Matters in Healthcare: Business has fallen behind on insurance payments

Question: My business is currently not doing very well. I’m trying to stay afloat, but I have fallen behind on our health insurance payments.  What are my legal obligations regarding my employees’ health insurance? 

You are not alone struggling to maintain your business and the Bermuda Health Council understands the difficulties. You are absolutely on track, as an employer, to recognize that you have legal responsibilities to your employees that you must fulfill. 

The Health Insurance Act 1970 mandates that all employers provide health insurance from a licensed insurer for all employees and their non-employed spouses.  

The employer must also provide the health insurance policy information to their employees, and inform them in writing of any changes to that policy.  

Because your policy is in arrears you should contact your insurer to ensure that claims are still being paid, establish a payment plan, and discuss options for continuing a health insurance policy with them. Your insurer may be able to offer an alternative package that meets your needs and your employees’.

 If your insurer does not wish to continue the policy, you must pay the backdated premiums and also find an alternative insurer to provide immediate coverage. 

The Government’s Health Insurance Plan (HIP) may be an affordable alternative. 

When establishing a payment plan, you should also determine whether the insurer will cover medical bills incurred by your employees during the time the premium was not paid. You could be held responsible for covering any benefits lost to your employees and reimbursing the employee for any deductions to salaries you made for health insurance, as per Section 25 of the Health Insurance Act. 

Finally, you must also inform your staff immediately in writing of the change in their policy status.

BHeC monitors employers’ insurance coverage for their employees and failure to ensure an active policy could result in an investigation by BHeC. Penalties for non-compliance with health insurance requirements include fines and potentially imprisonment.

Question: “I don’t often get sick, but last week I had a severe infection that required prescription drugs. I was surprised by the $30 co-pay I was charged on top of what my insurer would have to pay. Are there any regulations on the price of prescription drugs in Bermuda? 

No, there are no regulations on the price of prescription drugs or dispensing fees in Bermuda. Pharmacies can set their own prices which means that they can vary between pharmacies; import costs and other overheads contribute to the differences. 

One way to reduce your spending is to compare the approximate cost of a prescription drug between different pharmacies before getting the prescription filled. You may find one pharmacy is better suited to your budget than another.

Another way to reign-in spending on prescription drugs is to request the generic equivalent from your healthcare provider or pharmacist. The generic drug will contain the active ingredient you need and can be more affordable than a name brand drug. 

Requesting a generic drug may also reduce the co-pay you make at the pharmacy. 

That’s because many local insurers cover 100 per cent for generics, but only 80 per cent for name-brand drugs. 

This means the patient has to cover the remaining 20 per cent of a name-brand drug as a co-pay. 

Before you fill your prescription, check your insurance policy’s prescription drug cover. When possible, using generic drugs, which can be more affordable than name-brand, may not only save you money, but may also help contain healthcare costs in Bermuda.

Jennifer Attride-Stirling, is the CEO of the Bermuda Health Council.