The Tribune

By Neil Hartnell

Tribune Business Editor

nhartnell@tribunemedia.net

Bahamian health insurers yesterday urged the Government to ensure the National Health Insurance (NHI) overseer has the “necessary resources” to properly implement its newly-legislated mandate, adding: “As long as they’re ready, we’ll be ready.”

Marcus Bosland, the Bahamas Insurance Association’s (BIA) deputy chair for life and health insurance, told Tribune Business that while the one-year “transition” period is “sufficient” for the industry to meet its obligations under the NHI Act 2025 it remains concerned on whether the NHI Authority will be able to fully take care of its responsibilities.

Speaking after Dr Michael Darville, minister of health and wellness, confirmed that parts of the NHI Act have been “deferred” for a year so health insurers can adjust their existing policies and benefits packages, and bring them into line with the healthcare scheme’s standard health benefit (SHB), he added that the sector is monitoring whether the NHI Authority will be “appropriately funded”.

Besides having to enact regulations to support the Act, which was passed on July 30 this year, and give it teeth, Mr Bosland told this newspaper that “two-way data sharing” between private insurers and the NHI Authority also has to be effective.

He added that this was particularly critical to the scheme’s smooth functioning and co-ordination, especially in dealing with issues such as ensuring that the primary care doctor selected by an NHI beneficiary is among the scheme’s approved providers, and for monitoring patient use rates and payments.

“Certainly, from the industry standpoint, we need the year,” Mr Bosland told Tribune Business. “The law requires, essentially, all the health insurance policies issued by insurers to adjust in accordance with the Act. It will take some time to design the new policies, explain them to customers and implement them.

“A year is required. It’s reasonable to say it’s likely to be sufficient. We’ve been working closely with NHI for some time to have a reasonably good understanding of what is required of us.”

The NHI Act’s main purpose is to introduce the standard health benefit (SHB), which will act as the “minimum” primary care benefits package available to NHI beneficiaries who currently total some 161,000. Private health insurers, such as Colina, Family Guardian and CG Atlantic, will agree with NHI to become “approved insurers” to provide the SHB to beneficiaries enrolled with the Government’s scheme.

Mr Bosland yesterday explained that the standard health benefit’s introduction requires Bahamian private health insurers to adjust existing policies and benefits packages to account for its arrival. As a result, underwriters now have to “carve out” benefits that fall under the SHB from current in-force coverage - something that requires them to re-design existing policies.

“Essentially we have to carve out the current benefits that fall under the standard health benefit to allow insurance contracts without any co-payments, cost sharing or deductibles,” Mr Bosland said. “Once you touch one thing it’s like building a house; they have to bind together and line up one on top of the other. It’s going to be a fair bit of work.” However, he said this was unlikely to spark a rise in health insurance premium costs.

Voicing optimism that the Bahamian health insurance industry will fulfill its side of the bargain, Mr Bosland told Tribune Business: “I would say as a caution that there are things the NHI Authority has to do in order to allow us to be effective and we are hopeful those activities will be appropriately funded.

“They still have regulations that they have to pass to support the Act itself, and there’s also the matter that the system requires some dual sharing between the insurance companies and NHI Authority; two-way dual sharing….

“That requires some investment on our side to ensure some of the systems are properly capable of doing that, but it also requires some work on the part of the Authority.” The Davis administration expanding the NHI Authority’s annual funding by $2m in the Budget, increasing it from $46.2m to $48.2m for the 2025-2026 fiscal year - an amount projected to remain the same for the following two fiscal years.

Noting this, Mr Bosland added: “They [the NHI Authority] got an increase in the Budget this year. It’s not a massive amount. We want to encourage the Government to fund NHI appropriately to ensure they have the resources required to efficiently implement this Act.

“It’s one thing to have the Act. I’m really hopeful that the NHI Authority has the necessary to implement this. Primary care services, they are expensive in The Bahamas, but are not the primary driver of healthcare costs. It’s the serious illnesses that are the big driver. As long as the NHI Authority team is going to be ready, we’re going to be ready.”

Dr Darville yesterday confirmed in the House of Assembly that the NHI Act’s sections 28(2) through (5) and Sections 34 to 37, which deal with the integration of approved private insurers into the scheme, will be deferred for one year.

“This phased approach is deliberate and based on sound technical guidance. It gives the Authority and private insurers the time required for actuarial analysis, systems development and regulatory alignment. This preparation is necessary for a smooth and responsible transition when these provisions come into force,” he explained.

Hailing the NHI Act’s passage into law, he said the provisions now in effect “strengthen governance, accountability and financial management within the National Health Insurance Authority (NHIA).

“They formalise the Authority’s governance structure, continue the National Health Insurance Fund and plan, and set forth the framework for contracting and regulating both public and private providers within the standard health benefits Network. These sections also activate the systems for appeals, enforcement and transitional arrangements that will guide the Authority as it carries out its duties under this updated legal framework,” the minister added.

“In practical terms, these reforms give the Authority the tools to operate with greater transparency, stronger internal controls and improved operational flexibility. They ensure that essential services relied upon by thousands of Bahamians remain available. Primary care, maternity care, preventative screenings, and other key benefits will continue without interruption, supported by clearer standards and stronger management.”

The standard health benefit (SHB) includes primary care; early detection and preventative care; diagnostic imaging; and paediatric care. Other benefits involve “maternity care by a general practitioner, or by an obstetrician and/or gynaecologist” and “screening programmes for cancer and other specified conditions”.

Under the new NHI Act, beneficiaries will be able to “select a standard health benefit provider” from those approved by the NHI Authority. An “approved insurer”, who will offer the SHB package, must demonstrate “financial stability”; its compliance with the Insurance Act; and “ability” to provide the required benefits.

Such an insurer will be charged with providing “the standard health benefits to every insured person enrolled in [NHI] and covered by an agreement with the Authority”. They will also be mandated to inform the NHI regulator if a plan beneficiary’s “private sickness and health insurance is lapsed [and/or] cancelled” and encourage them to enroll in the Government-run scheme.