The vast majority of residents living in the Cayman Islands now have health care coverage, according to figures presented by Health Minister Osbourne Bodden, and in many cases, that health insurance coverage is better than what was previously offered.
But the improvements have come with a cost.
According to figures reported by the Health Services Authority, exactly 52,006 people in the Cayman Islands possessed some form of health insurance during the government’s 2011/12 budget year, up from 48,316 people covered just a year before – a 7.6 percent increase.
“This represents over 90 percent of the population with health insurance coverage,” Mr. Bodden said last week.
In addition, changes made by the previous government administration to the territory’s standard health insurance contract – the minimum requirement for health insurance in Cayman that took effect on March 1 – boosted coverage requirements for insurance plans.
Under the former regulations, the standard contract covered only $25,000 per episode of illness, a stipulation removed in the revised version. The new version retains benefits of $100,000 per year in medical fees and $1 million during the lifetime of the policy. The new health contract covers 80 percent of $400 for doctor office visits, radiology and laboratory work for diagnostics and physiotherapy with physician referral, compared to the old benefit that provided just $100 per year for those services.
The current health contract also covers wellness benefits, including routine physicals, annual exams, nutrition counseling and one dental examination, up to 80 percent of $200 per year. There was no provision for wellness benefits in the previous plan.
Other items that are covered include 80 percent to the coinsurance maximum and thereafter 100 percent up to $25,000 per lifetime for inpatient mental health care and 100 percent of the first $4,000 outpatient services for emergency medical care, including medication and ambulance provision, and then as per applicable benefit category. Air ambulance use is also fully covered up to $15,000 per annum, based on medical necessity.
Because of the increased benefits provided, most Cayman Islands residents on the standard health-care plan have seen medical premiums rise by at least 50 percent since March. The cost increases were rolled out as health insurance policies have been renewed.
The costs associated with those added benefits could even see some premiums double in price depending on risk factors and the type of coverage plan, the Health Insurance Commission said. The exact amount that each policy will increase will vary depending on risk factors and the level of coverage. About one in three Cayman Islands residents are on the standard health insurance contract and they have seen the most significant increases.
Also, fees charged to those health-care plan recipients to assist in supporting indigent health care doubled from between $5 and $10 per month to $10 and $20 per month.
According to Minister Bodden, the collections aimed at offsetting a portion of the cost of indigent care were just more than $2.4 million for the 2011/12, prior to the costs being increased via the standard health insurance contract. Those payments are placed in a “segregated insurance fund,” which is managed by the Health Insurance Commission. The increase in collections is expected to raise about $5 million a year for the fund.
Almost one-fifth of the Cayman Islands government’s budget goes towards health-care costs. Of that amount, 22 per cent is spent on indigent care – about $20 million a year. The costs covered by the segregated insurance fund are a small percentage of the amount Cayman pays each year for indigent care.
The government regulates the standard health insurance contract plans, but it does not regulate other plans offered by insurance companies.
The revised Health Insurance Law’s regulations also make it more difficult for an insurance company to turn down applicants with pre-existing conditions or to refuse to insure a person on any grounds.
A health insurer will have to present a case to the Health Insurance Commission if it wants to refuse to insure an individual. Prior to March 1, if two insurance companies turned down a person for coverage, that person would be deemed uninsurable and would then be liable to be covered under the government’s Cayman Islands National Insurance Company, with the premium paid out of the public purse.
Under the revised law, a private insurer must give a reason to the Health Insurance Commission why a person seeking insurance coverage has been turned down.
According to figures provided by Mr. Bodden, the Cayman Islands National Insurance Company, or CINICO, is still insuring the largest number of people in the islands, at 14,164.