) The Board of Trustees shall submit the accounts of the Fund to the Auditor-General for audit at the end of the financial year.

(3) The Auditor-General shall, within six months after the end of the immediately preceding financial year, audit the accounts of the Fund and forward a copy of the report to the Minister and the Board of Trustees.

(4) The financial year of the Fund shall be the same as the financial year of the Government.


24. Annual report and other reports

(1) The Board of Trustees shall, within thirty days after the receipt of the audit report, submit an annual report to the Minister covering the activities and operations of the Fund for the year to which the report relates.

(2) The annual report shall include the report of the Auditor-General.

(3) The chairperson of the Board of Trustees shall submit a copy of the actuarial report under subsection (2) to the Minister and the Minister responsible for Finance.


Beneficiaries and Services

25. Beneficiaries of the Fund

A person is eligible to benefit from the Fund if that person

(a) is a citizen who is insured under the National Health Insurance Scheme; and
(b) suffers from a chronic disease.


26. Application for support

(1) A person who is eligible to benefit from the Fund under section 25 may apply to the Fund through a specialist medical practitioner.

(2) An application under subsection (1) shall be in the prescribed form.

(3) The Fund shall, within fourteen days after the receipt of an application under this section, Services

(a) approve the application and give notice in writing of the approval to the applicant; or
(b) refuse the application and give notice in writing of the


27. refusal to the applicant and state the reasons for the refusal

(1) The Board of Trustees shall determine the specialist healthcare packages available to beneficiaries in accordance with the object of the Fund.

(2) The Fund shall provide the public with information in respect of

(a) the specialist healthcare packages available to beneficiaries;
(b) the rights and responsibilities of beneficiaries; and
(c) complaints and dispute resolution mechanisms.

(3) The Board of Trustees shall assess the specialist healthcare packages each year and advise the Minister accordingly.


28. Quality assurance

(1) The Fund shall only work with medical practitioners that are

(a) certified by the relevant national or international professional regulatory body; and
(b) licensed to provide specialist medical services by the relevant regulatory body in the country.

(2) The Fund shall, in collaboration with the relevant agencies and agents,

(a) implement policies and procedures that guarantee quality of care to beneficiaries; and
(b) commission clinical quality and treatment outcome audits of service providers.

(3) The clinical quality and treatment outcome audits include assessments of

(a) human resources;
(b) infrastructure;
(c) equipment;
(d) technology; and
(e) procedures and protocols.


29. Enlistment of service providers

(1) The Fund shall enlist specialist medical care facilities, pharmaceutical facilities, laboratory facilities and diagnostics facilities that are licensed by the Health Facilities Regulatory Agency and the Pharmacy Council as service providers of the Fund.

(2) A specialist medical care facility, a pharmaceutical facility, a laboratory facility or a diagnostics facility may apply to the Fund to be enlisted as a service provider of the Fund.

(3) The Fund shall, within fourteen days after the receipt of an application under subsection (2),

(a) approve the application and issue a certificate in the prescribed form to the applicant; or
(b) refuse the application and give notice in writing of the refusal to the applicant and state the reasons for the refusal.

(4) Where the refusal to enlist is as a result of a non-material defect in the application, the Fund may in the notice require the applicant to rectify the application within a specified period.

(5) A certificate issued under subsection (3) is subject to renewal each year.

(6) A service provider of the Fund shall display the certificate issued to the service provider in a conspicuous place or manner on the premises of the service provider.

(7) Where

(a) the Board of Trustees determines that a service provider performs below service quality standards, or
(b) the licence or accreditation of the service provider has been revoked by a regulatory agency, the service provider shall immediately cease to provide services to beneficiaries of the Fund.

(8) An enlisted service provider shall not

(a) provide services to a beneficiary in a facility that has not been enlisted as a service provider of the Fund; or
(b) carry out activities jointly with another facility without the prior approval of the Fund.

(9) A service provider who contravenes subsection (8) commits an offence and is liable on summary conviction to a fine of not more than two hundred penalty units or to a term of imprisonment of not more than one year or to both.


