Health Insurance Commission of the Cayman Islands

The Health Insurance Commission will look more closely to ensure small businesses owners are complying with the Health Insurance Law after getting a conviction two weeks ago against Marksman Electronics and Security Services Company Ltd.

Superintendent of Health Insurance Mervyn Conolly said the HIC did not have something against small businesses, but most of the cases where employers were not providing mandatory health insurance were companies with leas than 10 employees.

“We understand small businesses have their own challenges like running their own HR department and keeping their own books, but the [Health Insurance] Law clearly says it applies to all employers,” he said. “We can’t say this applies to some employers and not to others.”

Health Insurance Inspector Wesley Gibson was instrumental in getting the conviction against Marksman Electronics. Although no conviction was recorded against the owner of the company, Robert Michael Gooden, the company was ordered to pay a $1,000 fine. In addition, it was ordered to pay the portion of an employee’s hospital bill that would have been covered under the Standard Health Insurance Contract 1 had it been in place.

Mr. Gibson said one employee had brought about the action against Marksman Electronics after receiving a treatment at the hospital. When the employee brought the bill to Mr. Gooden for payment and he refused, the employee complained to the HIC.

“All it takes is one person to complain,” said Mr. Conolly. “If there is one employee that is not covered, we will come after you.”

Mr. Gibson said the problem with small businesses is often that they don’t have proper bookkeeping and payment records with regard to insurance on their employees. He pointed out, however, that they are required to keep those records by law.

Unlike the Pensions Law, which does not require domestic helpers to have a pension plan and does not require pension plans for non–Caymanians who have been working in the Cayman Islands for less than nine months, the Health Insurance Law requires all employees to have at least the SHIC 1 policy from the time they commence working. Employers must pay at least one–half of the premiums, while employees are required to pay no more than one–half of the premiums.

The law allows for a 15–day period for underwriting, which Mr. Conolly concedes can sometimes be longer depending on circumstances. In such cases the HIC would take a lenient approach, as long as the process of getting a policy was in the works.

Should a person be turned down for a policy for some reason by one of the approved group providers, Mr. Conolly said the HIC would refer the person to CINICO, which would then offer coverage.

Now that health insurance has been mandatory for more than a decade, Mr. Conolly says he doesn’t hear the excuse from employer that they did not know they had to provide health insurance for their employees.

“Now they’re more often saying they can’t afford it,” he said. “But that’s not our concern. Being unable to afford it is not something we can take into consideration. We can listen to you say that, but it doesn’t change the fact that the law requires all employers to effect and maintain health insurance with respect to their employees.”

Mr. Conolly said employees often do not find out they do not have health insurance until they go to the doctor or hospital and learn they have no coverage. There are a couple of ways employees can determine if they have insurance.

First, they would be asked to complete an enrolment application form when they start work. Then they would be issued a health insurance card.

“If you don’t get a card, there’s a good chance you are not enrolled and you’re not covered,” said Mr. Conolly.

Sometimes after an insurance card is issued, an employer will stop making the premium payments, thus terminating the coverage. The employee will sometimes think he is still covered because he has an insurance card and deductions are being made from his pay, but that is not necessarily the case. Mr. Conolly said if an employee has any suspicions that health insurance has been terminated, he can call the group insurance provider and it would, in most cases, let the employee know if he still has coverage.

In addition, an employee could take the card to a pharmacy, which could look up on the computer very quickly if the policy were still valid.

The Health Insurance Commission only has two inspectors currently, but Mr. Conolly said a third inspector should be in place within six to eight weeks. Right now, the HIC is mostly responding to complaints and following through with prosecutions, but when the third inspector comes on board, it will allow for more random inspections of employers.

The HIC can come into inspect any business’ health insurance records, sometimes without notice if it suspects a particular company is not in compliance with the law.

Although Mr. Conolly concedes the fines are not particularly harsh at the moment, a conviction against a company for a Health Insurance Law violation will likely make the HIC more vigilant toward that company.

Sometime this year, the HIC hopes to be able to use another tool in the getting employers to comply with the Health Insurance Law. A recommendation to amend the law so that fines can be levied directly by the HIC has been unanimously supported and approved by the Health Insurance Board and the Ministry of Health, Mr. Conolly said.

