Controlling the cost of health insurance

| 05/04/2016 | 22 Comments

Cayman News ServiceGeorge R. Ebanks writes: One of the areas that we face here in the Cayman Islands that is costly and is a real contributing factor in regards to our far too high cost of living is our mandatory health insurance cost. We need to urgently explore some common sense changes and start to think outside the box to find some solutions that, whilst retaining the essential option of having health insurance, the carrying cost to maintain it is not cost prohibitive and in the process would allow many more persons, especially at the lower echelon of society, to be able to access their individual health insurance coverage and afford it and hopefully maintain it for the long term.

It is a vital ingredient to ensure one’s quality and psychological security in life.

I therefore thought that I would toss out a few common sense suggestions, as I personally see them, which if acted upon by the government would result in better access to each and every individual to afford and maintain their National Health Insurance coverage.

One change that could and should be made is for some flexibility in the health insurance company (group) plans. At the moment, we the people are caught between the proverbial rock and a hard place. Our current health insurance regime offers no flexibility to allow each person insured to enjoy a lower premium based on his/her healthy lifestyle or economic well-being.

For example, under our current health insurance apparatus, in the working environment when the employer signs up for a staff health insurance plan, it is given to them as a “group plan”. This means that any and all frivolous medical claims done by your colleagues and co-workers gets pegged to a higher claim rate and within a short while the employer, and by extension each employee, is penalised by having to pay higher and often times what can only be termed exorbitant health insurance premium rates.

What can be done, and it will result in cost savings (both for the company health plan applicant as well as each individual staff member in the insurance plan) is to change the National Health Insurance Law to allow for group plans that allow “mixed members”.

This will then allow individual staff members to choose a health plan with personal deductibles that suit (or fit their budget). It is a fact that where you choose a plan with a low deductable your monthly health insurance premiums will be higher and vice versa. Where a staff member chooses a higher deductible, that should then translate into a lower monthly health insurance premium.

This of course would mean that the company’s monthly statement will reflect different cost charges for each staff member based on whether they chose a low deductible or a high deductible. The company will, of course, also deduct the agreed portion (insurance premium cost split) from each individual staff member and they themselves pay their agreed portion. But at the end of the day, what will result is higher and lower individual premium staff charges, based on their choice of deductible and risk.

The premiums for those who chose the high deductible should far offset the cost of the low deductible staff members and no material cost should result to the company with the group staff plan. One over-riding benefit, besides cost savings, will be the new flexibility offered to all who chose the National Health Insurance Plan for their health coverage.

Our current health insurance premium rates also now are artificially inflated because the premiums automatically factor in what the industry perceive as their inherent risks. This means that to have a female on a group health plan (or should they decide to insure as an individual) it is already perceived that a woman will have a child and even factors in an insurance band risk for childbirth and the risks that may be associated with such an event.

It is modern day now and we should start to appreciate those many women who do not care to have any children but are otherwise healthy. Why should all women be penalised by having their individual health insurance premium rates inflated because someone somewhere has already decided that it is only normal for a woman to have a child or children and attach a risk factor to them?

It goes without saying that if a woman who had chosen initially that she was never going to have a child or children but then decides to do so, the health plan should allow the flexibility that perhaps six months to one year before she starts to plan to become pregnant that she could advise her health insurance provider for a “temporary rider” to be added to her plan for that impending event and any associated premium costs would be then added on to her individual health plan (or coverage) and would result in a possible increase in premium cost.

I am of the firm position that a greater use should be made of the government-owned Cayman Islands National Insurance Company (CINICO) by allowing (and perhaps expanding its role) by mandating that all government-owned vehicles must be insured via CINICO.

Also, all pension monies collected by the National Pension Plan should be invested at CINICO and all pension funds should be retained and managed in the Cayman Islands. This will increase our money in circulation substantially and, with adequate safeguards in place, even allow for a set portion of those same pension funds to be made available for loans to businesses and mortgages and even to government for large viable and credible infrastructural projects.

CINICO could also be revamped and enhanced to make it the main health insurance provider and create like an “Obama Care” concept here in Cayman.

It is my considered view that we have to begin to address our far too high cost of living in these islands and especially our spiraling health insurance costs that we the people face in the Cayman Islands.

