Health Ministry & OBA On FutureCare
One Bermuda Alliance Shadow Minister for Seniors Louise Jackson said she “read with a sense of dismay the confirmation, issued by the Government’s Health Insurance Department late last week, that seniors who fall behind with their payment of insurance premiums are cut off from receiving benefits, including prescription medicines.”
“And the advice from the Health Insurance Department was that seniors who can’t pay their bills should seek financial assistance,” said Mrs Jackson.
“To seniors with little time left in their lives, dignity has an importance it does not have for young people. For some of them, asking for Financial Assistance means a loss of dignity, and they would do almost anything to avoid it.
“Some of them are land rich and cash poor, as they say, and know that in order to meet the conditions for receiving Financial Assistance they would likely have to lose their last remaining asset, as well as their dignity.”
“FutureCare should be a safety net for people who have spent their lives working for their children and their communities and who sometimes have little left to show for their work but their dignity.
“We should be trying to make things easier for them, not creating some bureaucratic nightmare. The Government should be looking at how they can use Financial Assistance to cover the shortfall when seniors find themselves unable to pay, so that appropriate health care can continue without interruption,” said Mrs Jackson.
A statement from the Health Ministry said, “When policy holders fall more than 30 days in arrears, their benefits lapse; this is the case with HIP, FutureCare and most other insurance policies. We notify policyholders of the lapse, and give them 60 days to bring their account balances up to date. However, if after 90 days there is no premium paid on an account, the policy is flagged as inactive.
“No insurer, public or private, can pay claims when premiums are not received to cover those claims. However, seniors can catch up with their premiums within 90 days and bring all receipts of prescriptions purchased during the period of arrears. The Department will reimburse them the FutureCare portion of valid claims. In essence, once the arrears premiums are addressed they will be made whole.”
“The Department has a flexible approach to addressing premium arrears. Once seniors have caught up with their premiums, they can bring all receipts of prescriptions purchased during the period of arrears and the Department will reimburse them the FutureCare portion of valid claims. In essence, once the arrears premiums are addressed they will be made whole.
“Any policyholder who is having financial difficulty in paying their premiums should approach the Department of Financial Assistance.”
The full statement from the Ministry of Health is below:
On March 7th, 2012, the One Bermuda Alliance commented on recent changes impacting seniors on FutureCare who were in arrears with their premium payments. To clarify the facts, the Health Insurance Department is providing the following information for the general public.
The FutureCare pharmacy benefit covers 80% of the cost of prescription drugs in Bermuda up to an annual maximum of $2,000 per calendar year.
In December 2011, the Health Insurance Department first advised FutureCare policyholders that if they had arrears in premium payments, they would need to make their accounts current by February 1, 2012. The series of notifications was as follows:
- The first letter was sent out on December 15, 2011 with the January 2012 FutureCare bills.
- The letter was re-sent to FutureCare policyholders who were in arrears for premium payments as a stand-alone letter at the end of January 2012.
- The Health Insurance Department sent a marketing message with the same information on January 25, 2012 at the top of the February 2012 bills sent to all FutureCare policyholders.
- The full letter was sent a third time to all FutureCare policyholders to remind them on February 21, 2012 with the March 2012 bills.
The letter is available on the Department’s website at: www.hip.gov.bm under the section entitled ‘Policyholders’. If premiums are not paid policyholders’ names will not appear on pharmacists’ list of policy holders with prescription drug coverage, and the individual is required to pay for the prescriptions until premium payments are brought up to date.
Termination of Health Insurance
When policy holders fall more than 30 days in arrears, their benefits lapse; this is the case with HIP, FutureCare and most other insurance policies. We notify policyholders of the lapse, and give them 60 days to bring their account balances up to date. However, if after 90 days there is no premium paid on an account, the policy is flagged as inactive.
No insurer, public or private, can pay claims when premiums are not received to cover those claims. However, seniors can catch up with their premiums within 90 days and bring all receipts of prescriptions purchased during the period of arrears. The Department will reimburse them the FutureCare portion of valid claims. In essence, once the arrears premiums are addressed they will be made whole.
More Accurate Information
The change in process was a response to pharmacies’ request for more accurate information. The pharmacy claims for persons in arrears with premium have always been rejected upon receipt by FutureCare. However, the pharmacies now receive more accurate information about who is current with their premiums.
