Health insurance woes

| 05/03/2016 | 36 Comments

Cayman News ServiceCandace Ebanks writes: I am absolutely disgusted with the Needs Assessment Unit. I tried to assisted a dear friend whom I have known almost all my life, a borne Caymanian, who under better times and conditions applied to CINICO and was needs tested and could pay a small amount towards a premium for CINICO. At that time he was deemed “indigent”, or the small income he made from his small business was still falling into the realm of poverty.

Then he had a heart attack in 2011 and his CINICO policy had lapsed because he could not make his payments. He had to be flown off island and received at a cath lab at Jackson Memorial in Miami, 2 stints that saved his life. As with any major health event, its aftercare, including medication and monitoring, [is critical] as it is statistically proven one’s chances of having another heart attack are higher.

I helped him to go back to Social Services and in fact, we first went directly to CINICO to see if his policy could be reinstated. But, of course, with a preexisting condition now and not being able to return to his business, CINICO’s premium, that took almost 8 months to get a response, was over $900 per month. An impossibility for him and even myself. I could not commit to that type of payment as my own monthly expenses, mortgage, utilities, car, insurance, etc. were barely being met on my end.

A very kind woman at CINICO suggested that we go to Needs Assessment Unit and see if he could be accepted as an indigent, just so that he could (a) obtain his medication and (b) have some form of monitoring by a physician. This is where the journey began! Information was collected and we were told that for an emergency, applications could be processed as quickly as one week. Over eight months later, after chasing and chasing a series of officers to check on the status of the application, on 2 occasions the paperwork was lost, the medication ran out and a social worker deemed it okay for him to wait until the following week to see if they could work something out to try to get his medication refilled.

I think it was at that point that I realized it is inevitable that someone will have to die before there is any attention placed on the value of a human life. Whilst I appreciate the constant understaffing, a social worker is not a doctor and they have no right to deny or not use their utmost skills to make sure something as simple as medication that some people are on for life or for very specific reasons be passed up.

We do what we can these days, and there are some doctors that are truly decent and have helped out. The Needs Assessment Unit needs so much help themselves it’s not funny. One day, when another application is slagged off for 8-10 months and they can’t even be bothered to say, ‘I haven’t forgotten you’, there will continue to be tragedies that were completely avoidable if someone would start taking some responsibility and fight and keep pushing and pushing with the ministry. When dealing with peoples lives, you just have to care and be willing to do whatever you can to cause people to be aware and take heed — this is a matter of life and death for people.

My last suggestion [concerns an issue] that in my opinion undoubtedly has a heavy drain on our limited resources in this country: at the point of entry, what does the health questionnaire look out for? Keeping well within our policy of importing poverty, we can also be importing disease and extended health care costs and commitments we just can’t afford.

What are we still testing for? AIDS, tuberculosis? We might want to review that list because if I have a helper or a nanny that has diabetes, the basic insurance many such workers have quite often does not cover all their medication. So, a work permit grant for someone who comes into the country and cannot prove to be financially responsible for their current disease,is going to end up in some way, shape or form costing this country to maintain their health. Why are work permit grants issued to 70 year old security guards?

I don’t mean to sound heartless, but we live in a small country with very limited resources and if we are turning away our own people because we have to take care of the poor and indigent from another country, it’s wrong, wrong, wrong. Charity begins at home. I wish I didn’t have to feel this way, but if people can’t hear, they will have to feel. I just hope it’s not your friend, mom, dad or family.

A dear friend of mine who became a social worker later in life in the US had a directive that came down from the then Bush administration because the welfare system was out of control. In the state where she worked, the numbers of disability applications that were pouring through the system was not sustainable. So they started a programme to revisit every application to determine how disabled a person was. In some cases it was determined that yes, someone was really and truly unable to work due to a physical or mental disability.

However, for some people they found they could contribute even 10 hours of work a week. The jobs were creative: some worked in a post office and could sort mail, some persons could greet people at a veteran’s centre, one lady could be a crossing guard at the schools, working for 2 hours a day. The point is, assess the real needs, find out what can be done, at least know where your money is going, live up to your name and responsibility.