30. Variation, suspension and revocation of enlistment

(1) The Fund may

(a) vary a condition of enlistment of a service provider; or
(b) suspend or revoke the enlistment of a service provider.

(2) The Fund shall suspend the enlistment of a service provider where the service provider

(a) fails to comply with a provision of this Act, Regulations made under this Act or any other enactment which applies to the service provider; or
(b) commits a material breach of an obligation under the agreement with the Fund which is capable of remedy, but does not remedy the breach within fourteen days after the notice of the breach and requirement to remedy the breach.

(3) The Fund shall revoke the enlistment of a service provider where the service provider

(a) commits a material breach of an obligation under the agreement with the Fund which, in the opinion of the Fund, is not capable of remedy;
(b) subcontracts or assigns an obligation under the agreement with the Fund to another person without the prior consent of the Fund;
(c) becomes insolvent or bankrupt; or
(d) engages in fraud, corruption or any other unethical conduct in a dealing with the Fund or a partner of the Fund.

(4) The Fund shall not suspend or revoke the enlistment of a service provider unless the Fund has

(a) given the service provider one month's notice of the intention to suspend or revoke;
(b) indicated the reason for the intention to suspend or revoke; and
(c) provided the service provider an opportunity to make representation to the Fund.

(5) Where the Fund varies a condition for enlistment or imposes a new condition, the affected service provider shall deliver the licence to the Board of Trustees for the variation of the licence.

(6) Where an enlistment of a service provider expires, is revoked or suspended, the Fund may apply to a Court for an order to protect and preserve beneficiaries and the public interest.

(7) Where an enlistment of a service provider is suspended, revoked or expires, the Fund shall arrange for the transfer of beneficiaries to another service provider

(a) enlisted by the Fund, and
(b) approved by the beneficiary and the Board of Trustees.


31. Medicines list and medicines tariff

(1) The Fund shall, in consultation with service providers in the public and private sectors, develop a Ghana Medical Trust Fund Medicines List and Medicines Tariff.

(2) The Fund shall, each year, review the Ghana Medical Trust Fund Medicines List and Medicines Tariff developed under subsection (1).

(3) The Fund may, in reviewing the Ghana Medical Trust Fund Medicines List and Medicines Tariff,

(a) remove, add, classify or group medicines; and
(b) review the prices of medicines.

(4) A medicine on the Ghana Medical Trust Fund Medicines List shall be referred to by the generic name of the medicine unless it is necessary to use the brand name of the medicine.

(5) The Fund may, in exceptional circumstances determined by the Board of Trustees, approve for use and payment, new technologies and medicines which may not be on the Ghana Medical Trust Fund Medicines List but have been cleared and recommended by the Technical Oversight Committee established under paragraph (c) of subsection (3) of section 11.


32. Service list and service tariff

(1) The Fund shall, in consultation with service providers in the public and private sectors, develop a Ghana Medical Trust Fund Service List and Service Tariff.

(2) The Fund shall, each year, review the Ghana Medical Trust Fund Service List and Service Tariff developed under subsection (1).

(3) The Fund may, in the review of the service list and service tariffs,

(a) remove, add, classify or group services; and
(b) review service tariffs.

(4) The Fund may, in exceptional circumstances determined by the Board of Trustees, approve for use and payment new technologies which may not be on the Ghana Medical Trust Fund Service List but have been cleared and recommended by the Technical Oversight Committee established under paragraph (c) of subsection (3) of section 11.


Claims Payable to Service Providers

33. Submission of claims by enlisted service provider

(1) An enlisted service provider of the Fund shall submit a claim for payment to the Fund.

(2) The procedure for submission of a claim under subsection (1) shall be determined by the Board of Trustees.


34. Vetting of claim by Fund

(1) The Fund shall, within one month after the receipt of a claim, vet the claim.

(2) The Fund may

(a) reject a claim with a material error; and
(b) communicate in writing to the enlisted service provider, the reason for the rejection.

(3) The Fund shall reject a claim in whole or in part where

(a) the claim is fraudulent, incorrect, or incomplete; or
(b) the claimant fails to comply with this Act or Regulations made under this Act without just cause.

