The Health Insurance Commission is working toward seeing several major changes in the health insurance industry.
Speaking at the Cayman Islands Insurance Association’s Health Insurance Seminar on Wednesday, HIC Chairperson Suzanne Bothwell said there are an increasing number of complaints regarding the practices of some approved insurers and healthcare providers.
‘Some of these issues are not yet resolved, but have been discussed with industry stakeholders with a view to resolving them in a mutually beneficial way,’ she said. ‘The issues… are viewed by the HIC as seriously undermining public interests and the underlying principles behind the regulation of the health industry in the Islands.’
Among the issues Mrs. Bothwell listed were the portability of insurance policies; the inconsistent position taken by insurers regarding pre-existing conditions; insurance coverage for senior citizens and the failure of the industry as a whole to market to individuals; the failure of the healthcare providers to complete claim forms for patients; the absence of an industry standard regarding healthcare providers being able to confirm coverage for patients with insurance cards; and the failure of improved insurers in fulfilling their filing obligations under that law.
During the period between July 2006 and June 2007, the HIC received 531 complaints, Mrs. Bothwell said, adding that about 70 per cent of the complaints were resolved, closed or referred.
Mrs. Bothwell said she hopes final resolution to the various concerns could be achieved quickly, either by industry initiatives or through dialogues though the HIC office.
‘For the upcoming year 2008, the Health Insurance Commission Board will be expanding its agenda to vigorously tackle these issues,’ she said,
The issue of portability of insurance has been dealt with before, but not fully.
When health insurance first became mandatory, if a person changed insurers as a result of changing jobs, they had to go through an underwriting process.
HIC Board Member Geoff Scholefield said the law was changed.
‘Now people can have at least the standard plan, where before they could have had nothing at all,’ he told the attendees of the seminar.
However, if a person who has changed jobs wants to get something better than the standard plan, he or she would have to go through underwriting and the possibility of having exclusion put on the policy or of being rejected.
During the seminar’s panel discussion, one member of the seminar’s audience called the limits of the Standard Health Insurance Contract ‘woefully inadequate, particularly the $25,000 per incident limit.’
Another issue being looked at by the HIC concerns a failure by employers and insurers in making it known to ex-employees of companies that there is a provision in the law to enable the extension of their coverage for a limited time.
Speaker Trevor Ward, acting senior crown counsel of the Cayman Island Legal Department, explained that employers have no choice but to extend the coverage for an ex-employee for up to three months if the person remains unemployed and asks for it to be extended.
‘If an employer fails or refuses to do so, the law sanctions that,’ said Mr. Ward. ‘The parting [of employment] might not have been under the most pleasant of circumstances, but the employer must still cover the employee.’
The ex-employee, however, must bear the full cost of extending the insurance, Mr. Ward said.