The Tribune

By NATARIO McKENZIE

Tribune Business Reporter

nmckenzie@tribunemedia.net

Bahamian insurers yesterday warned it will be “very difficult” to hit the revised National Health Insurance (NHI) start date of July 2020 with the scheme’s organisers “standing their ground”.

Tina Cambridge, the Bahamas Insurance Association’s (BIA) deputy chairperson for life and health insurance, said the NHI Authority’s revised proposal meant a “significant shift” for the sector if it was accepted as is by the Minnis administration.

She warned that the enforced changes to private health insurance policy pricing, benefits packages, administration and actuarial analysis will be difficult to implement by the proposed July 1, 2020, launch date.

“At this juncture, it seems fair to state that should the government accept the NHI Authority’s latest proposal in full, it would mean a very significant shift in the private health aspect of our industry,” Ms Cambridge said.

“The proposal as written would require significant changes to the business model of private health insurers, including plan designs, claims administration, billing and enrollment systems, provider contracts, actuarial and pricing assumptions.”

Ms Cambridge said that while the proposal suggests it would be possible for private health insurers to achieve “such a significant shift by a start date of July 1, 2020”, the BIA holds a different view.

“The BIA submits that it would be very difficult to achieve the implementation timeline given that collaboration between the NHI Authority and the insurance industry has not begin in earnest relative to this new proposal,” she added.

“If the NHI Authority fails to get government approval, release the amended laws and regulations, full benefit design for the standard health benefit and proposed catastrophic coverages as well as complete its negotiations with the health care providers, including the Public Hospital Authority (PHA), and work out its requirements of its private health insurers all by April/May 2019, it is very unlikely that all stakeholders could be ready for July 2020.”

Ms Cambridge added that concern remains over the $1,000 per annum premium for the Standard Health Benefit (SHB), NHI’s minimum level of coverage. “This, too, remains a concern for the BIA, and we will continue to do our part in further analysis once the National Fee Schedule and complete benefit details have been completed by the NHI Authority and are shared with stakeholders,” she said.

“The BIA will also be evaluating how the mandates and resultant numbers might affect existing solvency requirements for private health insurers. I am certain that this will also be of interest to the Insurance Commission of the Bahamas in its role as regulator.”

But the NHI Authority, in written responses to concerns expressed by the BIA and Bahamas Chamber of Commerce and Employers Confederation (BCCEC) over its initial proposal, argued that The Bahamas “must start to address this crisis” in healthcare without delay.

In similar replies to challenges to the initial January 2020 launch date, the NHI Authority wrote: “The proposed timeline has been adjusted based on feedback from the BIA, BCCEC and others, and is now set for July 1, 2020, for both large and small employers.

“This represents a six-month difference from the original date and 17 months from now. While we appreciate that the BIA, BCCEC and others may feel this is still too much too soon, we feel this is feasible provided all stakeholders come together in a collaborative way and commit to meeting relevant deadlines.

“We need to stand our ground and note the urgency of the situation we find ourselves in. Based on valid feedback, we have already adjusted the proposed start date back to July 1, 2020, to better accommodate Bahamian businesses, but we cannot delay any further and must start to address this crisis now.”

The initial NHI policy document, launched last year to kick-start public consultations, called for a January 2020 launch of contributions for companies with 100 employees or more. That was to be followed by an expanded roll-out to include all businesses with an annual turnover of $100,000 a year or more in January 2021.

However, Michael Maura, the BCCEC’s chairman, confirmed to Tribune Business on Wednesday that the NHI Authority is now proposing that there be one, single launch for all on July 1, 2020.

“They had initially anticipated having a launch on January 1, 2020, for those companies with a minimum of 100 employees, and having a January 1, 2021, roll-out for small businesses that now have revenues in excess of $250,000,” Mr Maura said. “They have moved away from that. July 1, 2020, is now the mandatory roll-out for all businesses with over $250,000 in annual revenues.”