Insurance corner

Can you explain the responsibilities of the various parties under the Health Insurance Law and Regulations (as amended), and the penalties of non-compliance?

LHT

An employer representative may be subject to conviction and fines if found guilty for a) failing to effect health insurance coverage for the employees; b) making unlawful deductions from employees’ wages; c) failing to provide information on the insurance coverage to new employees within 15 days of their employment; d) obtaining insurance coverage fraudulently; e) failing to allow an ex-employee to extend his insurance coverage for up to 90 days; f) failing to cooperate with the inspectorate of the Health Insurance Commission; and g) failing to maintain accurate employment records.

Directors, officers, and managers are considered employer representatives for the purpose of the law, and can be held personally liable for any negligent action of the employer.

An employee may be subject to conviction and fines if found guilty for a) not keeping his employer informed on relevant facts to the extent that the employer incurs expenses that he would not otherwise incur, and b) obtaining the insurance coverage by making false statements.

Health care providers, such as physicians, are also subject to the law and regulations, and on conviction may be fined for their failure to file changes in their fees with the Health Insurance Commission within one month of any such change.

Health insurers and their representatives also face conviction and fines for a) operating without being approved; b) failing to provide the required reports to the Health Insurance Commission; c) failing to issue identification cards within two weeks of coverage being effected; and d) failing to inform the Health Insurance Commission, within 45 days, of the termination of an employer’s health insurance plan.

While most of the fines range from $5,000 through $10,000 per offence, the law provides for a fine of $20,000 and one year of imprisonment, on conviction, for the operation of an insurance business without approval.

Do you have a question on insurance? Email us at:

[email protected]

Or write to us at:

Sagicor General

P.O. Box 2171

Grand Cayman

KY1- 1105

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