Fifty-One Group Health Plans Are Cancelled
The Health Department is cancelling 51 employer groups due to non-payment of premiums, Government announced this morning [Mar.26].
Speaking at a briefing on the new premiums being introduced for Government’s Health Insurance Plan [HIP] and the FutureCare programme for seniors, Health Minister Zane DeSilva said the group policies are being cancelled because the employers have been in premium arrears for more than 90 days.
“In some cases, these employers have not paid a premium in more than a year,” he said. “This will impact approximately 175 employees.”
The Minister said the Health Department has been in contact with the employers to resolve these outstanding premiums.
He added that the process has included notifying groups via letter, phone call and by setting up interviews to discuss with them the status of their accounts.
“The Department started the group clean-up project in February 2011 and the progress has been extremely slow in having employers address their premium arrears, ” said Mr. DeSilva.
Minister De Silva and the Director of the Health Insurance Department Collin Anderson
“We have attempted in all situations to work with employers. At times, we have referred employers to the Compliance Section of the Department of Social Insurance to formulate payment plans for arrears premiums. We stand ready to work collaboratively with any of our employer groups.
“HIP and FutureCare are insurance products providing good basic benefits at an affordable price. It is not unreasonable that group policyholders make their premium payments. The Department wishes to remind all employers and self-employed persons of the requirement under the Health Insurance Act 1970 to provide and maintain insurance coverage for themselves and all employees. Under the Act, licensed insurers are also permitted to terminate policies for non-payment of premium. The implication for these group policy terminations is that employees under these groups will be terminated.”
The Minister concluded: “We are ready and able to help individual employees with individual policies while the Employer compliance issues are dealt with at the Bermuda Health Council and the Department of Social Insurance. However, we recommend that employees actively pursue their employers in the first instance regarding their health coverage status as it is the employer’s responsibility to pay on their behalf.”
The Minister’s statement appears in full below:
Good Morning Ladies and Gentlemen,
Today I am here to announce the new premium rates for the Health Insurance Plan (HIP) and the FutureCare Plan which become effective April 1st, 2012. Additionally I will provide a briefing on Group Insurance Policies with the Health Insurance Department and comment on a new initiative, the Department’s revised Explanation of Payments for providers.
Under the Health Insurance Act of 1970, the Health Insurance Committee manages several of the Government’s insurance plans, including the Health Insurance Plan, or ‘HIP’, and FutureCare – a plan designed for persons over the age of 65 which provides comprehensive benefits.
Annually the Health Insurance Committee seeks advice from its Consultant Actuary and reviews the annual actuarial report for HIP and FutureCare. The Committee submits a recommendation to the Minister of Health for the setting of the premium, which is ultimately decided by Cabinet.
2012/13 HIP Premium
The HIP premium will increase on April 1st, 2012 from $385 to $390 per person per month. This is a premium increase of $5.00. This premium is the sum of the Standard Hospital Benefits Premium, including the Mutual Reinsurance Fund premium, and the HIP Supplemental Benefits premium. There will be no change in benefits. As of December 31st, 2011, HIP had 3,353 policyholders.2012/13 FutureCare Premium
Last year, the FutureCare premium for those on Phase 1 was $375 per month. The premium for those entering the program in Phase 2 and 3, from April 2011 was $635 per month.For the fiscal year starting April 1st, 2012, the FutureCare premium for Phase 1 policyholders will increase from $375 to $385 per person per month. The FutureCare premium as at April 1st, 2012 for Phase 2 and 3 policyholders will remain the same at $635 per person per month.
The FutureCare Fund ended its third year in a strong financial position. We expect FutureCare’s claims to increase significantly in future years and this first year’s positive results are not an indication that we will move forward without careful planning and prudent actuarial analysis.
There will be no change in benefits for FutureCare in the fiscal year starting April 1st, 2012. This marks the fourth year that the benefits have remained the same and it will provide us with good actuarial data to plan for the future. As at December 31st, 2011, FutureCare had 2,919 policyholders.
