Health insurers face reform

| 28/03/2010

(CNS): Cayman’s health insurers will soon be required to offer their customers more comprehensive coverage and they will not be able to pick and choose who they insure and who they drop. The Minister of Health has said that the government is currently reviewing the health insurance law and in particular the level and quality of coverage offered under the basic plans through employer’s health insurances schemes. Mark Scotland told the Legislative Assembly that the health care providers need to offer more transparent, fairer, coverage and that government was no longer going to pickup the slack for every insurer who refused to cover clients or to pay claims.

The minister was speaking during a private members motion debate when the MLA for North Side, Ezzard Miller requested a review of the law as he said he had received significant representation from his constituents with numerous complaints about health insures. He said people complained that they refusing to pay up, offered severely limited cover, dropped people when they moved from employer to employer o n the basis of pre existing conditions, as well as the inadequate coverage being given for what was still a significant premium even with basic coverage.  Miller explained that because some insurance firms are not paying the doctors or the hospitals, the health care providers were now making patients pay before they would treat them, forcing them to make claims after the event.

“The health insurance industry is not providing the healthcare providers with guaranteed and prompt payments for services rendered to their clients leading to the unfortunate situation where persons who have already paid high premiums for health insurance coverage are forced to pay the healthcare provider ‘up front’ and attempt to reclaim the expense from their providers,” Miller stated in the House as he called on the minster to establish a select committee to review the legislation.

In his response the minister revealed that the review of the law was already well underway. Scotland explained that government had come up with a proposed new basic package which significantly increased coverage on everything from routine doctor’s visits to hospital stay costs as well as dental and maternity cover and was now in the process of negotiating a set premium with the insurance companies. He said the aim was to have a flat premium rate for the basic health package for everyone which would be the same no matter which company an employer would choose to use as cover.

Scotland said the goal was to provide accessible, transparent health care policies for everyone in the Cayman Islands and to reduce the numbers which the private sector was dumping on government throughtheir refusal to cover the people they defined as higher risk.

“Government is currently playing a huge role in filling the gap of those who are under or uninsured,” he said, adding that the system was not working. He said the new legislation would not allow health insurers to drop people based on existing conditions or pick and chose who they insure when taking on employer’ coverage.

He also said that the health insurance commission would be given the power to prevent a health insurer’s license from being renewed if they were dropping clients or excluding high risk individuals, not paying health care providers are attempting to offer in adequate cover.

Scotland said the government wanted to get more people properly covered at an affordable transparent rate and to reduce the growing number of people the health companies wouldn’t cover forcing CINICO to take all the risks or the government to pay the hospital.

The ministry, Scotland said, was working on ensuring that all of the problems with the current system were addressed and as a result discussions were ongoing with all of the stakeholders including those buying the policies, the healthcare providers and the insurance companies and he hoped to have a bill to amend the existing law before the Legislative Assembly in June or July.

Closing his debate Miller warned the minister that trying to enlist the support and co-operation of the health insurers would be difficult and told him not to allow the health companies to negotiate the minimum premiums for the basic health plans or CHIC 1 but to enlist the services of independent actuaries and have them calculate what premiums needed to be paid to provide the new improved schedule of cover.

 

Category: Business

Comments (34)

Trackback URL | Comments RSS Feed

  1. Anonymous says:

    Government cannot force non-commercial enterprise onto the commercial world.   Where there is no underwriting, there is no transfer of risk and therefore ultimately no insurance industry in Cayman.  Lets hope CINICO can manage the extra people.  This proposal can only either increase premiums and/or the amount of uninsured people in Cayman.  Government can cost shift towards the insurance industry or the private person, but until Cayman comes to terms with the fact that healthcare costs paid to facilities and private doctors are amongst the highest in the world it will make little difference.

  2. Anonymous says:

    I pay  a lot for health insurance and have never claimed. My premiums are steep because the insurance company already factor in not only  just their profits but also everybody elses claims.

    If the insurance companies are now forced to take on the sick and lazy, then they are obviously going to have to pass the extra cost on to all the other customers by raising everybody’s premiums.

    At least currently, those people that are lazy and obese and don’t look after themselves, only burden me with having to pay for their cinico healthcare which is basic, obviously I pay this through my taxes, err fees.

    If these people are now getting full coverage then my premium will sky rocket as I will be paying for them to have the private rooms etc.

    If the taxpayers are going to be paying out more for these people I think it is fair that we should set down some rules that include limiting the intake of fast food for the obese, compulsory exercise regimes etc.

    Everybody likes fast food and would smoke if they could, but most people don’t, or at least only in moderation, because they try and keep themselves healthy. The idle, lazy and greedy people only eat fast food and stuff their kids with fast food. It is these unhealthy people that increase the burden on  the healthcare providers.