(4) An enlisted service provider whose claim is rejected may re-submit the claim after rectifying the error identified in the claim.


35. Payments to enlisted service provider

(1) A payment to an enlisted service provider shall be made within one month after the vetting of a claim submitted by the enlisted service provider.

(2) The Board of Trustees may determine further matters relating to payments to enlisted service providers.

(3) The Fund shall not pay less than the face value of a claim submitted to the Fund by an enlisted service provider where six months have lapsed since the receipt of the claim by the Fund.


36. Payment mechanisms for enlisted service providers

The following payment mechanisms may be used to pay for services rendered to beneficiaries of the Fund by an enlisted service provider:

(a) fee-for-service;
(b) diagnosis-related groups;
(c) capitation; and
(d) any other payment mechanism determined by the Board of Trustees.


Third-Party Administrators

37. Appointment of third-party administrators

(1) The Fund may appoint third-party administrators who shall, as directed by the Board of Trustees, perform functions on behalf of the Fund, including

(a) beneficiary on-boarding;
(b) enlistment of service providers;
(c) claims management; and
(d) patient navigation.

(2) For the purpose of subsection (1), a third-party administrator includes the following organisations:

(a) relevant public sector organisations as determined by the Board of Trustees;
(b) private commercial health insurance schemes;
(c) private mutual health insurance schemes;
(d) health maintenance organisations;
(e) disease related civil society organisations;
(f) faith-based civil society organisations; and
(g) other patient navigation organisations.


38. Qualification as third-party administrator

An organisation qualifies to apply for registration as a third-party administrator if the organisation is registered under the Companies Act, 2019 (Act 992) or established by an Act of Parliament.


39. Application for registration as third-party administrator

(1) A person who qualifies to be registered under section 38 may apply to the Board of Trustees for registration as a third-party administrator.

(2) An application under subsection (I) shall be (a) in the prescribed form; and (b) submitted with the following particulars:

(i) a copy of the constitution or regulations governing the operation of the organisation;
(ii) a certificate of registration of the organisation;
(iii) the audited financial accounts of the organisation for the preceding five years;
(iv) the annual reports of the organisation for the preceding five years;
(v) a statement of competency; and
(vi) evidence of the availability of a minimum financial security determined by the Board of Trustees.

(3) The Board of Trustees may require an applicant to provide any other information that the Board of Trustees considers necessary to determine the application.


40. Consideration of application for registration as third-party administrator

The Board of Trustees shall, within one month after the receipt of an application under subsection (2) of section 39,

(a) approve the application and give notice in writing of the approval to the applicant; or
(b) refuse the application and give notice in writing of the refusal to the applicant and state the reasons for the refusal.


41. Suspension and revocation of registration of third-party administrator

(1) The Board of Trustees may suspend or revoke the registration of a third-party administrator.

(2) The Board of Trustees shall suspend the registration of a third-party administrator where

(a) the third-party administrator fails to comply with a provision of this Act, Regulations made under this Act or any other enactment which applies to the third-party administrator; or
(b) an offence in relation to the third-party administrator is being investigated.

(3) The Board of Trustees shall revoke the registration of a third-party administrator where the third-party administrator

(a) loses the qualification on the basis of which the registration was made;
(b) knowingly makes a false declaration in an application for registration;
(c) subcontracts or assigns an obligation under an agreement with the Fund to another person without the prior consent of the Fund; or
(d) becomes bankrupt or insolvent.

(4) The Board of Trustees shall not suspend or revoke the registration of a third-party administrator unless the Board of Trustees has

(a) given the third-party administrator one month's notice of the intention to suspend or revoke;
(b) indicated the reason for the intention to suspend or revoke; and
(c) provided the third-party administrator an opportunity to make representation to the Fund.


Redress Mechanism

42. Appeal

(1) A service provider or a third-party administrator

(a) who is denied enlistment,
(b) whose enlistment is suspended or revoked, or
(c) whose claim has been rejected or modified by the Fund

may, within sixty days after the date of receipt of notification of the refusal, suspension, revocation, rejection or modification appeal to the Minister.