“It’s just a matter of drafting it up and amending the law,” he said, adding that he is hopeful the changes will occur this year.

In the meantime, the HIC is working much more closely with other agencies like the Immigration Department and the Department of Employment Relations to help determine if employers are getting health insurance for all of their employees.

The HIC is also trying to make sure employers, especially small business owners, have all the information they need about what is required of them. In addition to advertising efforts in this regard, the HIC is involved in educational programmes with the Cayman Islands Investment Bureau and the Cayman Islands Chamber of Commerce.

The Legislative Assembly unanimously passed a Private Member’s Motion brought by Opposition MLA Rolston Anglin to look into the issue of the portability of health insurance when employees in the Cayman Islands change jobs.

“This motion seeks to address what has been a long outstanding and troubling aspect of private health insurance cover,” Mr. Anglin said when introducing the motion.

Of particular concern is the fact that people who have health conditions covered by insurance are losing coverage on that condition when they change jobs, sometimes even if their new employer had the same insurance that their previous employer had.

“[The new insurance company} is able to deem anything that was a pre–existing condition not covered,” Mr. Anglin said. “That runs contrary to what the spirit of the Cayman Islands Health Insurance Law was when it came into effect.”

Mr. Anglin argued that the spirit and intention of the law was that once you had health insurance coverage and changed jobs, you would remain covered with no less favourable coverage than what you had at the time you entered the health insurance system.

Citing an example, Mr. Anglin said he knew of a case where an employed man with a child dependent with a serious health condition was offered another, better paying job. Because his new prospective employer used the same health insurer, both he and the employer thought he could transfer his insurance for all of his dependents. However, when the insurance company issued the coverage through the new employer, it would not cover the man’s child with the medical condition.

“Because of a gap in [the Health Insurance Law] regulations, health insurance providers utilize it… to exclude conditions they were already covering.

Mr. Anglin said the issue has made health insurance the key determinant as to whether a person changes jobs.

“It’s caused a large element of our work force to effectively become indentured servants,” he said, adding that some people are unable to change jobs even when they want to because they or one of their dependents will lose insurance coverage if they do.

“This runs contrary to the spirit of the Health Insurance Law that exists in the Cayman Islands.”

Mr. Anglin said the situation was an absolutely deplorable situation for the consumer.

“We must be able to have people work for who they want without having to worry if the health insurance providers will drop their coverage.

“This is a matter which has been brought to my attention by a number of employees and by the board of directors of the Health Insurance Commission,” he said.

Mr. Eden said the issue was being fully investigated by Government, but noted that any changes to the law would have to be done with consultation with all the relevant parties in the insurance industry.

“[The Government] has convened a working group to review this matter and advise how it could best be addressed.”

Failure to have a standard health insurance contract in place for a security guard cost his employer a fine of $500.

Failure to have a health insurance contract in place for himself cost the employer another $500.

The fines were imposed by Magistrate Grace Donalds after Garth Ebanks pleaded guilty on behalf of his company, W5 Security Services Ltd.

The matter came before the Summary Court for the first time on Tuesday and was dealt with the same day.

Both charges covered the same time frame, between 23 December 2005 and 26 July 2006.

Crown Counsel Tanya Lobban said the first charge was based on a complaint by a security guard working with W5. He told the Health Insurance Commission that Mr. Ebanks had not effected health insurance for him.

The employee said he had begun work in September 2004 and had asked over and over about health insurance. He said the employer promised to look into it, but that had not been done.

According to the procedure laid down in law, the Health Insurance Commission wrote to the employer, but there was no reply. A second letter was sent and there was no reply.

At that stage, the employer said he was looking for a reasonable policy for his employees. He said he had spoken with them and they all refused to sign the relevant forms.

For himself, he said he had coverage through his spouse’s insurance. This turned out to be not true.

In court, the magistrate asked if he had anything to say. She noted that the company was charged, not the individual. There was no defence attorney and Mr. Ebanks spoke on behalf of the company.

He said he had spoken to his employees and they remained the same. He apologised to the court that he did not proceed to get the insurance. He said he would go ahead and get it and bring it back to court to show.

The magistrate told him it would be a continuing offence if he did not get the insurance.

The maximum penalty under the law is $5,000. The court may also impose a fine of $100 per day for each day the offence continues.