    Civil servants etc on free healthcare should have to pay a deductible and half of the premium like everybody else. Becuase they don’t have to pay a thing they abuse the system and go to the doctor for many minor ailments that a private sector worker would not waste their own money on seeing  adoctor for. The doctors also like to keep the regulars sweet so have no problem signing off on their sick forms to keep the civil servants off work longer.

  3. B says:

    I am happy they are finally working on this issue, which has been a pain for me. I am 23 years old, yes on the big side medically obese(once your 20% over your medical weight) but to us Caymanians I’m solid or thick. 🙂  I had to get insurance from Cinico even though I work in an insurance company that provides medical to many people. I was told by the medical team I work with I may get through but they would most likely exclude certain things that relate with being overweight like diabetes, high blood pressure, etc. did a medical was shown to be in good health and still got decline. It is terrible and dishearting and I am working on my weight for myself and to get good insurance, but it pisses me off to know I have to pay medical insurance that I still have to pay for outpatient vists and will only get a cetain amount paid for by Cinico for inpatient services the rest again from my pocket. I hardly go to the doctor maybe 2 to 3 times a year, oh I fail to mention it doesn’t even cover dental and vision, I have to also pay for that out of pocket too. They certainly need to fix that law I’m paying insurance and still have to pay to see a doctor. Mark do what you have to do and insure that this is fix, I do want and need good insurance, if not I would like my money and actually pay when I need to go to the doctor.

    • Anonymous says:

      My dear B at 15;11:

      Would you invest a lot of money in a car with faulty brakes, tyres, ignition, chassis and general bodywork? No, I thought not.Neither would a sensible insurer. Good luck with the weight loss.

  4. Anonymous turtle meat says:

    I NOTICE THAT THE MINISTER GETTING PRAISE FOR THIS.   this is not his thinking this come about because the mother com panies has to do it now in the usa. i rather to give the credit to obama and his gov

    • NorthSideSue says:

      I agree.  The timing suggests a tie to the recently signed helath care legislation in the US.

  5. Anonymous says:

    The annual cap (that they do not propose to increase) requires increasing.  This doesn’t even come close to the costs necessary for someone who discovers they have cancer and require extensive Chemo and Radiotherapy.  I know many such situations here in Cayman.  These people need immediate care, they cannot simply wait until the next year if they have already reached or exceeded the ‘cap’ and most cannot afford to pay for themselves, thus they go cap in hand to government for assistance.

    A regulatory body should be established that cannot rule the insurers, but can ensure that their demands are reasonable.  Right now if you ever had a scratch on your back you’d be lucky to get any part of your back insured.  Where you have had a condition that has existed trouble-free all your life and has never been excluded by any other insurer, you can guarantee they’ll be looking to exclude it here.

    Furthermore, some medical treatment simply is not readily available here as it is in other countries necessitating a flight out of Cayman and a stay in another country.  Despite disproportionately high premiums compared to the States and elsewhere, people from Cayman have to foot the bill for flights and accommodation too.  Is it their fault the facilities don’t exist here? 

    I support also the idea of a database.  The insurers actually do already have such a database and share their information internationally with other insurers.  Its a pity they can’t give medical authorities access to a restricted area of the database to purely check coverage.  It would be much quicker than waiting while the hospital staff call and call and call the number never to get an answer and therefore you have to pay until such simple procedures are clarified.

  6. Anonymous says:

    The price of doing business in Cayman is about to up A LOT because of this idea, just when our clients are fleeing to other places with the fees already imposed on us.

  7. Anonymous says:

    Mark must definitely heed Ezzard’s advice re. bringing in the independent actuaries. The behaviour of the health insurers as a whole to date has been downright disgraceful.

     

     
  8. A Caymanian says:

    Thank you Jesus!!!!At Last !! At Last!!! There is some one who will take the B******* On!!!! For too Long they have been getting away with doing what they feel like doing!!!!! They cover certain people for the very same things they exclude the other person for!!!

     

    A Fed up Insurer payer!!!!!!!

  9. Cinic Al says:

    Does this mean I don’t have to pay for the Indigents to be covered any more?

  10. Anonymous says:

    I am glad to see that the Gov’t is going to close these loop holes that has allowed the insurance companies to pick choose and refuse. Being able to refuse coverage of the "high risk" person (s) has left the Government no choice but to cover all of these people, which is a huge expense. That is why the Civile Servants health insurance premiums are so high. To help CINICO offset the cost of having to cover these people. 

    The sad thing is that the average person believes that the Civil Servants have a platinum health insurance package, they don’t. Ask any Civil Servant if given the choice to obtain health insurance from a provider of thier choice, and they would be glad to….but they won’t be given that choice. Why?……because the forty odd million paid to CINICO by the various Ministries and Portfolios, for Civil Servants health ins. premiums, has to offset the high cost of the uninsurable. and not to mention, if given the opportunity to obtain private insurance, Civil Servants would not go to the HSA for health care.    