(2) The Minister shall, within thirty days after the receipt of the appeal under subsection (1), take a decision on the appeal and communicate the decision to the appellant.


43. Redress in court

A person who is dissatisfied with the decision of the Minister may, within thirty days after the receipt of the decision, seek redress in court.


Miscellaneous Provisions

44. Data privacy and security

(1) The Fund, a service provider, a third-party administrator appointed by the Fund and any other person authorised by the Fund shall keep data collected on beneficiaries from unauthorised access in accordance with the Data Protection Act, 2012 (Act 843).

(2) The Minister shall issue guidelines for the security and privacy of data on beneficiaries of the Fund and third-party administrators.


45. Regulations

The Minister shall, within twelve months of the coming into force of this Act, by legislative instrument, make Regulations to provide

(a) for the procedure for submission of a claim under this Act;
(b) for further matters relating to payments to enlisted medical practitioners and service providers;
(c) for the forms to be used under this Act;
(d) for the classification of chronic diseases for the purposes of this Act;
(e) for the medium of public information in relation to section 27 of this Act; and
(f) generally, for the effective and efficient implementation of this Act.


46. Interpretation

In this Act, unless the context otherwise requires,

"Administrator" means the person appointed under section 15;
"beneficiary on-boarding" means the conditions and process by which a patient is approved as a beneficiary of the Fund;
"Board of Trustees" means the governing body of the Fund established under section 6;
"capitation" means a payment method where a service provider is paid a fixed amount in advance to provide a defined package of services for each enrolled individual for a fixed period of time;
"chronic disease" means a condition that lasts for one year or more and requires ongoing medical attention or limits activities of daily living and are the result of a combination of genetic, physiological, environmental and behavioural factors including cardiovascular diseases such as heart attacks and stroke, cancers, chronic respiratory diseases such as chronic obstructive pulmonary disease and asthma, autoimmune diseases and diabetes;
"diagnosis-related groups" mean a payment method for hospitals where a hospital is paid a fixed amount per admission or discharge, depending on patient and clinical characteristics including diagnosis and other factors;
"fee-for-service" means a payment method where a service provider is paid for each individual service delivered, with a fee or tariff fixed in advance for each service or bundle of services;
"Fund" means the Ghana Medical Trust Fund established under section 1;
"Health Facilities Regulatory Agency" means the Health Facilities Regulatory Agency established under the Health Institutions and Facilities Act, 2011 (Act 829);
"Minister" means the Minister responsible for Health;
"medical practitioner" means a person registered to practise medicine under the Health Professions Regulatory Bodies Act, 2013 (Act 857);
"National Health Insurance Fund" means the National Health Insurance Fund established under the National Health Insurance Act, 2012 (Act 852);
"National Health Insurance Scheme" means the National Health Insurance Scheme established under the National Health Insurance Act, 2012 (Act 852);
"non-material defect" means an omission to submit a required attachment which does not involve the alteration of information in the application already submitted;
"patient navigation" means the process by which a beneficiary of the Fund is guided to access specialist procedures and care with the assistance of a trained support staff or an expert organisation;
"Pharmacy Council" means the Pharmacy Council established under the Health Professions Regulatory Bodies Act, 2013 (Act 857);
"service provider" means an entity enlisted as a service provider under section 29; and
"third-party administrator" means an organisation or an agency that has been contracted by the Fund to provide operational services such as claims vetting and processing, patient navigation, benefits management and monitoring, and evaluation of services.


47. Consequential amendment

The enactment specified in the second column of the Schedule is amended to the extent specified in the third column of the Schedule.


SCHEDULE

Consequential Amendment
(Section 47)
NO. ENACTMENT EXTENT TO WHICH AMENDED
1. National Health Insurance Act, 2012 (Act 852) The National Health Insurance Act, 2012 (Act 852) is amended in section 42 by the insertion after subsection (1) of
"(1A) Despite subsection (1), the Authority shall allocate twenty percent of moneys allocated to the Fund to the Ghana Medical Trust Fund established under section 1 of the Ghana Medical Trust Fund Act, 2025 (Act............).".
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