No date decided on co-pay benefits in CS

| 22/02/2018 | 36 Comments
Cayman News Service, Cayman Islands Civil Service Association

Cayman Islands Hospital entrance

(CNS): The civil service management has not set a date to introduce co-pay health or pension benefits for government employees, the financial secretary has confirmed. Government has been in talks with its staff for several years now about the possibility of them co-paying in the first instance for their health insurance cover. But the Cayman Islands Civil Service Association, the closest thing Cayman has to a workers’ union, has resisted the idea and will only accept the possibility of new hires being subjected to co-pay, as they point out the benefits are part of their contracts.

Speaking at the Public Accounts Committee on Wednesday, Financial Secretary Kenneth Jefferson told the members that government had accepted that this would be the only way to introduce the plan, proposed as a way of cutting the growing healthcare bill without impacting the existing contracts of public servants.

“It is intended that cost-sharing would only apply to civil servants at a future hire date and, to the best of my knowledge, a date hasn’t been decided,” Jefferson said.

But he also noted that the impact of introducing co-pay for new workers would not be significant. He said that, given the commitments to existing public sector workers and others covered by government, taking part pay from the small number of new employees government will taken on would not make much of a difference to the overall cost of healthcare in the short-term.

He said the public was well aware of the challenge government faced to provide cover for a growing and aging population. Jefferson said the numbers can look scary when you think about the future liability government has for covering the health costs of its workers, retired civil servants, the indigent and elderly, but it was not at a crisis yet.

He said that he was not underestimating the significance of the liability, but so far government has successfully cared for retired civil servants “without this becoming a national crisis”.

Government pays for the health cover in full for all of its 3,500 plus workers and their families though CINICO. It covers the costs of retired civil servants, the indigent, some elderly people, the disabled, and seamen and veterans. It also picks up the tab for the uninsured and under-insured by paying medical bills directly in some cases.

Falling short of actually calling for single-pay healthcare, Jefferson warned that government should at least be seeking to continue funding healthcare through the surplus budgets based on increasing government revenue rather than increased taxes or borrowing.

But as he considered options suggested by PAC Chair Ezzard Miller about how government pays its premiums to CINICO for the people it covers, he pointed out that government could also opt for a national health care system.

Miller, who has now thrown his backing behind a single national health care system, once again raised the point that the current insurance market was not working as it should, with the burden of covering the sick and elderly not falling on the young and healthy. Jefferson confirmed that even government is paying its premiums to CINICO in bands depending on the age of its workers.

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Category: Government Finance, Government oversight, Health, Health Insurance, Politics

Comments (36)

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  1. Anonymous says:

    just a thought: free health coverage only if you go to HSA ( no choice unless you pay 100% at a private clinic), free health coverage for certain services. Civil servants (most of whom earn under $3000), (around 65% of the civil) may not have an issue contributing if they had a choice of which doctor they could go to without a referral. If I was a civil servant I would want choice.

  2. Anonymous says:

    There is a retired banker who regularly comments on another publication, and is very anti Civil Service getting any benefits, and by doing so he is anti Caymanian since the majority of the Civil Service are Caymanians.This man needs to realise that Civil Servants do not get any bonuses or pay rises like he did in banking, are paid less than the private sector and for more than a decade salary increments were frozen due to austerity. The two cost of living raises given were taken away as well. How can Civil Servants now pay for healthcare when they are so behind in their earnings.The Association needs to argue for topping up those who were left behind, compared to new recruits who were not affected by the austerity measures.

    • Anonymous says:

      I am a banker & have not received a bonus this decade. I’ve also only had one pay rise in the last 5 years – despite excellent reviews as the bank I work for does not make a profit after paying annual licence fee to government (the minimum fee for a bank is $60,000 per annum). What does the bank get for that fee? Nothing except the right to have an office here and so we can pay towards the Cayman Island expenses including civil servant salaries.

      Yes I’m Caymanian.

  3. Anonymous says:

    No politician is going to grasp this nettle. To do so would surely mean having to get a real job after the next election. Excessive public sector benefits are a problem the world over; the UK now has a $2tr unfunded public sector pension liability. $2000bn!

  4. Anonymous says:

    read miller shaw or e&y reports……….tells you everything you need to know.

    • Anonymous says:

      EY Report – How to fleece the country for profit
      MS Report – Still waiting for someone proselytizing it to explain the tourism graph, but no one can actually explain the illogic of that report.

      • Anonymous says:

        Two thumbs down. But cant’ refute/answer my challenge. guess they didn’t actually read the reports.

  5. Anonymous says:

    Everyone is missing the big picture here. Politicians don’t get to determine the terms and conditions of civil servants pay and conditions. That is the responsibility of the Governor and Deputy Governor. And thank godness they don’t.

    The politicians can ask and suggest. That’s it folks.

    • Anonymous says:

      Yet they get a say in private pensions, which are part and parcel of the terms and conditions of private sector employees, and absolutely nothing to do with CIG. Sounds reasonable… NOT!

    • Anonymous says:

      Don’t know why this is receiving downwards votes…its sad that people don’t truly understand the various powers of authority in our country.