  11. Anonymous says:

    Good move Mark and Ezzard, Good Move !!!! Now let’s get some action going on these issue’s and not just words.

  12. Anonymous says:

    In the past three years I have paid $7,500 in health insurance premiums.  I have made no claims.  What worries me that when I reach age 60, they will no longer cover me because I am too big a risk to them and I know that it is their policy to drop you at age 60 unless you pass a a medical indicating that you are healthy.  But the minute you become unhealthy, you can bet that’s your last year of insurance.

    I would much rather have paid the $7,500 and all my future premiums to the hospital of my choice, whether that would be the George Town hospital, or the Chrissie Tomlinson hospital as the two hospitals in Cayman, in return for medical coverage for the rest of my life.  This of course would only entitle me to medical care on island and I am quite happy with that. At least the hospital would benefit more rather than the insurance companies, whose sole aim is to make profit for their shareholders.  The hospitals could then budget better and have more money at their disposal to improve and offer more and better services.

    I think that government should make it clear that the hospital only provides health care locally and those who wish health care above and beyond that, need to acquire medical insurance for that, as the government will no longer be covering that.

    I would then only need to have to buy supplemental medical insurance to cover the risks of major medical expenses that might only be available overseas and the premium for those are very cheap in comparison.

    I think it is a disgrace how people abuse the medical system here and get doctors to refer them overseas, which government then has to pay for. I think it is a disgrace to pay so much in premiums for basic health care and get so little in return and then know that when you get old and really need health insurance, you won’t have it.

    I wonder how many others would agree with me about paying our premiums to one of the two hospitals in return for life time treatment.

    • Anonymous says:

      I also paid $7,500, but mine was that amount per annum. I practice preventative medicine and save and except for my annual medical, I made no claim on my health insurance. I placed a small claim of less than $500. which included the cost of a mammogram, which the insurance company refused to pay, informing me they do not cover such things. I decided to check other companies, they were no better and I was also informed that they would not accept me as a customer because I was over the age of 55. There needs to be a change in the Law. If the change results in some companies not doing business, I say good riddance to bad rubbish. I am greatful for CINICO and I am willing to pay their premium even if it means that my premium is helping some other less fortunate person. At least it is not lining the pockets of the owners/shareholders of the insurance companies. I wish those con-artist would all disappear. CINICO should be available to everyone whowishes to insure with it.

      • Unvcivil Servant says:

        I am a Civil Servant and over the past 12 months I paid nothing for the Insurance cover which I did not use.

  13. Anonymous says:

    I am glad Mr Miller that you have initiated the debate with the Minister.

    The facts mentioned inyour presentation are true.To long , we have allowed the Insurance Companies to push their clients and thedoctors around. I am sure the HSA isalso getting short changed in this whole exercise.

    The sphysicians are frustrated as they are made to precertify for procedures above a certain dollar amount. However thir is no guarantee of payment for services even after precertification.

    And the horror stories go on !

    Mr Scxotland, you have a heavy responsibility to sort this mess out and for heavens sake please donot  allow the insurance companies to set the rules etc.

  14. Anonymous says:

    Good Job Minister Scotland , after a fight President Obama did it – so I do not see why we can’t do it here in the Cayman Islands.

    Your Govt. has so many disfunctional laws to tackle, it seems like the past administration done nothing but spend, spend and waste precious resources which we wish we had today to employ caymanians and stimulate our economy.

    Keep up your determination and hard work.

  15. Anonymous says:

    Good work Minister Scotland, President Obama just done it I don’t see why we can’t do it here in the Cayman Islands.

    Keep up the good work – your Government has so many disfunctional laws to redo it seems like the past administration did not do anything but to waste money. 

  16. Anonymous says:

    It is about time that this is sorted out, as this is why the debt of CINICO is so high which in turn is now a large reason for why the costs to the country are so high. No wonder our deficit now exists!

  17. Come on Man! says:

    Of the utmost importance is coverage for seniors.  Coverage & benefits must be for life.  The very time you need coverage is when you are older.  Mark & Ezzard, don’t let that slip thru.

  18. slowpoke says:

     While I admire the fact that this issue is being addressed at all, the proposed solution is misguided and will prove to be ineffective.  There is no way to legislate or otherwise require private (health insurance) companies to ignore their stakeholders.  Ultimately, they are not responsible to either Government or clients/policy holders but, to their shareholders.

    Don’t believe me?  Look at the recent news where a baby born with a very rare heart disease (d-transposition of the arteries) was denied medical coverage because the insurance company decreed it a “pre-existing” condition.  When did that condition take place exactly, during intercourse, conception or gestation?