There is currently another case before the court that involves an employer’s alleged failure to provide health insurance for an employee. Cayman Elite Ltd. and Wendel Wendel have pleaded not guilty. The part–heard trial was scheduled to resume on 23 October (Caymanian Compass, 10 August).

Trial began in Summary Court on Monday for an employer accused of failing to effect and maintain a standard health insurance contract for an employee.

The defendants are the company Cayman Elite Ltd. and the individual Wendel Wendel.

The first witness was Mr. Mervyn Conolly, Superintendent of Health Insurance and chief executive officer of the Health Insurance Commission.

He explained the process by which complaints are received and how letters are then sent to the employer complained about.

A person who wishes to complain is required to fill out a complaint form, which must then be signed and witnessed, he explained.

In this case, he confirmed receiving a complaint from an employee in October 2004. After efforts to ascertain the legitimacy of the complaint, letters were sent to Mr. Wendel in February and April 2005.

Mr. Conolly explained that it is an employer’s duty to have a standard health insurance contract for each of his employees and any child and unemployed spouse of an employee. The employer is responsible for half of the monthly premium.

The law also provides for situations where an employer neglects to effect a contract of health insurance coverage or does not comply with the law regarding payment of premiums.

In such cases, Mr. Conolly indicated, if a person has lost the benefit of health insurance, he is entitled to recover loss or damages from the employer.

In the matter before the court, the complainant was claiming compensation for insurance he said he obtained on his own plus $224.78 in uninsured medical expenses.

Cross–examined by Defence Attorney Keith Collins, Mr. Conolly said he understood that Mr. Wendel’s other employees were covered.

Mr. Collins then asked him about situations in which an employer would not be liable for providing insurance.

Mr. Conolly agreed that a previously unemployed person who was covered by his spouse’s insurance could elect to continue coverage through the spouse’s employer or be covered by his own employer.

Mr. Conolly also said that, to the best of his knowledge, the complainant did not say that he had told Mr. Wendell he was covered through his wife.

If he had, Mr. Conolly said he would want to know why the complaint was brought. If he had facts such as those put to him by Mr. Collins hypothetically, “we would not bring the case,” Mr. Conolly said.

Crown Counsel Trevor Ward also called Mr. Wesley Gibson, an inspector with the Health Insurance Commission. He told the court about visiting Mr. Wendel at his office in connection with the complaint.

He also confirmed that Elite Cayman Ltd was a registered company with a valid trade and business licence.

Questioned by Mr. Collins, he said he knew that the complainant’s wife was working on the island, but he did not ascertain whom she worked with.

Mr. Gibson indicated that the complainant himself was off–island because of work–related matters.

Mr. Collins said he could not agree to having the complainant’s statement read; he wanted the man to give evidence in person so that he could be cross–examined.

The earliest date that could be agreed on for the trial to continue was 23 October and Magistrate Grace Donalds adjourned the matter until then.

Health insurance fees in the Cayman Islands are about to go under the microscope.

The Ministry of Health announced last Friday the launch of its Standard Health Insurance Fees 2006 Revision Project.

The project will take another look at health insurance fees and standardise the amounts that health insurance companies have to reimburse healthcare providers.

The new standard fees will not represent the fees that healthcare providers will charge, however.

The Standard Health Insurance Fees lists descriptive terms, identifying codes and the reimbursement amounts for about 7,500 medical procedures. These codes are called Current Procedural Terminology.

The project is a joint project with Kroll (Cayman) Ltd., which was represented at the conference by Mr. G. James Cleaver. Kroll Cayman Ltd. Was formed in early 2005 when Ernst and Young was restructured.

The list will be available through the Legislative Assembly or online at www.hic.ky.

An important aspect of this project, however, is the in–depth analysis of actual healthcare costs.

“We are most excited about looking at the true cost of providing healthcare in the Cayman Islands through a detailed survey that will take place,” said Chief Officer of the Ministry of Health and Human Services Ms Diane Montoya.

Prior to 2005, the individual insurance companies would decide how much they would pay back to the healthcare providers, she said.

Insurance companies complained at a recent HSA forum they couldn’t ensure the costs healthcare providers were charging were accurate.

This new project will aim to appease both sides. As for patients, there is no guarantee that premium costs will be adjusted by this new project.