The comment was posted in response to Long road to welfare reform.

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Category: Health, Medical, Viewpoint

Comments (36)

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  1. MM says:

    Our NAU has hundreds of “PR” holders receiving benefits which is an additional strain, and yet, the Immigration Law clearly states that PR can be revoked if the individual it is awarded to is found to no longer be able to maintain their same living state as when first awarded.

    So why is it that benefits continue to be rolled out? The excuse is that these people were married to Caymanians or have Caymanian children – it is only so long this island can continue to fork our KYD$50 million a year!

  2. lo-cal says:

    Lets think about this for a while.

    I do not mean to defend NAU but if he is operating a small business is he not supposed to be self insured? If he has employees are they not also ensured then? As it its with most cases here people will always bash GOV for anything. A lot of the people are accustomed to just walking in a demanding service and receiving it and now that NAU is doing a means test and the freeloaders are exposed it now a problem.

    I always thought that this Island should start keeping records by rolling out social security cards program to each citizen/worker. This card will have the citizen/ workers status on the islands, employment location, insurance status, Pension Status and salary. This will go a long way to assist NAU in identifying the indigents of the country and will help immigration to enforce the law where each business is not in compliance.

  3. Anonymous says:

    I don’t believe that there is a 70 year old security guard with a work permit in Cayman. I suppose it is easier to make up a fact to get people excited, rather than deal with the sole fact of this piece – that you can’t get the file reviewed in a timely fashion from this government owned insurance agency….

  4. Anonymous says:

    The crux of your problem is that you can’t get a timely response from CINICO. A related issue is that poor Caymanians can’t get adequate health coverage. Yet, somehow your article turned into issues with work permits?!? Then you choose to add some racist remarks about workers from the Philippines?!? If Cayman ever has any hope of dealing with social and economic issues, pointing at work permit holders needs to stop. Work permit fees are a major contributor to the economy. Without the fees, Cayman would be broke. The fact that non-Caymanians are willing to work for $6 an hour, has nothing to do with the fact you can’t get CINICO to return your call.

  5. Donnie's E Child says:

    Attempts were made to address this situation of staffing at the NAU however the same person talking about reform is the same individual who is obstructing them being hired and is the same source for a number of problems in that ministry and the Deputy Governor needs to explain to the public why he keeps covering for them! Need I say more

  6. Anonymous says:

    Despite the complete lack of efficient cross departments team work that has been demonstrated here, perhaps CINICO would be in a better position if:

    a). Civil Servants would be asked to pay a contribution towards the health insurance for their family members,

    b). CINICO would start referring to Shetty where possible rather than paying for airline tickets, hotels and car allowance for every small medical procedure in Miami, which many confuse with a Cayman Government paid for shopping trip!

    • Anonymous says:

      a) makes sense but I feel if they are going to have them pay towards their health insurance they should not be limited to HSA. They should be able to use it elsewhere as accepted.

      • Anonymous says:

        That’s a choice you make when you choose an employer. Eg in the private sector I won’t know which insurance company or the extend and cost of the plan until I’m hired. Sometimes I ask in advance but generally you don’t know the terms until you’re hired and signing all the documents.

        Coverage can vary from absolute bare minimum with basic coverage as per law to amazing.

        If individuals feel so strongly about the dislike for the insurance provided by govt, then find another job or pay for private insurance separately. Govt workers are lucky. They have insurance for life. This is another advantage. Private sector workers, once no longer employed, have no insurance coverage.

        Stop complaining and weigh your options.

    • Anonymous says:

      But it does not matter who pays CINICO, the Gov or the employee the amount CINICO get will be the same…..

    • Anonymous says:

      Just build a Target or Walmart beside Shetty and problem solved.