The Ministry is prudently managing HIP and FutureCare. Our external actuaries provide advice to ensure the sustainability of the Funds. Appropriate premiums are required to ensure FutureCare and HIP can pay claims. This means we must be both fiscally and actuarially responsible. We are aware of the difficult economic times and as such we have only implemented moderate premium rate increases for HIP and FutureCare Phase 1 policy holders.
Group Insurance Policy Update
The Health Insurance Department is in the process of cancelling several health insurance policies with employer groups due to non-payment of premiums. The cancellations of these policies impacts approximately 51 employer groups who have been in premium arrears for more than 90 days. In some cases, these employers have not paid a premium in more than a year. This will impact approximately 175 employees.The Department has been in contact with the employers to resolve these outstanding premiums. The process has included notifying groups via letter, phone call and by setting up interviews to discuss with them the status of their accounts. The Department started the group clean-up project in February 2011 and the progress has been extremely slow in having employers address their premium arrears.
We have attempted in all situations to work with employers. At times, we have referred employers to the Compliance Section of the Department of Social Insurance to formulate payment plans for arrears premiums. We stand ready to work collaboratively with any of our employer groups.
HIP and FutureCare are insurance products providing good basic benefits at an affordable price. It is not unreasonable that group policyholders make their premium payments. The Department wishes to remind all employers and self-employed persons of the requirement under the Health Insurance Act 1970 to provide and maintain insurance coverage for themselves and all employees. Under the Act, licensed insurers are also permitted to terminate policies for non-payment of premium. The implication for these group policy terminations is that employees under these groups will be terminated.
We are ready and able to help individual employees with individual policies while the Employer compliance issues are dealt with at the Bermuda Health Council and the Department of Social Insurance.
However, we recommend that employees actively pursue their employers in the first instance regarding their health coverage status as it is the employer’s responsibility to pay on their behalf.
Explanation of Payments
Finally I would like to comment on another step that the Department is taking to improve upon its turn-around-time for paying medical providers. Over the next few months, the Department will be changing the format and process for the Explanation of Payment (EOP). The EOP is the way that we inform medical providers of the items that we have paid or rejected for claims submitted. The Department incorporated requests from Providers to make the new EOP format more easily understood.The upcoming changes are:
- A new EOP format which will be easier to read and will offer Providers more information.
- Timeliness for payments and EOPs will be greatly improved, as we will move from a monthly to a weekly claims payment cycle.
- The new EOP will not be accompanied by payment for the services. Payment will be sent under separate cover. The EOP number will be the identifier for both the payment and the mailed EOP document and will allow Providers to post and reconcile the payments.
Implementing this change will enable the Department to dramatically reduce its turn-around time for claims reimbursement.
Additionally, it is our hope that we can also remit all payments to medical providers electronically. We are sending out Electronic Payment Agreement Forms to be completed by medical providers. It is to their benefit to complete them and return them to us for quicker claims payments.
These changes will result in more timely mailings and improved quality control, as the changes in the process will help to bring our department in line with the practices of large international and national insurers. This step is one that equips the Department to meet the 30 day turn-around-time deadline for insurers to pay outstanding claims as part of the newly passed up-front payments bill.
We trust these are welcome changes for our Providers and we look forward to continually improving our services over the course of 2012.
Thank you.
Wait…. what??
Name the employers.
Agreed, the employers names and the responsible management of these companies should be named in the newspapers.
I wonder if the employees of these groups know that their policies have been cancelled, and if they were paying premiums from their cheques for the last year than what has happened to their money.
That is a great question Alicia, I wonder what the Employers did with their employees money that they deducted from their cheques and SHOULD have been putting towards their health plans but were not…
Unfortunately they find out when they go to a doctor or a pharmacy to pay for a service, as was the case with employees of a certain supermarket recently. Goverment really needs to step in and protect employees whose employers continually deduct funds for pension, medical etc., and don’t do the right thing with it. That is fraud and theft on multiple counts….
What is the Attorney Generals office waiting for!!!
