FRIDAY, JAN. 25:
Question: My 88-year-old mother recently fell and cracked her hip. She had to stay in the hospital after the surgery but is better now, She no longer needs the 24-hour care of the hospital and wants to be released. I work so I cannot look after her while she is at home and she will still need IV antibiotics, wound dressing, help to just be at home, etc. Her insurance doesn’t cover this, so what are we supposed to do? At the hospital she’ll get the care covered, but if I take her home we have to pay out of pocket.
Answer: Your dilemma is unfortunately common. At any time there are about 12 patients at the hospital in a similar situation. People who don’t need acute care but remain in hospital beds because families can’t take them home.
This is risky for patients, costly for insurers and the government, and an inconvenience for families who would prefer to see their loved ones in the comfort of their homes.
Currently there is work underway to remedy this situation. Legislative changes are in the works to include home health/medical care in the minimum insurance package, the Standard Hospital Benefit (SHB).
This means it would be covered by any insurance policy and by existing patient subsidies.
The changes would require that in order for a hospital stay to be covered by SHB it would have to be medically necessary. Once a patient doesn’t have a medical need for a hospital bed, they would need to be discharged and the home healthcare benefit under SHB would kick in to cover the medical care needed at home.
Question: Is it noted in The Act that once a person terminates from their health insurance policy that they are covered for 30 days after that date for HIP benefits only? If so, please direct me to the location in the Act.
Answer: As you may know, employers are required by law to provide hospitalization insurance to their full-time employees and their non-employed spouses as per the Health Insurance Act 1970.
This requires coverage for not less than the Standard Hospital Benefit (SHB) and NOT for HIP. Those who are self-employed are also required by the aforementioned Act to obtain health insurance.
If an employee willfully leaves their employment or is terminated from their position, the employer is required under the Health Insurance (Cover) Regulations 1971 to continue to provide not less than the Standard Hospital Benefit (SHB) coverage for a period of four weeks. Section 5 of the Regulations, states: “…where a person ceases to be compulsorily insured by an employer whether by virtue of the termination of employment or otherwise, and does not become compulsorily insurable by any other employer, the first mentioned employer shall continue to provide health insurance cover in respect of that person for a period of four weeks from the date on which that person ceased to be compulsorily insurable by that employer.”
The difference between SHB and HIP is important. Employers are only legally mandated to provide SHB, though most provide additional coverage and no insurer sells SHB as a stand-alone product (exceptions are made where legally necessary).
SHB covers only hospitalization, while HIP has additional supplemental benefits like doctors’ visits. HIP is the Government’s Health Insurance Plan that is offered as an affordable insurance policy to individuals or groups.
As stated in the Regulations in Section 4, if you find employment within the four weeks from your termination, your previous employer will be liable for not less than your SHB coverage until the 1st of the month following the first day of your new employment.
Clear as mud? For example, if you left your current employer today January 25th, then coverage from your current employer would continue until January 31st.
If by February 1st you do not have an employer or another health insurance contract, you will be covered until February 22nd or four weeks from your termination date by your previous employer.