  7. Anonymous says:

    you are so correct on the ‘bigger picture’ here. our first line of defence is immigration. no person with a major medical issue entering the island for the first time should be granted a permit. we are too small and in 10 more years, health insurance will not be affordable….we just don’t have the number of people to off set the cost. for those suggesting tax, we are taxed, just not directly. it seems like our gov’t is trying to get each dept sorted, maybe they just have not got to social services or cinico as yet!!

  8. Colonial Reciprocity says:

    The UK and FCO are well aware of the problem but because the problem is someone’s pet who is loyal to them,they will do very little or nothing and will even deliberately ignore what is happening and on greater scale this gov’t who will ascend to everything they are asked to do by the UK in return they are granted free reign to do as they would like.

  9. Anonymous says:

    Go to CINICO and ask for funds to get breast augmentation and you will be approved, go to CINICO and ask for help with a life threatening illness and you are denied. XXXXXXX And yes, there has been breast augmentations approved and paid for by CINICO, but we will probably never know how many nor potentially know the real cost.

  10. Anonymous says:

    The inefficiency and heartlessness of the offices in your friends case sound awful. Almost as bad as when I was rolled over despite being legally eligible to stay. You have my sympathy.

  11. Sharkey says:

    I think that the insurance law needs to be changed to not be able to refuse to insure people with existing conditions, or drop people insurance after they have been diagnosed .
    Insurance company should not be allowed to only insure healthy people, and the government needs to make sure that the safety nets that are for the people, are working for the people and not how it was working for Watson an whomever.

    And I am Caymanian.
    Miss Candice you need to take Anonymous 6:13 am advice in the comment , and don’t get discuraged by the inhumane comments on this subject.

    • Anonymous says:

      Hey Sharkey you got to hear this one. Some years ago when I worked for a government company I asked if they would pay $200 per month to upgrade me on my wife’s private plan (this upgrade was better than what CINICO offered). If they said yes they would have saved over $7,000 per year on insurance coverage for me and the wife.

      But common sense did not prevail and the company forced me into taking CINICO. Even when you try to save Government money they don’t want to hear it!!!!!

      Whiskey Tango Foxtrot

  12. Anonymous says:

    Perhaps you are willing to pay a large amount of your earnings as income tax to fund health care for such people?

    • Anonymous says:

      Please please please I beg for income tax and to get rid of the duty system! I am Caymanian well in favour of an income tax system. Its just a fairer system…it would also ensure that people who work in the country contribute to the country. As it stands, a person who lives in Cayman for 30 years (read a Caymanian) pays more over their lifetime then a person who comes here at 25 years old and get PR at 35 years old. 10 years of contributions instead of 30.

      This system is fairer. And, too taxation and PR fees could be adjusted to what you are expected to have contributed to put you on the footing of a Caymanian (in your income position) not some arbitrary amount based off purchasing a house and putting cash in the bank..

      Thats real…also Duty system slows commerce and only the big players can clear their goods quickly (unfair). Say goodbye to duty say goodbye customs long lines say hello The cost of living goes down and the oligarchy starts to crumble or as Dart put it Crymble ! fitting name

  13. Anonymous says:

    You are Caymankind at its best.
    Self centered and no idea of the world past West Bay.

    • Anonymous says:

      You are challenged when it comes to vocabulary. Always the same crappy comment about Caymankind. The writer was simply stating the facts. If you have a problem with a belonger asking that the systems look after our own first then perhaps you should’nt be on here. Are you one of the spongers too?

      • Anonymous says:

        Nice descent into “flights leaving daily” when addressing the problems of everyday racism.

    • Anonymous says:

      This government , any government can fix this problem by implementing income tax which should have been put in place many many years ago. If it had been done we would now have the ability to provide free medical. When Cinico was set up the plan was that it ,would morph into the national insurance company and every person working on the island would have to join. I can only imagine the fall out from the other insurance companies but they would just have to get use to it. If anyone chose they could go ahead and take out their own supplemental private insurance but Cinico should have been mandatory.