However, should any insurance company wish to increase its premiums, there has always been a monitoring system in place, said Mr. Mervyn Connolly, chief executive officer of the Health Insurance Commission.

“They have to file their premium rates with us, and if they request an increase in them they have to apply to the commission with justification,” he said.

It seems that all stakeholders in the health insurance issue have been pleased with the project and are working well together, said Minister of Health Mr. Anthony Eden.

“Non–Government Organisations are required to comply with Government’s new financial requirements, which are based on output budgeting,” said Mr. Eden.

“The Ministry recognises the vital role NGOs play in the growth of the community,” he said.

This combining of the private and public sectors is essential for creating a world–class health service in the Cayman Islands, Mr. Eden said. “If we look at what the Cancer Society has just done, this is a great example of what we need to encourage here.”

The Cayman Islands Cancer Society just purchased a $300,000 mammography machine without any funding from the Ministry, by raising money from the private sector.

Some of the healthcare issues also being addressed by this project include over–utilisation of the services, said Mr. Connolly.

“We don’t want to discourage people from going to the doctor if needed, of course not,” he said.

“However, we do aim for people to gain better health through lifestyle changes and preventive methods.”

Ms Montoya explained that steps are being taken to see if Public Health Services will expand their public health programmes.

“We should have a consultant coming down in a few weeks to see if we need to increase the capacity (for public health programmes),” she said.

The first Standard Health Insurance Fees document was developed by Drs. Hann and Akoto and the Health Insurance Commission, in consultation with the Cayman Islands Medical and Dental Society and a special committee of the Cayman Islands Insurance Association, said a press release from GIS. These fees are to be revised annually.

Upon approval by the Governor in Cabinet and after consultation with the Health Insurance Commission, the revised Health Insurance Fees that are to be paid by approved health insurers will be published in the Cayman Islands Gazette.

The Standard Health Insurance Fees project will aim for completion by late July, said Mr. Cleaver.

HIC Superintendent, Mervyn Conolly, discusses the
factors that make up the standard health insurance
fees as James Cleaver of Kroll Cayman looks on.

Even though it is mandatory here in the Cayman Islands, as much as 25 percent of the population may still be without health insurance in spite of laws requiring employers to provide coverage.

The Superintendent of the Cayman Islands Health Insurance Commission (HIC), Mervyn Conolly, said his agency is actively pursuing employers who are not compliant with the law.
"The HIC has targeted the construction industry as we have received many complaints from workers in this field," said Mr Conolly.

"Construction work can be high risk from falling off roofs to operating dangerous equipment, so it is important that construction workers have adequate cover. We have also met with the Contractors Association and they are cooperating."

Other industries that have been targeted for non-compliance have been the security services and domestic workers. Although Mr Conolly acknowledged that many complaints come from workers in low wage earning positions - he stopped short of saying that non-compliance is focused in this area.

He added there were much fewer complaints from workers in higher paying fields, such as in the financial services industry.

According to the latest figures of the HIC there are 41,000 people with health insurance coverage in these Islands. With the population estimated to be between 50,000 and 55,000 that leaves the uninsured numbers at 9000 to 14,000 people.

The Health Insurance Law requires all employers to insure their employees regardless of them being temporary or long term work permit holders, part or full time, or domestic workers.

The high cost of health care and health insurance has been a concern among businesses and the community. It might be difficult to afford health insurance premium for some low wage earners, but Mr Conolly explained that it is even more costly if there is even one catastrophic illness or injury, which can easily run up to tens of thousands of dollars.

That is why it is important to have the minimum standard health insurance plan, which is really a hospitalisation plan, he said.

These monthly premiums for this basic plan are more economical but they provide minimal coverage for outpatient care. Better health insurance coverage is typically provided to by higher paid positions and top firms. Industry experts have noted that higher wage earners have more ability to pay for their own medical costs.

According to the Minister of Health Service, Hon Anthony Eden, the Cayman Islands is the first country in the world to mandate health insurance for all residents. Recently two states in America, Vermont and Massachusetts have recently enacted similar legislation.

Stakeholders from insurance, health care providers and employers have stated there are issues in providing health care at affordable costs. Some private practice doctors have stated there is not a big enough population base.

