Healthcare Matters: I wasn’t told that I don’t have health insurance

Question:  I went to the doctor recently and was told that I’m not insured.  I get insurance through my job, so I contacted my insurer and they told me that my policy was not active. Why wasn’t I told before?  Whose responsibility is it to inform employees if their health insurance is not active; the employer or the insurance company?

Answer: As the employee, your employment contract should outline both you and your employer’s obligations under the Health Insurance Act 1970.  Your employer is entitled to deduct 50% of the premium amount from your wages whilst contributing an equal portion towards an active health insurance policy with a licensed insurer. Although you are also contributing towards the premium, the contract is between the insurer and your employer.

According to section 24A(1) of the Health Insurance Act 1970; an employer is to provide an employee details of an active health insurance policy upon the commencement of employment. Section 24A(2)and (3) state that if an employer fails to effect an active policy for any reason, he is to ‘promptly’ inform all employees in writing of the change in policy status.  Failure to maintain this obligation or provide this information is an offence liable upon summary conviction to a fine or period of imprisonment.  So essentially, it is your employer’s responsibility to inform you of the status of your health insurance policy.   
    

Question: The current economic climate has resulted in financial strain on my business.  I don’t know if I can afford to cover health insurance premiums for my employees. What should I do in these circumstances?   

Answer: The Health Insurance Act mandates that, as an employer, you have to provide an active health insurance policy for yourself, all your employees, and their non-employed spouses. If you cannot maintain your current health insurance premiums you should contact your insurer or other insurers to find a policy that is more financially viable. In the event that you do close your current policy, be sure to settle all premium back payments in addition to enacting a new policy with an alternate insurer.    

Question: As an employer, is it normal for the Bermuda Health Council to contact me when I change insurance plans for my employees?

Answer: The easy answer is yes. The Bermuda Health Council monitors employers’ compliance with the requirement to provide employees and non-working spouses with health insurance under the Health Insurance Act 1970. The Act requires that insurers report to BHeC any lapses on the part of an employer to comply with requirements under the Act. If an employer terminates a policy with an insurer they will be reported to BHeC as part of this monitoring process. BHeC then contacts employers to ensure they have started a new policy with another insurer. If an employer can’t provide evidence of a new policy further investigation is conducted by BHeC and the Department of Social Insurance (DOSI). 

Question: I recently found out that my employer has not been providing health insurance coverage.  I assume that he has also failed to pay my social insurance as well.  Who should I contact to verify this?

Answer: The Department of Social insurance is responsible for monitoring employers to ensure that social insurance contributions are paid regularly for all employees. They can be contacted directly by any employee to verify if this is the case. If it is determined that your employer has failed to provide any of the mandated benefits in accordance with the Contributory Pensions Act 1970 and Health Insurance Act 1970 (health insurance, pensions) then they are subject to an inspection of company records in support of possible legal action. Failure to comply with the Health Insurance Act 1970 can result in a fine between $500 and $1,000, or six months imprisonment, and liability for medical bills an employee may have incurred while an active policy was not in place. 

For more info about employers’ responsibilities regarding health insurance, please see the BHeC’ pamphlet ‘Why health insurance?’ at www.bhec.bm/wp-content/uploads/resources/documents/WhyHealthInsurance-pamphlet.pdf. Answers supplied by Jennifer Attride-Stirling, CEO of the Bermuda Health Council.