    • Anonymous says:


      • Anonymous says:

        What was Anthony Eden paid for??? He was in charge of the Health Insurance of the cayman islands, but still people with pre existing conditions cannot get coverage. So they will become a burdon to the cayman islands government. Work permit holders who come with hypertension diabites, to name a few won’t be covered and then just racks up the medical bills at the hospital. Come on something like this should be addressed for people with pre existing conditions. Hey always comparing the US does it this way, the US does it that way, well the US covers pre existing conditions.

        • Anonymous says:

          Come to think of it I dunno what purpose Mr. Eden served a part from wanting to abolishing gays.

  14. a concern Caymanian says:

    You are soooo right. The insurance companies are a legal way to steal your money. The Government need to place a tax, and it does not have to be that much maybe like the tax man suggest on payroll, and remove the manditory insurance on the Caymanian people. Anyone who chooses to not have insurance (Caymanian) can only go to the Health Services Authority and if they wish to go to other Health Care Providers then they will have to stand the cost of that by either insurance or out of pocket.
    They are many people who are not making the money to pay health insurance and make ends meet. Those persons still end up at the steps of Government either for medical assitance or financial assistance or both.
    When is the governments going to take its people as its people and stop strangling them to death. There has not been another Politian since the deatth of the Hon. James Manoah Bodden that had its Caymanian people to think about. He had his faults as he was also human but he ensured that Caymanians were given the chance to be someone in their land.
    I trust that others will have the testicular fortude to stand up and voice their concerns.
    I respect very highly the Hon. Anthony Eden for standing tall in LA on the Bible princiiples also Al Sukoo. It seem that those two have the Caymanian people at heart.

    Stand up my Cayman people. Bahamian people did it in the 80’s
    A concern and proud Caymanian

  15. Anonymous says:

    This is what you get for employing so many Caymanians in the Civil Service, some work hard for their money, many treat their job as an entitlement and expect to be paid just for showing up at the office.

  16. Anonymous says:

    Hi Ms Ebanks thanks a lot u have hit the nail on the head yes it is a crying shame to see how our people in this country that is really in need and need the help and cannot get it. That NAU Department have to close down they are not here to help the people of these three islands they prefer to help the expats first they are just like NWDA.

    They are the so call Social Workers that should be working for Caymanians they are just like the staff from DCFS that should be protecting our children from harm but it looks as if they want to take people children and give them to those people that have/had all kind of serious convictions do not work but lives off of NAU.

    • Anonymous says:

      Hey bobo, you is right about the NAU. Seems like if you is a Jamaican, Honduranian, or Filipino you can get help from NAU. Wonder how many of the staff at NAU is Caymanian?
      Would not surprise me if they had more expats working there than our own people.

      NAU does not stand for Needs Assessment Unit. It is Not Anything for Unna.

  17. Anonymous says:

    If you have a pre-existing condition, cancer, heart, hypertension, to name a few, is not covered here. If you have any of the stated, if you don’t have the money, the end result is you will die!!! If for some reason you lapsed and want to be reinstated or obtain new insurance YOU WILL NOT BE COVERED FOR YOUR PRE EXISTING CONDITION

    • Anonymous says:

      8:49, would you buy a car knowing that it was going to break down and cost you a lot and then maybe stop working altogether? That is what health insurance is all about. You wouldn’t buy that car I described and insurance companies will not insure someone they know will cost them money and then die. The only decent health care system is a national health one funded by EVERYONE paying into it but in Cayman we are so obsessed with pandering to the private sector (in this case, insurance firms) we will never get there.Same as America.

  18. Anonymous says:

    Miss Candace, the overall government bureaucracy is to blame. In your friends case you have to deal with a least three separate departments – Needs Assessment Unit (which does the financial part) DCFS (which reviews NAU’s information) and CINICO. You also have to deal with two separate Ministries.

    The Politician’s, Cabinet, Chief Officers and Directors are all to blame for the bureaucracy experienced by your friend.

    The Deputy Governor is always looking for an opportunity to get himself in the news – well Mr. Franz as the #1 Civil Servant this is your chance to organize and fix the whole entire mess. The DG is in an excellent position to facilitate immediate change as he is in Cabinet and in charge of the Civil Service – and it is easy for the public to see that he is FAILING.