    The only way to address this issue effectively is to have a single primary care insurance provider, for all Caymanians and residents.  It does not need to be Government operated, but the “for-profit” aspect has to be removed. 

    Private insurance still has a place, for the perks, private room, travel coverage, dental, eye, etc.

  19. durrrr says:

    how is this going to work? you surely can’t force a private entity to do any business, let alone take on the risk of insuring people?

     

    This needs to be handled very carefully, or we’ll risk having insurance companies pull out of the jurisdiction…

    • Anonymous says:

      Durr: You seem to be the only one who understands the very great dangers in this militant approach. Ezzard cannot get it because he is all about threats and bombast.

    • Anonymous says:

      Where as this sounds great, again it won’t be enforced.  To this date there are still doctors who won’t accept your insurance card no matter who  you are insured with.  The law states that physicians are to accept insurance cards (this isn’t enforced) but yet we are still paying our premiums and paying the doctors and waiting for our payment back from the insurance company. 

  20. Anonymous says:

    It need to scrap the health insurance rules which it stopping people have international health insurance, like BUPA. The bigger insurance company do give better and bigger coverage than cayman health insurance.

    • Anonymous says:

      I had BUPA in addition to my local provider and they also denied treatment for my infant son on his 2nd surgery saying it was a congenital birth defect. Eventually their premiums became unaffordable (US$8,000 p.a. for a small family) and I had to cancel the insurance.    

  21. Happy Island People says:

    Good news, I really enjoyed reading this piece of news.

    I for one has had a battle personally with health insurance providors.

    Suggestion: The grading of persons considered obese should  be revamped.  This is prejudicial and additionally, insurers should be required to incorporate obesity medical treatments such as reduction surgeries, coverage for diet programs, couselling etc. This is beneficial for the caribbean especially as we are known for our high carb & alcohol diets.  Such conditions should never be a reason for refusal, our culture and lifestyle should not be compared to any other area of the world’s, but our own.

    Suggestion: If medical is mandatory, then no one should be refused coverage, glad that they have finally fixed that bug.

    Also, here’s another suggestion free to you my Govt.:

    Put in place a central database system whereby all insurance providors can send in information to daily updating their clients coverage.  This way hospitals, and clinics and private doctors can access to confirm that this individual cover is valid etc.  This way when you go the private hospitals after hours you don’t have to pay the money up front they can find out through an online access etc.  Govt. can charge the insurance companies and the private hospitals and Dr offices a fee each month/year etc. or based on usuage etc.  to keep the program running.  Now you all don’t need to call in an expert to give you advice on this one, I have given you all the free information you need, now get with your Computer Services people and build the database and sell it or pass a policy that it’s mandatory for all medical agencies/offices etc to be apart of this.  Make it happen.

    Thanks for fixing the bug in the law, which could have been fixed from so long ago but don’t know why we allowed it to take so long to begin with, it is not as if we haven’t been screaming our heads off out here the community about it.  Well someone listened.  Thanks Mark. 

     

     

  22. Anonymous says:

    This is long overdue but it is a good move by the present government. I hope they will look into those series of stabbing they’ll see that although they have their insurance providers but the coverage itself only covers about a mince 10% of what was actually needed. People or expats have to resort in asking donations from friends, co-expats, caymanians to cover the 90% still due or needed. Have you heard about the expat that was stab and later sent to Jamaica? I think he needs more than US$30,000 to date and the insurance is not all helping.

    Let’s pray that this new hope for everyone be reviewed and acted upon quickly.

     

     

     

     

  23. Anonymous says:

    Kudo’s to the Cayman government. Take note of how special interest groups in the United States have worked hard to protect the interests of the healthcare industry at the expense of the American people. Our Republican party has honed the skill of getting very suggestible, short-tempered people to vote against their own better interest. Fortunately, the people won this time around.Hopefully they will in Cayman also. 

  24. what a mess says:

    This is very much needed!

    As the current system allows the private insurance companies to discriminate against those persons with pre-existing conditions.

    I sincerely hope that Mr. Scotland and Mr. Miller will also bring about a law that these same insurers cannot discriminate against persons for "Life" insurance because of pre-existing conditions. Currently the insurance companies hand pick only the healthiest and leave all people with pre-existing conditions with no way to get life insurance. Life insurance is "required" by banks for mortgages and business loans etc. This system ensures that someone with a pre-existing condition will have no choice but to rent and not be eligible for said mortgages…and is thus discriminatory.

    The insurance companies have gotten away with such discriminatory, unscrupulous and unethical practices for far too long!

  25. Twyla Vargas says:

    Thank you CNS a very lovely photo of Mr Mark Scotland, that is the Mark I used to remember.

  26. Anonymous says:

    You are all failing to enforce the laws we have now. Get people complying with that first before raising the requirements, otherwise you will just keep hurting honest busineses, and helping those that ignore the law.