If insurance companies do not pay them for some treatments it is hard for the doctors to make up the income without a high patient volume, something that is possible in the United States.

Insurance companies have stated that patients frequently over-utilise the insurance for unnecessary treatments, which then in turn drive up insurance premiums.

The Health Services Authority (HSA) has said the Accident and Emergency Room is overused for non-emergency health care.

Another concern is that health insurance companies reimburse health care treatment at various rates, which has caused issues for health care providers in the regard of what to charge the patient. That is why the Standard Health Insurance Fees was implemented in July 2005, which determined the minimum reimbursement paid by insurers.

On 16 June, HIC announced a study to review Standard Health Insurance Fees and running a medical practice. Kroll Cayman Ltd will be doing the study in conjunction with Mercer Oliver Wyman Actuarial Consulting.

Kroll will be surveying local physicians about their expenses to determine how much it costs to operate medical practices in this country. This information will then be used to make any necessary adjustments to the Standard Health Insurance Fees.

The Chief Officer of the Ministry of Health Services, Diane Montoya, said funding health care is a complex process.

"We need to shift the costs of health care from Government to employers and the patients," noted Ms Montoya. "There are many factors in costs of health care and premiums. The Ministry of Health Services has been gathering data so that it can have the necessary information to make decisions about the costs of health premiums."

She explained that doctors need to be confident that when they take an insurance card they are going to be reimbursed and not incur debt in the process. Collecting data from this survey will be an important piece in the whole puzzle so that the Ministry can forge a holistic policy that considers the needs of all stakeholders: patients, employers, health care providers and insurance companies.

shurna@caymannetnews.com

Some doctors are still refusing to accept valid insurance cards from patients without first attempting to verify coverage.

Mervyn Conolly, superintendent of health insurance, understands the concerns of doctors.

“I recognise that health care providers have legitimate issues that have to be addressed. We don’t want them exposed to risks of not getting paid for services provided. They have reasonable concerns.

“Health care providers cannot with confidence be 100 per cent sure that insurance companies will pay for services provided.

“Sometimes the patient is not covered for the particular benefit and it is not that the health care provider would not take the card. It is not always the health care provider at fault,” he said.

“We want the health care providers at least to try to verify what benefits are covered.

“We’re saying that in instances where you have a valid insurance card with a level of benefit that would cover the services and procedures required by the patient, the health care provider should make reasonable efforts to verify the coverage.

“The commission also wants to be able to follow up on complaints from health care providers if they are not getting claims paid on time,” he said.

As recently as late last year, a forum which included Mr. Conolly; Minister for Health and Human Services Anthony Eden, representatives of insurance companies and doctors, addressed compliance with the 2004 Health Insurance Regulations.

Ear, nose and throat surgeon Dr. Robert Glatz finds there are still problems with the verification process.

“The law is misleading. Doctors will accept the insurance card when they know the insurance company will pay, but they will not guarantee payment. No insurance company will.

“They’ll tell you the insurance is intact and it is up to date, but they won’t tell you they will pay for a specific situation,” he said.

“I accept the card as a courtesy for large amounts such as for surgery; most physicians will do that. But for office visits, there are so many instances where the insurance company doesn’t pay.

“For office visits, I will ask for payment up front and I’ll fill out the claim form for the patient and I’ll have them drop it in the mail,” Mr. Glatz explained.

Mr. Conolly understands there are situations that prevent doctors from being able to accept a person’s insurance.

“If a doctor takes the insurance card and can‘t get through to the insurance company, it’s not his fault. At least, in those instances, a doctor could fill out the claim form for the patient,” he said.

If a doctor refuses to take an insurance card and will not try to verify a person’s coverage, then the patient may file a complaint with the Health Insurance Commission, Mr. Conolly, who is also CEO of the HIC, explained.

The HIC will investigate the complaint and take any appropriate action, he said, but added that the complainant should be willing to go on the record.

While there is no fine for refusing to take an insurance card, there are penalties for not cooperating with a health insurance investigator.

If a doctor will not answer questions or obstructs the investigation he can be liable on summary conviction to a fine of $5,000.

“We are hoping the health care provider will be professional enough or ethical enough to work with us on a particular issue,” he said.

Employers are required to provide all employees with a standard health insurance contract including full-time, part-time, temporary work permit holders, and domestic helpers according to the Health Insurance Commission.