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Category: Health, health and safety, Viewpoint

Comments (22)

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  1. Anonymous says:

    Love you George ,you always hit the right problems to talk about. Health insurance for Fat or obesity is trip off my friend who is 300 plus pounds doesn’t want to be 300 pounds I can assure you . He’s very uncomfortable, he has pains in different parts of his body. But he keeps trying different diets and walking a mile but it’s not working. His wife is a real good cook. So there are issues. But he is forced to pay insurance at CI$ 800 a month and has to sign a waiver that says the company will not pay on any sickness caused by his obesity. How can this be anything beside corruption at its highest level allowed by Gov’t? Something has to be done.
    AT Fedup , are you so perfect you have no issues? Alcohol,drugs, mental, preexisting from a family member, how about other members of your family ? No one is born or will die perfect.

  2. FedUp says:

    How about people being responsible for maintaining a healthy body weight? And smokers should certainly have to pay a higher premium! Where is the accountability for one’s own health? Accidents are inevitable but obesity can be prevented by looking after yourself!

  3. Pay up, sucka says:

    Costs of insurance around the world is too damn high!

    Insurance now equals legalised extortion.

    Period, full stop.?

  4. Anonymous says:

    I know this is long, but please read. This is a very serious, troubling situation.

    Kudos to George for bringing this forward. I don’t know how the powers that be can just leave this situation as it is and not be concerned about the healthcare for the people of these islands. As is see it, it is a TOTALLY untenable situation. Consider the following:

    1. The health insurance law is based primarily on the premise of an employer/employee relationship (if you read the law and regulations you will note the repeated reference to “the employee” or “the employer”. We all know the level of unemployment that exists. Unemployed individuals have no recourse as they are unable to pay the premiums for individual premiums.

    2. HSA has gone from the sublime to the ridiculous – did you hear the call to the radio station about the 8 month old baby who was refused service because the mother didn’t have insurance? after decades of negligence in collecting from insurance co panties AND individuals they have now gone to refusing everyone without insurance. I am told that they are refusing some private insurance cards at the district clinics. A newborn checkup cost the young parents $92 at a district clinic! WHAT have we come to that babies are refused service at a government institution?

    3. Retirees – to have any level of meaningful coverage, one would have to be independently wealthy or a Government pensioner. The insurance companies are just sucking every dollar from they can from the people – they know it cannot last forever so they have to take everything they can.

    POSSIBLE SOLUTION: We have a National insurance company which should be open to ALL, offering different levels of coverage. This way they will have a large enough book of business to offer affordable premiums. They should allow participants to go to the doctor of their choice – they can put a cap on what they will pay for services, which the private insurance companies do anyway. They will receive premiums from healthy persons and Not only the uninsurables and civil servants.

    The MLA members are not concerned because they will be covered by CINICO for their lifetime – see they changed the law in order to cover Mrs. Lawrence? If she was not eligible for coverage what makes her more important than anyone else in these islands? Nothing against at her but she just happens to be the subject in this case.

    Education and healthcare has been totally ignored by successive governments. These are fundamental rights of any people. We can brag about our successes, and being the richest country in the Caribbean – who was it that said a country is judged by the way it treats it children and elderly? Everyone who has ever held power in this country should hang their heads in SHAME. And as for mental health care……that’s another discussion – relative to the Government AND the insurance companies.

    • Anonymous says:

      CIMA hired Nicol Morag on a permit which was supposed to be for 3 months in May 2014 as Acting Head of Insurance to among other things find a permanent head of Insurance. She doesn’t seem to be at CIMA for a few weeks now. So if she just left that’s much longer than 3 months and no sign of a new Caymanian head of insurance. It doesn’t seem like she got to addressing the issue of high cost of insurance either.

      • Anonymous says:

        The Head of Insurance post has had no impact on reducing the high cost of health insurance. The (same) person(s) in the role of CIMA Acting or Permanent Head of Insurance are repeated holders of the post no matter of circumstances of multiple repeated departures and returns from/to the post.

  5. Anonymous says:

    Healthcare has become a product you can buy instead of a human right. So if you are on the bottom of society, you unfortunately can not afford the product.
    Healthcare should be a human right, and the more you earn, the more you should contribute. Also rates for doctors should be limited to normal amounts.

  6. Anonymous says:

    George, yes Cayman healthcare is a disaster. Same price as US. Worse quality. No right to sue. Who is silent on this? The LA. Ask yourself why. If you join them, which you are clearly trying to do, you won’t win even if you are sincere in your comments. You will become part of the problem.

    • George Ebanks says:

      But why are you “pre-judging”me?@9:49. I will be a candidate in the 2017 General Elections and I could well be the ONE that contributes to REAL POSITIVE and PROGRESSIVE CHANGE for these beloved Cayman Islands.

      • Anonymous says:

        George, I love that you try. If you don’t get why you will only become part of the current system you are either lying to yourself or us.

