Health Insurance in the spotlight

Several recent incidents, including the serious injury and eventual death of an uninsured man, have underscored problems with the Cayman Islands’ mandatory health insurance scheme.

In addition, the Grand Court trial of Godfrey Bowen and Air Tech Corp. Ltd. started Monday. They have been charged with failure to effect and continue standard health insurance.

Edwin ‘Eddie’ Edwards, who died from injuries sustained when the commercial bus he was driving crashed into a tree, had no health insurance. One of his employers, Dadford Dixon, said Mr. Edwards had paid the premiums for the insurance for the first couple of months, but he then let it go.

‘He said he didn’t want to pay it,’ Mr. Dixon was quoted as saying last month.

Because he did not have insurance or a $130,000 deposit, Mr. Edwards was unable to go to Jackson Memorial Medical Center in Miami, a level one trauma centre, and instead had to go to University Hospital in Kingston, Jamaica.

He died nine days later.

There have also been questions raised whether Kaloyan Kisyov, a 20-year-old employee of Action Watersports who recently broke his neck on the job, and whether 19-year-old Shellesha Woodstock, who gave birth on a Cayman Airways flight to Kingston, had health insurance. Superintendent of Insurance Mervyn Conolly said the HIC was looking into both cases.

Mr. Conolly pointed out that health insurance is not an option for employees.

‘Section 5 (2) of the Health Insurance Law states that it is the responsibility of the employer to effect and continue, at a minimum, the Standard Health Insurance Contract 1.’

Employers, not employees, are required to make the premium payments for the cost of the health insurance, but they are allowed by law to deduct 50 per cent of the premiums paid from the employees’ earnings, Mr. Conolly said.

Although Mr. Edward’s employers paid $15,000 for the air ambulance and another $1,500 for an in-flight doctor, they are now liable for any medical expenses relating to the injury that would have been covered by insurance if he had it, as is set out in Section 12 of the Health Insurance Law.

‘If the employee has uninsured medical expenses because of failure or neglect of the employer to provide health insurance for his employee, then the employee or his estate, where the person dies as a result of the injury or illness while he was employed, is entitled to recover from the employer any benefit which would have been covered under the [Standard Health Insurance Contract 1),’ Mr. Conolly said.

In the Grand Court case concerning Air Tech Corp, it is not only alleged the company failed to take out insurance for an employee, but that it also deducted from the employee’s wages 50 per cent of the cost of health insurance anyway.

Some employers do not realise they had to have health insurance for their employees, but Mr. Conolly said ignorance of the law was no excuse.

All employees, whether they are on a full work permit or temporary work permit, are required to be under the policy of an approved insurer within 15 days of commencing work.

‘The law makes no exceptions,’ Mr. Conolly said, noting that some employers get confused because they are not required to pay pensions for people on temporary work permits, and they aren’t required to enrol foreign employees into the pension play until they’ve been on working on the island for nine months.

Mr. Conolly said he was aware that sometimes the insurance providers can take longer than 15 days to process the application.

‘In those cases, where there is a claim for uninsured medical expenses before the effective date of cover under the contract, the Commission could investigate and determine, based on the facts, who had responsibility for the delay or failure to effect the health insurance coverage for the employee,’ he said.

In addition to the employees, any unemployed spouses and school-age children of the employee must also be provided with health insurance. Although employers are responsible for ensuring these dependents are insured, they are entitled to deduct all of the additional cost to insure the dependents from the employee’s pay.

Mr. Conolly said employees who are refused insurance coverage because of a pre-existing condition can obtain coverage automatically through CINICO, the government-owned insurer.

In some cases, employers have taken out health insurance policies on employees but allowed them to lapse. Because of that, Mr. Conolly said many employed people only find out they don’t have health insurance when they actually try to use it

When policies lapse, as opposed to being cancelled when an employees leaves the company, the insurance provider is required by law to advise the Health Insurance Commission.

Most of Cayman’s approved health insurance providers are vigilant in advising the HIC of lapsed policies, but Mr. Conolly said a couple of them are not.

Mr. Conolly said the HIC knows there are a number of employees that are uninsured in the Cayman Islands. Latest figures supplied to the HIC indicate there are approximately 46,239 people insured, including those covered by CINICO, Mr. Conolly said. Depending on the source, the population estimate for the Cayman Islands is between 52,000 and 55,000.

In efforts to discover which employers aren’t insuring their employees, the HIC has had some recent meetings with Chief Immigration Officer Franz Manderson to discuss ways of ensuring foreign nationals who get work permits have health insurance.

The HIC also pays random visits to businesses to check health insurance enrolment of employees. Mr. Conolly said he hopes to hire another insurance inspector so more of these random visits can take place.

With health insurance suddenly at the centre of several news stories, a very timely event will take place next week.

The Cayman Islands Insurance Association will hold a conference on the topic of health insurance beginning next Wednesday. The conference will take a look at the mandatory health insurance scheme ten years into it.

Slated to speak at the conference, among others, are Minister of Health Anthony Eden; HSA Action CEO Lizette Yearwood; Cayman Islands Legal Department’s Legal Senior Legal Counsel Trevor Ward; and HIC Chairperson Suzanne Bothwell.

Comments are closed.