“The health insurance requirement was intended to help individuals pay for catastrophic illness,” said the Hon Gilbert McLean, Minister of Health Services. “By having health insurance for employees, it makes health insurance more affordable for everyone, rather than the individual reaching into his pocket and paying individual rates.”

The Compulsory health insurance section of the Health Insurance Law (2003 Revision) states all residents of the Cayman Islands must by covered by a standard health insurance contract. It further states, employers are required to provide health insurance coverage for themselves, their unemployed spouse and children, their employees, and their employees’ unemployed spouse and children.

Employers who do not comply with the Health Insurance Law are guilty of an offence and will be fined $5,000 in a summary conviction and $10,000 if convicted on indictment.

All employees who do not have health insurance, whether fulltime, part-time, temporary work permit holders or domestic helpers, should contact their employer to provide health insurance or contact the Health Insurance Commission at 946-2084.

The Health Insurance Commission has reminded the public that one of its key functions is monitoring the operations of approved health-insurance providers, including changes in premium rates.

As required by law, premiums charged by approved health-insurance providers are not to be increased without prior authorisation from Cabinet, which bases its decision upon recommendations from the Health Insurance Commission.

“These procedures are in place to ensure that premium increases are warranted,” said the commission’s Chief Executive Officer Mervyn Conolly, who is also the superintendent of health insurance.

The two pieces of legislation that govern premium increases are the Health Insurance (Amendment) Regulations 2003 and the Health Insurance Commission Law (2003).

They specify that approved health-insurance providers must file proposals for increases with the Health Insurance Commission.

The commission may then secure the services of an impartial actuary to determine if the increase is justified.

The commission will subsequently inform Cabinet of its recommendation, to receive Cabinet’s assent. The commission will then notify the provider, in writing, of the decision.

Mr Conolly noted that any approved insurer who increased premiums without prior Cabinet authorisation was operating outside the law.

The Health Insurance (Amendment) Regulations 2003 also outlined the four standard health-insurance contracts that all providers are to eventually offer the public.

This provision is intended to help the public understand their insurance coverage and “comparison shop” with greater ease.

Greater assistance in dealing with health insurance complaints and disputes is now available for the insured public, with the formation of the Health Insurance Commission (HIC) and the commencement of the landmark (HIC) law, which came into effect this month.

The commission's Chief Executive Officer Mervyn Conolly said: "The primary purpose of the law and the commission is to ensure that the provision of health insurance to the public is well regulated."

Mr Conolly, who is also the superintendent of health insurance, pointed out that the Health Insurance Commission Law, in conjunction with the amended Health Insurance Law and Regulations, had strict enforcement
powers and increased penal provisions.

"I look forward to working with the HIC and our stakeholders, to prevent the difficulties previously experienced through inadequate enforcement of the Health Insurance Law and Regulations," he said.

The primary role of the HIC, established under section 3 of the Health Insurance Commission Law (2003), is to monitor the performance of the health insurance industry.

Also it must provide five vital functions: Advising the minister responsible for health insurance on any matter relating to health insurance, requiring every health care facility and registered health practitioner in the Cayman Islands to file with the HIC, annually and at every adjustment, the fee charged for each health benefit they provide, investigating and settling disputed claims to health benefits, and answering questions arising in connection with the provision of health insurance, providing advice to the Governor-in-Cabinet on the premium rates charged by health insurers, and managing the Segregated Insurance Fund (SIF), including the collection of money from premiums charged by approved insurers to cover medical costs for indigent people.

In addition to the commencement of the law, the Ministry of Health Services has announced the names of those who serve as members of the Health Insurance Commission.

They include: Suzanne Look Loy, government lawyer and chairperson of the commission, Andrea T Bryan, permanent secretary of the Ministry of Health Services, Dr Gerald Smith, chief medical officer of the Cayman Islands, Dr F Robert Glatz, medical doctor and representative for the Cayman Islands Medical and Dental Society, Peter Small, accountant, Geoff Scholefield, health insurance specialist and representative for the Cayman Islands Health Insurance Association, Carole Appleyard, health insurance specialist with the Cayman Islands National Insurance Company (CINICO), Vincent Frederick, representative of the public, and Mervyn Conolly, chief executive officer of the Health Insurance Commission and superintendent of health insurance.

