Health insurance cap to go

Minister plans sweeping change to health care laws

Some maximum health insurance
coverage amounts – known as “caps” – will change this year if Cayman Islands
Health Minister Mark Scotland gets his way.

Currently, the country’s standard
health insurance contract sets maximum coverage limits per incident of illness
at $25,000.

Mr. Scotland said Cayman’s Health
Insurance Commission has recommended that per incident cap on benefits be
removed.

Yearly maximum coverage limits of
$100,000, and lifetime coverage limits of $1 million will remain, the minister
said.

Mr. Scotland said the proposal
would help fix what has been a major problem with health care coverage in
Cayman, as well as keep insurance premiums affordable for businesses and their
employees.

The $25,000 limit on health care
coverage per incident was blamed for causing the death of a woman who was
injured in a car accident in a relatively recent local case.

A vehicle hit Carol Romero as she
walked across Shamrock Road in January 2008. She suffered severe head injuries
and had to be flown off island to receive care. 

Ms Romero was hospitalised and
initially appeared to be recovering. When her health insurance ran out she had
to be transferred from the facility she was in and ended up at a Honduras
hospital indigent patient ward where she eventually died.

North Side MLA Ezzard Miller said
the maximum coverage caps were just one area where Cayman’s health care system
needed to change.

“To say that there is no great
confidence in the Health Insurance Law in this country is an understatement,”
Mr. Miller told members of the Legislative Assembly last week.

Mr. Miller had submitted a private
members’ motion in the house seeking to form a select committee to review the
country’s Health Insurance Law and bring necessary changes to the LA by the
second meeting of the next fiscal year – probably around September.

Mr. Miller recommended a number of
changes including altering the make-up and current structure of the Health
Insurance Commission, which he said was “ineffective” at supervising the
private health insurance industry.

He proposed charging a half per
cent or one per cent levy on health care premiums that would pay for regulatory
regimes in the Cayman Islands health care system.

The North Side MLA also suggested
that government approach health insurance companies who had previously told the
Cayman Islands that they could not cover people with pre-existing health conditions
because their parent company in the US forbade them to.

A health care reform proposal
passed last week by the US congress would no longer allow insurance companies
to deny health care coverage based solely on pre-existing conditions.  

“How many (health care providers)
will contact the Health Insurance Commission this week? I have a strong
suspicion that’s not likely to happen,” Mr. Miller said. “Profit is more
important.”

Minister Scotland said his staff
was already drafting changes to the Health Insurance Law (2005 Revision) and
regulations, as well as the Health Insurance Commission Law, 2003. He did not
state when amendments to those might come before the Legislative Assembly.

Among the other changes proposed:

*Allowing for “portability” of
health care coverage, Issues often arise when an individual who is employed
with one company switches jobs and cannot receive health care coverage in the
new post because they have developed a condition like diabetes or hypertension.
Mr. Scotland said the current law is too vague and does not really prevent
insurers from denying those who need health coverage.

*Increasing maximum coverage for
things like in-patient and outpatient services, as well as emergency
transportation for patient air lift. Right now, the current benefit is limited
to $4,000 per calendar year for air transport – the new proposal would increase
that limit to $15,000.

*Exploring the potential for
electronic claims processing. This would speed up health care claims and allow
health care providers to receive more timely payments from insurers.

*Elimination of a loophole that
allows health insurers to treat pregnancy as a pre-existing health condition.

*Allowing retired people to
purchase the standard health insurance coverage without any underwriting.

*Giving the Health Insurance
Commission the ability to fine employers who do not pay for workers insurance
without taking the case before a magistrate. Fines for non-payment convictions
in Summary Court would double or triple in most cases.

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