This is definitely a problem especially if the employees have not been made aware of their employer’s negligence. I don’t recall reading anything above stating the individual employees have been notified about their cancelled policies and I agree that if the employees have been making their contributions all the while then their monies most certainly need to be accounted for. This is ridiculous, shaking my head. Sigh
I hope that Minister De Silva has educated the employees of the individual plans and seen to it that each affected employee has had an opportunity to transition from the group plan to the individual plan before cancelling the group plan. Otherwise, should an employee require medical assistance between today and when they are successful in applying for the individual plan they will be uninsured. The goal here should be to punish the employer. However, as I have understood the press release, it appears the employee is getting the cane; and it appears to be a very expensive and unexpected cane, I might add.
The employers should be publicly named. How is an employee to know if their employer is one of the 51 whose group plans are being cancelled for default. All of the commentary in the press release speaks of Government dialogue with the employer. It is the employee that will suffer as a result of not being covered. What dialogue has Minister De Silva facilitated with these 175 households that their insurance was at risk and that it is now cancelled? I’m hoping that this has happened.
The employees should sue the employer for fraud if the premiums have been deducted but not applied to the health insurance programme. Too often I have heard of this happening and now there is clear evidence of non-payment in the wild. This should be collected by the employees and a suit brought against the employer. By naming the employers previous employees would be able to ascertain if they too were defrauded and participate in the suit.
I’ll also note that I heard of similar deductions from employees salaries for social insurance with the payments never making it to Government. This too should be looked into.
Ride
Maybe I missed it when I read, but have the employees involved been contacted, or just the employers? And if not, then either the employees should be contacted directly, not leaving it to their employers to fill them in, or the employers names made public so that the employees can find out. Far quicker than everyone calling the Health Department to find out if they’re involved.
I imagine a lot of the cash just went trying to meet payroll some weeks – there is a recession going on in case anybody has not noticed.
That is not an excuse. These people work and therefor must be insured. The employer can cut down on their lavish lifestyle.
Seriously, we are probably on the same page: I would suggest that a cut in pay is better than not being insured and it needs to be made abundantly clear to employers that this is the preferred course. However, I doubt most small business owners (51 businesses, 175 employees the minister referred to by the minister) live lavish life-styles. Many struggle; trade receivables are a huge issue for many businesses at the moment, i.e getting paid for the work that you do. At a certain point, a business person has to ask why bother anymore if his/her best efforts are not being rewarded and are instead being killed by costs such as taxes to support a huge Government infrastructure or health insurance to support a very inefficient medical establishment (I know of a number of practices that really stuff it to the insurers, bet you know who immediately comes to mind).
You’re right ofcourse, hard times for people and just to make payroll, but they deducted this amount from the employees, so they should have paid the bill. Hard but not impossible.
Victor,
Try to understand. That money does not belong to the employer and they do not have the right to use it for payroll o anything else. Case closed! How would you feel if a member of your family got ill and had to go to the doctor and found out that (a) they had a life threatening disease that would need months of treatment and (b) they had no insurance because their employer did not use the money to pay for their insurance but instead used it for payroll. Once your payments are delinquent for X amount of days the policy is void and they will be denied coverage. Try getting insurance after you have a pre-existing condition…good luck there. Their choices are then, pay for the treatments out of their own pocket (if fortunate enough to be able to afford it) or go without.
I agree with many of the sentiments above for sure. If employees have had money deducted from their checks then they should certainly have an opportunity to assume the responsibility for thier own accounts and remain insured. But as Victor reminds us, there is a recession going on as desperate times will lead to desperate measures. I imagine that they employees are well aware of the situation in many cases. If the boss says he can’t afford to pay the employees wages, payroll and insurance but is willing to get creative and only pay the wages I’m sure many employees would accept it being happy to still have a job.
I’m sorry, I understand that perhaps their heart might be in the right but they do not have the luxury to make that call. It could mean the difference between life and death. Many employees might agree to that out of desperation and think its an OK idea, UNTIL one of them get seriously ill. Trust me on this one, I was the biggest complainer of insurance until I was involved in an accident that landed me in hospital overseas. If my employer had not paid my insurance I would have been denied full treatment as there is no way I would have been able to pay the $340K in medical bills. You can not play Russian Roulette with someones health. It would be far less cruel to reduce hours and keep them insured or lay off some staff giving them the ability to seek employment elsewhere.
