Cedric Stephens | The complexities of healthy ageing

A health tip published in this newspaper by a private hospital cited age as a major risk factor for a variety of life-altering diseases.

“Getting regular health screenings can help … by detecting a specific disease or condition early even when there have been no symptoms or signs of disease. With early detection and treatment, the body can be provided with the best defence of diseases,” the tip read.

The statement, which could have been used in ads for health insurance targeting senior citizens, says nothing about paying for the huge costs and expenses involved in the regular screenings, detection, and the treatment of illnesses.

Families USA, an advocacy group, estimates that “more than 26,260 Americans aged 25 to 64 died in 2006 because they lacked health insurance – more than twice as many as were murdered”.

As a reluctant member of the growing demographic group and one who suffers from a chronic illness, the tip caught my eye. It rings true. Those who follow the long debate in the United States about healthcare policy and politics know that many persons there share the ideas in the tip.

Locally, the Ministry of Health and Wellness is looking at ways to improve service delivery at public hospitals. It is also trying to “reduce the burden of financing borne by the State and individual seekers of medical services”. And the Government is exploring a National Health Insurance Plan (NHIP) to achieve that goal.

However, given the complexity of this subject and the many financial and other challenges that are involved in funding an NHIP, persons in my age group are likely to be dead when it is introduced.

The private sector has found a short-term solution for some senior citizens. CGM Gallagher Insurance Brokers Jamaica and Sagicor Life Jamaica have partnered to develop what they call a Comprehensive Group Health Insurance Scheme. It is now available to members of the Caribbean Community of Retired Persons. The scheme is noteworthy because it solves a problem that faces a growing number of the country’s elderly population: funding the cost of medical care.

The target group includes persons whose savings and other assets are not stashed overseas, those who do not have dual citizenship, and, therefore, are entitled to Medicare or other overseas healthcare benefits; persons who have recently retired who do not have access to health insurance; and other groups of retirees.

Overseas health insurance plans are available locally. The insurance regulator has allowed several foreign providers to sell their products with minimal supervision. The major problem with many of these plans is that because the premiums are invariably payable in foreign currency, only a small segment of retired persons can afford them. The premiums include hefty commissions.

The CGM Gallagher-CCRP health plan provides a wide range of benefits to help seniors fund the cost of the detection and treatment of a wide range of illnesses and diseases. They include doctor’s visits; prescription drugs; treat in-hospital expenses; surgical benefits; consultants fees, laboratory and diagnostic fees and the usual range of other related costs, including dental and optical. There is also a major medical limit of $5 million per annum and an optional extra of $500,000 life insurance coverage. The major medical benefit and life insurance option may offer some level of comfort to senior citizens.

Pre-existing conditions

Eligibility requirements for the scheme include membership in the CCRP. There is no age limit to join the scheme during the first three months – the open enrolment period closes on November 30 – irrespective of their health condition and without providing medical evidence to the insurer.

Persons who join the scheme after the open enrolment period will be required to provide medical evidence of their health status – that is, evidence of insurability, to use the jargon. This provision will not apply to 50-year-old members.

Coverage will continue as long as the scheme remains in force. And premiums are payable quarterly, half-yearly, and annually in advance.

Unlike the benefits that are available under the Affordable Care Act in the US – commonly referred to as Obamacare – pre-existing conditions are excluded from the local plan as is the case with all local health plans.

A pre-existing condition is medical illness or injury that existed, was diagnosed, or treated within six months before the start of the plan. Conditions like diabetes, COPD, cancer, sleep apnoea, lupus, epilepsy, and depression are examples of pre-existing health conditions. They tend to be chronic or longterm.

Coverage for these pre-existing conditions will start after a six-month waiting period. I have not studied the fine print in the contract to understand the full details of this provision.

Monthly premiums inclusive of GCT for medical, dental, and optical benefits range from $6,400 to $16,035, depending on age range and number of persons on the plan.

The monthly premium for the life insurance benefit is $2,460 per month. The annual premium for a member and single dependent in the 70+ plus age group for health and life insurance works out at $251,500.

The developers of the plan would have made the scheme more affordable if they had obtained government permission to exclude the 16.5 per cent GCT add-on to the health insurance premium.

Suggestions for improvement

Studies show that persons who improve their nutrition and engage in regular physical exercise reduce their health risks.

This applies to members of all age groups. The health ministry recognises this fact.

The schedule of benefits should be expanded to include the payment for gym membership and consultations with a nutritionist. Some senior citizens would welcome these benefits. Final words: To use a car metaphor, this plan is not a Rolls-Royce, a BMW, Mercedes Benz, Porsche, or Land Rover. It is like the reliable Toyota RAV 4 SUV, which is one of the most common vehicles on the road. Would I buy it? Definitely.

- Cedric E. Stephens provides independent information and advice about the management of risks and insurance. For free information or counsel, write to: aegis@flowja.com