Cabinet-level responsibility for health insurance rests with the Minister of Health Services, the Hon Gilbert McLean.

He said: "I anticipate that problems being experienced with health insurance, including the enforcement of the laws and regulations, investigation of complaints and resolution of disputes, will be appropriately addressed with the commencement of the Health Insurance Law (2003) and the establishment of the Health Insurance Commission."

The Health Insurance Commission office is in UBS House, second floor, Elgin Avenue, George Town. The telephone number is 946-2084. The fax number is 945-8961.

A panel of specialists and representatives from the public explained and debated key points concerning health insurance at a forum at Mary Miller Memorial Hall Tuesday, 29 November.

The theme of the forum was Understanding Health Care – Health Insurance in the Cayman Islands. During the meeting which was broadcast live, moderator Suzanne Look Loy, chairman of the board of the Health Insurance Commission, addressed questions to the panel as well as took queries from the public.

Minister for Health and Human Services Anthony Eden opened the forum, which was attended by approximately 50 people.

“The objective of our meeting here tonight is to better understand matters related to health care and more specifically, health insurance in the Cayman Islands. The issues surrounding health insurance in our country are varied and quite complex in some cases,” Mr. Eden said.

The minister sees a need to educate as many people as possible about health insurance.

“What we have found is that not only are many people questioning the need for health insurance but that they are also unaware of the changes to the health insurance legislation that have taken place over the last few years.

“We want to make sure that you are fully informed of your rights and obligations and that you understand the health insurance legislation as it pertains to you,” Mr. Eden said.

The panel discussed such issues as the proposed four standardised health insurance plans, the role of the HIC in regulating the industry, and the use of health insurance cards and their acceptance by health care providers.

The panel comprised Mervyn Conolly, Superintendent of Health Insurance; Samantha Bennett of the Cayman Islands Society of Human Resource Professionals; Dr. Robert Glatz of the Cayman Islands Medical and Dental Society; Bill Rewalt, a member of the public who spent 46 years in the insurance business in Bermuda and Cayman; Gordon Rowell, health insurance consultant; Trevor Stuart, of Cayman General Insurance; and George Ebanks, a member of the public.

The Ministry of Health and the Health Insurance Commission will be hosting a town hall meeting Tuesday, 29 November to discuss important issues relating to health insurance.

The public forum, Understanding Health Care: Health Insurance in Cayman, will take place at Mary Miller Memorial Hall in Red Bay from 7pm to 9pm. Cayman 27 and Radio Cayman will broadcast the forum live.

Minister of Health and Human Services Anthony Eden will address the forum, and a panel consisting of Superintendent of Health Insurance Mervyn Conolly, representatives from the Cayman Islands Society of Human Resources Professionals, health care providers, health insurance industry and the general public will guide the discussion.

“The purpose of this Health Insurance Forum is to inform and obtain feedback from the public about issues relating to health insurance,” explained Mr. Conolly.

“What we have found is that many people are questioning the need for health insurance and they are unaware of the changes to the health insurance legislation that have taken place over the last few years.

“We would like to make sure that the public is fully informed of their rights and obligations and that members of the public understand the health insurance legislation as it pertains to them,” he said.

The forum will also include discussion and questions moderated by Suzanne Look Loy, Chair of the Health Insurance Commission Board. People attending the forum as well as the broadcast audience will be able to voice their opinions and pose specific questions to the panelists.

Topics will range from health insurance coverage and eligibility to the proposed standardized health insurance contracts to the role of the commission in resolving disputes.

Tuesday 27th September, 2005

Caymanian Compass

The new Health Insurance Commission office was officially opened Friday, 23 September, in Anderson Square.

“In preparing for this event, I was reminded of the many improvements that have been made to ensure the residents of this country continue to have access to healthcare,” Mr. Eden said.

He then chronicled the history of the Health Insurance Law and Regulations, and the Health Insurance Commission Law.

“The Superintendent of Health Insurance and the staff of the commission currently receive complaints regarding the provision of health insurance and carry out investigations with the aim of resolving 100 per cent of the complaints,” Mr. Eden added.

To date, the commission has received 527 complaints and/or inquiries, with 90 per cent of those resolved and a very few pending resolution in the courts, he said.