This allows them to charge seniors who are in lapse status at the point of issuing the prescription drugs instead of receiving a rejection notice from FutureCare and then having to pursue seniors for the full payment of the drugs.
Alternatives for Seniors
The Department has a flexible approach to addressing premium arrears. Once seniors have caught up with their premiums, they can bring all receipts of prescriptions purchased during the period of arrears and the Department will reimburse them the FutureCare portion of valid claims. In essence, once the arrears premiums are addressed they will be made whole.
Any policyholder who is having financial difficulty in paying their premiums should approach the Department of Financial Assistance.
Impact on Policyholders
Aside from a few seniors coming and paying their back premiums, the Health Insurance Department has received few complaints on this matter. As usual, the Department invites any policyholder with questions to contact them at: 295-9210.
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Louise Jackson’s full statement follows below:
I read with a sense of dismay the confirmation, issued by the Government’s Health Insurance Department late last week, that seniors who fall behind with their payment of insurance premiums are cut off from receiving benefits, including prescription medicines.
A Government spokesman said this policy was no different from those in place at utility companies, which cut off electricity or telephone service if bills are not paid.
And the advice from the Health Insurance Department was that seniors who can’t pay their bills should seek financial assistance.
There are two points that I would like to make. First, the analogy with utility bills is completely inappropriate. With seniors, prescription medicines are necessary to the preservation of health, and sometimes of life itself. Comparing medicine to cell phone service is insensitive, to say the least.
And anyway, do you think, if a senior were on a respirator at home and failed to pay his Belco bill on time, that they’d cut his electricity off? I have a feeling Belco would be sensitive enough to try to find some alternative way of dealing with the situation.
To seniors with little time left in their lives, dignity has an importance it does not have for young people. For some of them, asking for Financial Assistance means a loss of dignity, and they would do almost anything to avoid it.
Some of them are land rich and cash poor, as they say, and know that in order to meet the conditions for receiving Financial Assistance they would likely have to lose their last remaining asset, as well as their dignity.
I’m not talking about a handful of people, this is quite a common attitude among seniors, well known to those people and agencies who deal with them on a regular basis.
Bureaucracies do not like to deal with awkward exceptions. They like one-size-fits-all policies, because they’re easier.
But there’s no easy work with seniors. They must be treated as individuals. That’s what doctors do as a matter of course, and I don’t see any reason why the Government can’t put some effort into doing the same.
FutureCare should be a safety net for people who have spent their lives working for their children and their communities and who sometimes have little left to show for their work but their dignity.
We should be trying to make things easier for them, not creating some bureaucratic nightmare. The Government should be looking at how they can use Financial Assistance to cover the shortfall when seniors find themselves unable to pay, so that appropriate health care can continue without interruption.
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The GHID need their ASSES cut these senior citizens have paid their dats to sociaty
and should be taken care of. The Government can find money when THEY need it well let’s take care of these people.
The budget debate on Health for today should be quite interesting. Let us all go to the House and see the debate in person or listen in on the radio.
and make sure you ask Zane how he is going to make that first $46,500,000 payment on the hospital in 2014…better yet ask him how the OBA is going to make that first payment
It is shocking what they do to the elderley. You can cut them off just like that. But yet we spend millions of dollars for Legal Aid Criminals, providing the best legal defense. On some cases providing them with QC’s. They have matters backwards. Take care of the elderly. Leave the crimals to find there own money for legal defense, they will find it. Come on Government turn off the Legal Aid money, and give to our Elderly. You all know what you have to do next election.
Every day a newer low! I keep hoping we’ve finally hit rock bottom, but no. Still more to come
The $1.7 million originally budgeted for legal services rose to $5.6 million in this year’s revised estimate. The 2012/13 estimate is listed at $3.2 million. So do the math lets see how much they spend on the criminals this year. You better start increasing the budget for Financial Assistance because we will have more seniors turning to them for assistance.
I find it curious the constant arguments presented by members of the public and the Honourable Opposition. On one hand spending is out of control and needs to be reigned in on health care in Bermuda and on the other hand there isn’t enough being done to help those that are finding it difficult to help themselves. Which one do you want? You cannot have it both ways… clearly the cost of health care (on a global scale just not Bermuda) is one that is escaping folks. FutureCare is not a charity programme – like any other insurer on island that offers health products it costs money. If you don’t take in premium from customers you CANNOT afford to pay claims that are submitted by the folks that are not paying and then have to dip into Government money to pay the claims and moreover asking for that money is not something that can be afforded right now. If you don’t pay your premium at Colonial or Argus or BF&M eventually your policy is terminated… FutureCare and HIP are no different; the Health Insurance Dept in regard to those plans works the same way but some how that reality is lost.