    Cabinet is empowered by the PMFL to direct funds, basically at their discretion and can use the language contained within the law to make said funds available to whatever they deem fit.

    In a previous article it was mentioned that NAU had 24 staff to deal with approximately 10% of the ENTIRE GOVERNMENT BUDGET!!!!!

    So, Chief Officer Dorine Whitaker, NAU Director Tamara Hurlston and Minister Osbourne Bodden need to immediately do something about NAU. It is really the Hon. Minister who has the ultimate power to bring this issue to Cabinet. Cabinet then behind closed doors can then direct that funds be appropriated for NAU.

    Here is some food for thought about NAU:

    1. Immediately hire SUFFICIENT staff to deal with workload volume. Why don’t you just get NAU the full complement of staff – if problems persists after that then you need to look at the NAU leadership and their policies and procedures.

    2. Reconsider your Assessment/Reassessment policy of some persons having to provide documentation and receipts every 3 months. Last year the policy was 6 months for people like me, so why did I have to come every three months now???

    3. Dedicate SUFFICIENT solely to CINICO applications and nothing else.

    4. Allocate funds to pay overtime to current staff (it appears that every time NAU staff receive the DG Award for Employee of the Month it is because they worked plenty of extra hours). But I really wonder if staff is getting overtime – and if they are getting COMP TIME that means they are not in office – which doesn’t make sense if NAU is already understaffed.

    5. Have CNS do a Freedom of Information (FOI) Request, asking about NAU job descriptions, work hours, actual Time Reporting (TRS). Find out NAU processing policies (i.e following the paper trail from the time people like me come into the office, where the application goes, criteria used for review, how I get an answer and how my benefits are determined).

    Miss Candace, in your friends situation your best bet is to give Minister Bodden and the Deputy Governor a chance to get this thing sorted out. If that fails the appeal directly to the Governor’s Office and write a letter to the FCO. Miss Candace take the contents of this blog to those in power – they all know that way I have said makes sense.

    NAU doesn’t need some sort of outside expert to come in and tell them what to do – they need the leadership, staff and incentives to make decisions that are based upon common sense and internationally accepted accounting standards.

    Underemployed Caymanian struggling to get by.

  19. Big Bird says:

    That is because those who are now preaching reform are only interested in promoting their own family and making sure their salaries and benefits are secure. No time for those who are in genuine need because they are too busy hiring consultants. Question you have to ask is how long has this person been at helm. This PPM minister is totally useless.

    • Anonymous says:

      Big Bird you are right.

      The time that the Minister, Chief Officer and NAU Director spend fumbling around with so-called consultants is just a waste. It really shows how inept and incompetent that our politicians and senior civil servants are in what should be a matter of following standard operating procedures.

      While these big shot officials are stumbling, bumbling and fumbling, the little guy like me has to wait 5 weeks for an answer on whether I am going to be approved for the “pa pa list” just to get a few groceries.

      I didn’t want to come to NAU, but in my field (construction) Caymanians like me cannot work for $6 an hour like all the Filipino’s and expect to pay rent, light, water, gas, food, insurance – not even mentioning that I don’t have cable, internet, AC and don’t drink alcohol, use drugs or smoke cigarettes. And to all the bloggers, I work 10 hours per day 6 days per week and still find it hard to meet the basics to support my household.

      It may be just a hunch, but I believe one of the main problems is the leadership at the Ministry and at NAU. Last year when I first went for assistance, one lady at NAU had just started as an assessing officer?, now I hear that she has skipped from being a supervisor to the manager at NAU – in a few short months – kind of fast-tracked if you ask me.


      Each time I go to the NAU office I see a new face at the front counter and it is a different assessing person asking me for every document and receipt. So makes one also wonder if there is a high turnover in staff at NAU.

      The whole process just seems like it is so subjective and disorganized. But who am I to say, I am just a Caymanian construction labourer. I am thankful for the help,

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