It has been “pretty much accepted” that the Cayman Islands civil service will have to start paying a portion of their own healthcare premiums by 2018, Finance Minister Marco Archer said Thursday.
Mr. Archer’s comments were made in response to a parliamentary question asked in the Legislative Assembly Thursday that sought to ascertain whether government had considered extending health insurance provided by Cayman Islands National Insurance Company outside of the government Health Services Authority.
Mr. Archer indicated that, according to government estimates, offering choice for healthcare coverage would increase overall costs of healthcare coverage. The minister said government was not keen to do so, given that healthcare costs now make up about 20 percent of the government’s annual budget.
Providing healthcare coverage for civil servants, pensioners and Cayman’s indigent population costs $106.6 million in the current government spending plan.
“Offering choice … will increase the government’s healthcare premiums and, more than likely, reduce the usage and service of the Health Services Authority,” Mr. Archer said. “Government will not be able to sustain or pay the expected increase in the cost of healthcare premiums on its own.”
North Side MLA Ezzard Miller, who asked the question about extending healthcare coverage, asked Mr. Archer how government intended to get civil servants to accept paying a portion of their healthcare costs without offering a choice of providers.
“It has already been pretty much accepted that the civil service will move to a co-pay by 2018,” Mr. Archer said. “It is the final details that are being worked out. It is accepted that they will move to co-pay with choice.”
According to rates provided to the Cayman Compass as part of a Freedom of Information request, retired pensioner rates under the Cayman Islands National Insurance Company plans go from $870 per month for non-married individuals, to $1,306 per month for non-married people with children, to $1,741 per month for married couples, and finally to $2,176 per month for the CINICO family plan.
Similar rates for working civil servants are $416 per month for single adults, $832 per month for married couples, $832 per month also for single adults with children, and $1,242 per month for families.
Those rates are covered entirely by the government. Civil servants and civil service pensioners pay nothing out of their own pocket for that coverage.
Both civil service plans under CINICO have a $5 million maximum “lifetime limit” for healthcare coverage. There are no limits on prescription drug purchases, inpatient or outpatient care. Overseas accommodations and airfare, if the covered government worker or retiree must fly elsewhere to obtain treatment, are covered 100 percent.
Mr. Miller said he did not understand why costs needed to increase, for civil servants or government, in order to provide choice in healthcare providers. He said he was aware of several local private providers who could provide services at the same rates government charged presently.
“There’s no need to predict an increase in costs,” Mr. Miller said.
Minister Archer said, if there were such providers, they would be required to sign contracts – as Health City Cayman Islands has done – in order to provide consultative or tertiary healthcare services. “We want to get what they said we would get,” the minister said.
Deputy Governor Franz Manderson told the Legislative Assembly last year that, while he understood the need to reduce the territory’s looming $1.18 billion future healthcare liability over the next 20 years, significant changes to the system could not be rushed.
“This is something that will take time,” Mr. Manderson said.
Mr. Manderson also clarified that while the elected government had the right to raise the issue of healthcare co-pays, it is the Cayman Islands governor who has authority for the terms and conditions of the civil service employment contracts. In practice, the governor delegates her authority to the deputy governor (formerly the chief secretary) as head of the civil service.
Mr. Manderson had not previously made any statements indicating that co-payment of healthcare premiums for civil servants was a certainty.