From BVI Beacon

With registration for the National Health Insurance programme set to begin on Tuesday, residents are bracing for widespread changes to the territory’s health care system.

Many of those changes are expected to be positive, with thousands of uninsured residents soon to receive coverage.

Others likely will be painful, including increased taxes for employers and employees, layoffs in the private insurance industry, and reduced coverage at an increased cost for many residents who have to switch from private plans to NHI.

But for some, what is most striking is how many questions remain unanswered four months before the plan is scheduled to take effect.

Sarah Hatcher, president of the Insurance Association of the BVI, said private insurers still haven’t received enough information to adjust to the impending transition.

Because of that, the IABVI released a lengthy statement on Tuesday night laying out some of the industry’s questions and concerns.

“We’ve been talking to NHI officials throughout the process as individual insurance companies,” she said, adding that they felt that many of their concerns weren’t being taken into consideration. “So when NHI was announced that it would be going ahead, the Insurance Association thought it would be better to act collectively.”

Out of office

Government administrators in a position to provide answers were unavailable to the media this week.

An employee at the Social Security Board told the Beacon that SSB Deputy Director Roy Barry, who oversees the board’s NHI division, is on vacation all week and won’t be back in office until Monday.

Other NHI officials said they were in meetings and training sessions all week, and thus could not grant interview requests made on Monday and Tuesday. Nor did anyone respond to an e-mail sent to the SSB and the Ministry of Health and Social Development on Tuesday morning.

Nonetheless, much information has been disclosed in recent days: Administrators have begun an informational campaign, publishing a brochure, a revised benefits package, and a frequently-asked-questions page about NHI.

Those items lay out some of the basics about what the programme will cover, what various services will cost, and what people need to do in order to register.

Unanswered questions

However, the unanswered questions are wide-ranging.

“We’ve sent a list of 20-odd questions that are technical in nature,” Ms. Hatcher said.

Many of the undisclosed details have to do with how claims will be processed: how many people will be on staff to handle NHI claims; what standards the Medical Review Board will be held to for evaluating claims; whether residents will be able to appeal a claim rejected by the MRC; and other related details.

Private insurers also say they need more information about the exact schedule of benefits that will be offered by government, and claim they cannot design supplemental insurance policies for potential customers until they have that information.

“They have released the revised benefits package, but there are a lot of technical questions that surround it,” Ms. Hatcher explained. “For example, do they have staffing and systems in place to deal with the volume of claims? Because obviously … as the second insurer we need to know whether a claim has been accepted or rejected before we can step in.”

The IABVI also has questions about the relationship between NHI’s mandatory scheme and the private supplemental schemes: Ms. Hatcher said it could be the case that supplemental insurance can only be used on services that aren’t covered by the NHI.

For example, NHI officials might have to sign off on a request to use a supplemental package to pay for childbirth overseas, she said.

“Whether they’re going to do things that way, we don’t know yet,” she said. “But given the rhetoric that this is mandatory, then insurance companies will not take you until you’ve been signed off through that scheme.”

Months needed

Even after those details are released, it will take private insurers several months to design supplementary packages, insurance executives said.

Based on the expected cost of NHI and what it will cover, insurance industry stakeholders expect supplementary packages to be unaffordable for most residents once the NHI’s 7.5 percent tax goes into effect.

As a result, a majority of insurance agents who work in medical departments will be laid off, according to the IABVI.

“Members of the IABVI would like to offer their customers supplementary or top-up plans, but due to the expense of NHI, they do not feel that this would be affordable to most customers,” the organisation announced Tuesday night in a press release. “Therefore, all firms who employ staff in medical departments will have to make the majority of their departments redundant as a result.”

Ms. Hatcher estimated that the layoffs could affect around 24 employees in the private insurance industry.

In its statement, the IABVI listed 10 questions about the NHI implementation process, including the following:

• What staffing and systems are in place to handle claims, which are estimated to be a minimum of 200,000 per year?

• What reinsurance has the government purchased?

• What is the composition of the Medical Review Committee and how will it function?

• What will happen to patients who will require more than 30 days hospitalisation?

The IABVI also released a series of projections, comparing NHI’s cost to private insurance, estimating the number of claims NHI will have to handle, and estimating how much money it is expected to raise.

For most people, the cost of health insurance will increase, according to the IABVI.

“Based upon average health insurance premiums across the BVI, the cost between the employer and employee for NHI is generally more expensive than the cost of private health insurance,” according to the organisation’s statement.

NHI is generally more expensive than the cost of private health insurance,” according to the organisation’s statement.

The group added that the projections don’t take into account the fact that workers will have to pay an additional 3.75 percent if they have unemployed spouses, which will further increase the cost of NHI.

That increased cost will likely provide less coverage than private insurance, too, the IABVI claimed.

For example, the typical private insurance package in the VI has a $2 million lifetime limit – double that of NHI, according to the group.

Along with the projection that NHI will cost more for most people than private insurance, the IABVI also predicted that the Medical Review Committee will be saddled with a massive number of claims that require pre-approval before treatment.

IABVI members handle about 6,315 such “pre-certified” claims per year, which equals roughly 17 per day, the organisation stated.

When the approximately 28,000 residents are all enrolled in NHI, the MRC could have to handle about 10,000 pre-certified claims per year, which is about 27.5 per day. Ms. Hatcher said about 40 agents will probably be needed to handle so many claims.

The IABVI also released projections as to how much money will be raised by NHI taxes.

“Based upon an average salary of $40,000 per annum, and 100 percent compliance of collection, NHI would collect $54 million per annum,” the release states.

According to the 2015 budget estimates, the Ministry of Health and Social Development will allocate about $54 million to NHI between 2015 and 2017, with about $17.3 million coming this year.

Added to the $54 million figure quoted by the IABVI, that puts the funds at just above the $70 million figure that government officials said they expect NHI to cost in its first year. However, that assumes full compliance with payments — and that the territory’s average per capita income is $40,000 per year.

The IABVI also estimated that at least 15 percent of the premiums NHI collects will have to go towards administration expenses.

For more on this story go to: http://www.bvibeacon.com/1/index.php/news-articles-2/2001-august-27-2015/local-news-august-27-2015/7286-questions-remain-as-nhi-registration-looms

IMAGE: thinkprogress.org