Luckily FutureCare is subsidized by the Government so that it is affordable. The true cost of FutureCare is a little over $1000/month (if you went to a private insurer) but is offered at $635 and the rest of that premium is eaten by Government. Could the premium set for FutureCare been more appropriately costed at the beginning… YES most definitely – it is the enormous subsidy of the programme that was too much for Government to bare and why the Opposition and the Health Council published reports of a health system potentially costing a billion a year if spending, like the subsidy on FutureCare at 2009 levels, continued. Not to mention the other costs like prices at the hospital which Government is looking at capping to make BHB more accountable for their part of health costs in this country.
FutureCare cannot be a safety net, if there is one it is the Age Subsidy that is provided for those 65+ after they come into the Health Insurance Dept. and apply for a Certificate of Entitlement (which wants to know if you are an ordinary resident) and there you have it a saftey net which your tax dollars fund for the elderly for treatment at the hospital covered at 80% – 90% dependant on age range over 65 years. There is also the Indigent Subsidy which is for folks that cannot afford care at the hospital, the Government pays for those claims as well… and then there is the Geriatric Subsidy which pays for folks that cannot take care of themselves and are in the Continuing Care Unit at the hospital. And then there is Financial Assistance which (thank goodness) is changing their criteria so that seniors with homes can get help for bills if they are land rich and cash poor.
So all these things are done which cost 10′s of millions of dollars a year just for the elderly along with all the other subsidies in different Government Dept’s long before the PLP got in which they have added to and continued BUT still it isn’t enough and the Opposition wants MORE. But on the other hand the Opposition says the Gov’t is spending too much. You cannot have it both ways my friends… could the system be better… YES, but is Nothing being done… def. NOT. And I am sorry but pride should not stand in the way of seniors getting help and where are their families to aid them… this is a small community. We must help each other because Bermuda has lived beyond its means for generations long before the PLP government so let’s not be short sighted and believe the opinions of Mrs. Jackson (she has served our country well however she is presently doing the community a disservice by spreading half truths and jaded “facts”)
Jay,
This is what Dr Ewart Brown said in the election run up in December 2007:
The first is the free day care scheme which would be Island-wide, means-tested and would use existing facilities and churches. Asked how much it would cost, Dr. Brown said: “We do not have a figure but guess what? Whatever it costs we will do it.”
He said the idea was to take away the financial burden of paying for day care from young Bermudians.
The other initiative is Future Care, a scheme which Dr. Brown said would provide comprehensive health care and insurance beyond what’s currently offered by HIP for seniors aged 65 and above.
He said it would give “access to effective, safe and affordable health care coverage at a time when it’s needed most”
He said he didn’t care what these 2 “give aways” would cost, which is why 4 years on the Government has no money and is borrowing $200 million a year. By the way, up to 2004 which included nearly 6 years of PLP Government, Bermuda lived within its means and had a surplus most years.
I also agree with the comments made by Alsys says.
@Jay, it’s not having it both ways. The Opposition and those of us who are just concerned citizens want the gov’t to stop FRIVOLOUS spending not stop spending altogether. Don’t be so disingenous. I have no problem with us subsidizing our seniors in need. I do have a problem with the gov’t paying for unnecessary cars and their resulting expenses, trips overseas for non-essential travel with their entourages, paying a bloated civil service when efficiences can be realized and cost overruns on capital projects. These and other things are the “spending” that is consistently being referred to.
Can someone have it both ways? No. But if you are choosing to equate assisting seniors in need by not cutting off their prescription after 30 (!!!) days of non-payment with spening 4k a night for non-essential hotel stays, you are severely confused.
Jay….to add to the other responses to your post..! ALL of the ‘for profit’ Ins COs waived the prescription drug customer co-pay if the customer accepts a generic version. Only FutureCare does NOT do this- even though it save BOTH them and the customer $$$ as generics are about 30+pct cheaper!
I have previously brought this to the direct attention of the Minister and his senior staff—yet nothing gets done!! So THAT is an example of the indifference to seniors and others that is NOT based on race or political preference–of which I have none–except to say shame,shame on them!!