      • Anonymous says:

        Fully understand them. Fully understand that just as they shouldn’t pilfer with contractual agreements with their own employees, nor should they do that with the private sector. But just as another commenter has said, they took control over private pensions, and retrospectively too. Meaning they not only changed contractual benefits of thousands of workers, but backdated it too. Effectively all those employees are no longer working under the employment contracts they signed. There’s such a thing in law as privaty of contract. It basically means that only the parties to the contract can change it. This is what the civil service association are saying now. But nobody did the right thing when the CIG did the same wrong to all those private workers.

  6. Tut alors!. says:

    This issue has been debated for years. Why on earth have new hires not been required to contribute for health benefits and pensions like everyone else in the real world. Is there a single person in the Civil Service or in Government can explain why?. Instead Gvernment are making ever increasing contributions to fund these liabilities for our public service fat cats out of taxpayer revenue instead of spending it on new roads, schools and other infrastructure.

    • Anonymous says:

      Or full paid leave for a few years for civil servants who had to be “suspended”. ….must be nice when you can spend money with zero accountability

    • Anonymous says:

      Because elected Govt don’t want to do the hard work of really dealing with this. – Also its a way of making the CS competitive vs private sector in attracting skilled employees.

  7. Anonymous says:

    This is a dead issue. It was one of the nails in Marco’s coffin.

  8. Anonymous says:

    Oh, so its OK for CIG workers to keep the benefits stipulated within their employment contracts but when it comes to taking the private pension savings of any expat on this island, no problem! Such flicking hypocrites.

  9. Anonymous says:

    12:22pm: Agree – many of the employees of the statutority authorities pay 25% and above on their health insurance premuims whilst many of the CS top managers want the same pay but not the responsibilty of paying.

  10. Anonymous says:

    don’t worry….they can always increase the cost work permits more when they run out of money…..zzzzzzzz

  11. Anonymous says:

    solution: cross party committee to be set-up to tackle this issue once and for all.
    then no party can be held accountable at election.

    • Anonymous says:

      Cross party committee comprising all the previous and current govt people who have failed to change a damn thing for years…like that’s gonna work.

    • Anonymous says:

      What Parties? I’ll just vote independents next time to cancel it out.

  12. Anonymous says:

    of course not…this is the ppm…..lets kick this can down the road for another 4 years…zzzzzzzz

  13. Anonymous says:

    Another glorious day at the Civil Service trough.

  14. Anonymous says:

    Yawn…really? Quelle Surprise.

  15. Anonymous says:

    Why is this a discussion? Insured should pay 20% like anyone else.

    • Anonymous says:

      They are talking about having to share in the cost of the monthly premium.

      • Anonymous says:

        Actually they (the Govt.) don’t know what they’re talking about. its why this has never gone anywhere yet.

    • Slacker says:


      Those paying 20% should not be paying anything. Anything else, is just another regressive Caymanian tax favoring the rich.

    • Anonymous says:

      OK. But I expect the same not-CINICO not-just-HSA coverage as everyone else in my field. And I’m going to be renegotiating my contract to reflect that 20% tax to pay for everyone else that Government is covering. (CINICO uses the fees they charge GOvt. for the Civil Service to subsidize their other coverages.) And the HSA will now lose a big chunk of its business (as we all go private) meaning that they’re going to need a bigger annual subsidy from the Government to keep providing those services to the country.

      • Anonymous says:

        1:25pm, you got it almost all correct. Next time around you probably will.

        Over time, the subsidy will decrease as there will be 6,000+ persons (CSs and dependents) to pay full premiums for.

        Over time, HSA will hopefully become more competive and scale back it’s operations to suit its customer base or form a strategic partnership or some combination thereof.

        Nothing wrong with that?

        • Anonymous says:

          No, as those 6,000+ persons go private the HSA subsidy will increase. They can’t make strategic partnerships because they don’t pay what the private sector will pay. So, when my private doctor sends me to their private lab for blood work HSA looses that money. Govt will have to pay more to keep HSA phlebotomy open to service the reducing number of patients (under-insured HAC holders, etc.) because it will still be cheaper than paying private rates for everyone. But if you think that a country can survive without a public health care provider, name me said country as an example.

          • Anonymous says:

            Still dont get? Okay.

            But never said that there should be no publicly funded health facilities – merely was acknowledging that the current $1.7 billion post retirement health care liability alone is not affordable – not to mention the ongoing subsidy of health care by CIG.

            Put another way.

            Perhaps your assumption that all CIG 100% sponsored patients will all go to private facilties is conjecture, at best.

            Perhaps, your assumption that all privately run health care facilties are better than HSA and will always be, is harsh.

            Also, there are 2 little things in private enterprise called pricing AND service. Get those balanced, then let the games begin.

            Further, perhaps CIG can subsidse the deductible at government hospitals/centres perhaps …etc

            All of these options only need be balanced against paying 100% of premuims now and forever, which is just not an option.

            • Anonymous says:

              And you’re still missing the point that CIG already subsidizes the HSA, on top of the hidden subsidy of sending all CIG employees & retirees there. Now we know that CIG employees want choice of provider (mostly to get more timely service) if they have to pay. So we know that some % will go private some % of the time. So as the hidden subsidy goes down the outright subsidy will have to go up. Because any big/public hospital relies on the ‘profitable small cases’ to help pay for the unprofitable big ones, e.g., dialysis. I fully get your hope that somehow the free market will produce both efficient and fairly priced services, but it hasn’t yet. The subsidies will continue and they will grow as Govt. money is shifted from the public to the private sector health care providers.

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