The commission ensures the provision of health insurance is well regulated and helps the public resolve any health–insurance related complaints.

“With the relocation of our office from UBS House to here, at Anderson Square, we hope to serve our customers and clients and the general public even better,” he said.

“Permit me also to take this opportunity to thank the staff of the HIC. Firstly, for their assistance in planning and arranging this event, but more importantly, for their loyalty and commitment to the duties and responsibilities of the Health Insurance Commission, during this year of challenges, changes and transition,” he said.

Suzanne Look Loy, chairman of the board of the commission, outlined the HIC’s achievements, which include the compilation of standard fees for health insurance; continuous review of premium rates; establishing the enforcement arm of the commission to ensure resolution of complaints; and the launch of a public awareness campaign.

Calling the task of the commission mammoth, she added: “(The) continued partnering of all stakeholders will only ensure that the health insurance industry in the Cayman Islands remains beneficial for all, is equitable, effective, efficient and most of all cutting edge in its approach to providing the best product available to the stakeholders in the health insurance market.”

In addition, Mr. Eden called for all those involved to support the work of the commission.

“(The) success of the Health Insurance Commission depends upon the relationship it forges with the health insurers, health care providers, employers and employees. Therefore, I implore all of the stakeholders to work together for the greater good.

“I understand there are problems and special needs of each group but it is only through constructive, open dialogue that we can find the answers and resolve the problems,” Mr. Eden said.

The publication of the standard fees to come into effect on 1 August has been approved after consultation with the Health Insurance Commission, the Cabinet briefing heard on Friday.

“The standard fees are not necessarily the fees charged by a doctor, but are the baseline fees from which an approved insurer will determine payment to be made under a standard health insurance contract for a health care benefit provided to a compulsorily insured person,” said Minister Anthony Eden.

“In accordance with the Health Insurance Law, every health care facility and registered practitioner must file with the Commission annually and not later than one month after any adjustment the maximum fee charged for each health benefit provided by such health care facility and registered practitioner,” he added.

The fees had been gazetted and additional information could be received from the office of the Health Insurance Commission on the second floor of the UBS building or by calling 946–2084, said Mr. Eden.

Cayman’s Health Insurance Commission will publish on 15 July a list of standard health–insurance fees.

Publication will enable health insurers, registered medical practitioners, health–care facilities and patients to calculate how much money insurance companies will reimburse practitioners and health–care facilities for services provided in the Cayman Islands, according to a press release from the Health Insurance Commission.

In accordance with The Health Insurance (Amendment) Law, 2003, the “fees”, referred to as the Standard Health Insurance Fees, are the amounts of money approved health insurers will pay for a health–care benefit provided to compulsorily insured people.

Publication of the fees is a significant step toward identifying the true cost of health care in the Cayman Islands. The published fees will be reviewed on an annual basis.

“Implementation of the Standard Health Insurance Fees is a vital step toward creating a more transparent health–care industry in the Cayman Islands,” said Superintendent of Health Insurance Mervyn Conolly.

“Patients will now know in advance how much their health–insurance company will reimburse their doctor or health–care facility for a specific procedure or service and whether or not they will be balance–billed.”

A balance bill is when a medical practitioner or health–care facility bills an insurer more than the insurance company will reimburse.

Health–care facilities and doctors can still charge whatever they believe is reasonable for their services and procedures.

However, the insurer will only reimburse the amount that is listed in the Standard Health Insurance Fees document.

Mr. Conolly explained that months of planning, research and analysis went into provision of the Standard Health Insurance Fees, detailing nearly 10,000 codes, respective procedure descriptions and accompanying fee for each code.

“It was a long and difficult process and we could not have done it without input from the Health Insurance Standing Committee, the Cayman Islands Medical and Dental Society and the Economics and Statistics Office,” Mr. Conolly said.

“I applaud all stakeholders for their hard work and their willingness to compromise in order to achieve this important goal.”

Copies of the document can be obtained from the Health Insurance Commission for $20. Call 946–2084 or email HIC.COM for more information.

Copies of the Health Insurance Law and Regulations can be obtained from the Legislative Assembly.

For all other documents please visit our Forms page or submit your request via email to hic@gov.ky

ARTICLES

Tuesday 27th September, 2005

Caymanian Compass