That is fraud at its highest level. When the employer deducts the monthly expenses from the employees salary, it should be passed on to the correct facilities. Some businesses have been doing this sort of thing waaaaaaaaaaaay before the recession and for many, many years. They now will use the recession as their excuse.
TO VICTOR AND TWO SIDES SAYS: How would you feel to find out that your employer has being taking deductions from your salary and not passing it on? They are stealing from you, not getting creative, bottom line. They can blame the recession if they want. This is totally unethical. Most of the employers who do not pass forward the deductions are only looking out for their own self interests and don’t give a damn about the employee. I have heard it said by certain employers that the employees should just be glad to have a job. Mind you some of these theives are upstanding good christian folk.
I totally concur – all I am saying is make sure the money gets paid where it is meant to go without another twenty or thirty small businesses going to the wall. I doubt you realize how hand to mouth many businesses are at the moment, not to mention many in negative equity.
Name and shame all the employers involved. Plus, name all the non-payers of Social Insurance. They’re all making ‘stoppages’ from employee’s wages, and keeping them.
Bernews, would you mind letting the readers know that they can check their social insurance payments online. All they need is their Social Insurance number and date of birth. It simple. PLEASE, IF YOU KNOW SOMEONE THAT IS NOT COMPUTER LITERATE HELP THEM OUT BY CHECKING FOR THEM BEFORE IT IS TO LATE AND THEY TOO FIND OUT THEY HAVE BEEN A VICTIM.
Go to website: http://www.gov.bm/portal/server.pt?open=512&objID=258&&PageID=226868&mode=2&in_hi_userid=2&cached=true
Chances are that if their Social Insurance is not current neither will their pension contributions and POSSIBLY even their health insurance.
Many Pension Programs are easy to check online as well. Many allow you to monitor your payments, check your portfolio and make sure your pension (your future) money is being paid on your behalf.
The employee is the victim here. If for whatever reason the employer realises that they cannot make the health insurance payments, they should at least have the guts to tell the employee and let them decide if they want to continue the insurance plan on their own. Deductions SHOULD NOT be taken from wages. It is theft anyway you look at it. Employers have to held accountable for breaking the law.
no goin miles market …………. is better then payin for insurance SERIOUS
ANY way they should all be exposed and takin 2 court
but let a young person get caught for a spliff umbeviable
IF THEY DONT POST THEN ALL WILL GET EXPOSED ITS SIMPLE
WHAT U DO BEHIND CLOSED DOORS WILL COME OUT IN DE LIGHT
wtf was that? …abc…..?
This is a joke, a year of not paying premiums that should have been paid to government, that were deducted from employees…. it seems like fraud is the order of the day. What happened to the social insurance inspectors whose responsibilites are to investigate these types of issues and to protect the employees. This is theft, plain and simple. But there is an election coming so government won’t be to heavy handed. When will people learn to stand up for themselves!!
Name them Minister. Don’t defend their actions. They stole from the employee and Government. These employers are PUNKS!
@Liars says
WATCH UR MOUTH OR ELSE SOUND LIKE GUILTY CONSIENCE EH ……………….
WATCH WHAT U SAY
Around & around it goes. How about vendors who have provided services to Government but Government is months & months in arrears in payment for services?
How about the Government Finance Ministry which is months & months behind in forwarding funds from places like Civil Court where money has been paid, forwarded to the Finance Ministry where it sits or disappears to places unknown.
Don’t try to call these people. They don’t answer phones. Don’t bother leave a message either. They don’t return phone calls.
Maybe the answer is to withold paying taxes owed till money owed from Government is recieved.
What a wonderful financial state Bermuda is in!
ya look out employers now not only are they going after your import costs, your land taxes, your gas prices….now they want your dignity too!
I hope Minister DeSilva is doing his part with his employees and there monies that are being deducted from there pay packets.