NHF adds Guardian Life to COB plan
Published:Wednesday | January 19, 2011 | 12:00 AM
The National Health Fund (NHF) is partnering with Guardian Life Limited to coordinate benefits for the holders of their respective health-insurance cards under a plan for more efficient processing of transactions, the second of its kind in two years.
Guardian offers health insurance under its Medecus brand.
"The NHF coordination of benefit, COB, mechanism was developed in an effort to make it easier for NHF pharmacy providers to efficiently process prescriptions using multiple health cards from various carriers," said NHF chief executive officer Hugh Lawson in a release.
"While many pharmacies currently accept more than one health card when processing claims for NHF cardholders, it is often a burdensome, time-consuming task," he said.
In 2008, NHF inked a similar agreement with Sagicor, and now says beneficiaries only need one card to access benefits under all three plans.
"The pharmacist only needs to swipe a single card from NHF, Sagicor or Guardian/Medecus to adjudicate the claim and the NHF beneficiary is able to cover his/her drug bill from all three cards," said the release.
Under the NHF plan, prescriptions are subsidised 50 per cent, while private providers like Guardian and Sagicor give 80 per cent coverage to capped limits. Having all three cards allows beneficiaries to significantly reduce out-of-pocket payment for drugs.
The patient's taxpayer registration number (TRN) is used as the identifier to connect the health plans.
"It is no different from what currently obtains, just that they will be able to access the NHF database as well as the other carrier's basket of benefits," said Lawson.
The same rules that apply for a standalone card will continue to apply, he said.
Lawson, however, was unable to quantify the savings from the coordination programme, but his release said it should lead to improvement in the auditing of claims, as well as reduce the need for paper-based claims and payouts.
The agreement with Guardian Life took effect on January 3.
The development cost of the COB mechanism was not disclosed, but it was done in colla-boration with Advanced Integrated Systems Limited, a Kingston base developer of technology solutions.
Already 50 of the 385 NHF pharmacies have agreed to participate, with others expected to come on broad.