Increased exemptions and tiered contributions under NHI

NHIA Chairman Dr. Robin Roberts.

NASSAU, BAHAMAS – Employees who make over $30,000 per year and sign up under the revamped National Health Insurance (NHI) scheme could be required to pay more than the previously capped $42 per month, according to National Health Insurance Authority (NHIA) Chairman Dr. Robin Roberts.

According to Roberts, that was one of the recommendations stemming from the authority’s discussions with stakeholders since last October.

“There have been some very positive suggestions that we feel should be included in our proposal going forward,” he told Eyewitness News.

“…The whole idea of the stakeholder meetings is to have their input and of course, reflect that.”

The authority has proposed several mechanisms to fund the revamped universal healthcare scheme, which it estimates would cost around $100 million per year for the standard health benefit (SHB) package.

This includes an employer mandate that would see employers and employees share the funding of the scheme; a government contribution from the national budget; valued-added tax (VAT) levied on health insurance premiums; a sin tax of sugary drinks, and distributions from the creation of a risk equalization fund (REF), which would establish a common pool of resources, collected through contributions as a portion of collected premiums from both the public payer and private insurers.

Based on the authority’s policy paper, an individual who makes $10,000 per year, for example, would contribute $17 per month, while their employer would contribute $67 per month.

An employee who makes $25,000 or $30,000 or more would pay $42 per month, while the employer would pay the same.

The annual premium per person is estimated at $1,000 per person per year for the SHB.

“…For the employer you know… when they have 100 people employed and you start to multiply the factors, that can be quite an additional expense,” Roberts said.

“We have to be real about this and more so because we have also prorated that amount depending on the income of the individual.

“If we have someone making minimum wage, he’s not paying $42 [per month]; he is actually paying $8 and the employer [pays] that additional amount up to $84.

“We have to be real that in some areas this could be costly.

“In going through our stakeholders and having their input, some of them have made some excellent suggestions.

“Just to give you an idea of what you are looking at, some of them are saying ‘you now have a ceiling of $25,000; Why don’t you increase [it]? What about those individuals who can definitely pay more, like [those] making $100,000 a year.

“So, why don’t you make those individuals pay a little more’.”

When asked what the new contribution cap would be, Roberts said that would depend on the business relationship between the employer and employee, and the terms of any existing insurance plan those individuals may have.

“If I use myself as an example — I am involved in a couple of companies — in all of the companies I am involved, all the employees, their insurance is paid 100 per cent by the companies,” he said. “I don’t see that changing.”

The NHIA has proposed that the employer mandate take effect in January 2020 beginning with businesses that have more than 100 employees.

Small business with revenue under $100,00 per year would be exempt from the employer mandate.

Yesterday, Roberts said there was also a recommendation to increase that exemption to businesses with revenue of $200,00 or less or $300,000 or less.

He said the authority was also receptive to that.

“Those are two things that definitely seem to be coming out,” Roberts said.

Roberts pointed out that the NHIA’s consultative exercise has been expanded to the end of January.

He said the authority has plans to hold town meetings in Exuma and New Providence in the coming weeks.