  7. $okers says:

    I was pre approved by my insurance provider to complete minor operations on both my legs.
    Instead of taking the 2 separate visits the doctor said would be required originally, it went so well both were done the same day.
    The problems started when the doctor placed the wrong code on the insurance form, and i had to fork out for 1 operation.
    So basically it would have been cheaper for myself, to have said to the doctor “hold on, I will get that one next week”.
    Appealed the decision, this took 12 months in total.
    Took it to the Health Commision, they were a waste of time.
    Gave up.

  8. D. Beauchene says:

    Health Insurance here is an absolute ripoff. I retired here from the US in 2001 and as a benefit I have lifetime health insurance with worldwide coverage from the US Military provider TRICARE. even though I have proof of continuous coverage, I have been told by Health Insurance folks here that since TRICARE is not a “Local approved provider” I must PAY for a local provider to provide for a service I already receive as a benefit. I spend my US pension here, so I support the economy. I don’t collect any benefits from CIG, so I am not a burden to society. But I think the law needs to change and remove the “local provider” provision, as long a you have health insurance. I feel that by restricting coverage to about a half dozen providers is a racket.

    • Anonymous says:

      I had the similar problem which I was covered by BUPA for many years and they offer 10 times better cover than ‘local approved provider’ These local company are too small to cover people in cayman that why it better have BUPA or international health insurance as they have millions of people as member also they have far more contract with hospitals worldwide than CINICO. Now few hospitals in florida have banned Cayman people with CINICO covered as CINICO fail to pay the medical bills on time.

      • Anonymous says:

        7:08 – it is sometimes difficult enough for medical providers to collect from local providers; overseas providers – Next to impossible!

        • D. Beauchene says:

          My TRICARE coverage is not billed by the Doctors or the clinic, I pay the bill and file the claim for reimbursement. So the clinic and Doctors are not waiting for payment.

  9. Anonymous says:

    Does anyone know if the Health Insurance Commission has updated the price guidelines it gives to insurance companies? Because the last time I asked, the insurance companies were conveniently using the 2012 list to decide how much they would pay – whilst the doctors were charging the 2015 rates- considerably more. Leaving us poor saps to pick up not only the deductible, but the considerable difference in cost.

    • Anonymous says:

      The Standard Fee per the Health Insurance Commisiion for the majority of services dates back to 2005!!! This is a fact. It was reviewed however most of the charges remIned the same. In the meantime, costs to medical providers, as any other business, has steadily increased.

  10. Anonymous says:

    The problem with too much personalization of health insurance cost is that you loose the ‘price pool’ for unhealthy people. So their insurance becomes unaffordable and the state has to pay for it (somehow). You can either have a national health insurance provided by the state or provided by the private sector (Cayman Model). Either way you force the healthy to pay for the infirm, on the assumption that we’re all just an accident or old age away from the later category so it benefits society for all to contribute so that all are insured. (The other option, of poor people not having insurance and so dying of treatable conditions is generally frowned upon in first world countries.) In short, your ‘solution’ solves nothing it just shifts how the payments will have to be made.

    PS> Keep our pensions out of CINICO. Investing in a government company within the jurisdiction is not generally a diversified investment. Why is it that everyone’s solution (around the world) is to target the pensions funds when they want cash now, leaving pensions as tomorrow’s problem? There’s no problem getting a mortgage, if you’re a good risk. The problem with socially driven pension investment (mortgages, business loans, government infrastructure loans) is that they tend to fail spectacularly, leaving the pensions funds broken. Again, the point of pensions funds is to provide a Government service (social security) through the private sector. Not to circulate money around the economy. (That’s taxes to create a Nation Building Fund.)

  11. Anonymous says:

    George, thanks for approaching this subject and presenting solutions to the problem. Yes, problem; in case our present or future Governments think it is not.

    Please investigate the dilemma facing retirees of public authorities whose contracts, upon transition, retained all their civil service health care benefits but yet who are now disenfranchised and must pay costly private health insurance premiums. This is a result of an unlawful, or a the very least, unethical and unannounced change to the Public Service Management Law in 2013,facilitated by the DG and affects a large number of persons. The DG (as head of the Civil Service) and Govt are hoping it will go away. Well it won’t !!

    Check with your brother as he has now inherited that mess in the organization he now works for!

    • Anonymous says:

      No worries especially if your name is Mary. Simply ask to enroll in the free lifetime government healthcare insurance top level plan now that the health insurance law is changed to accommodate free enrollment for life privileges for those “chosen by special circumstance persons”.

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