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Government confirms strict rules overt FutureCare premiums defaulters

Government has confirmed reports that seniors who fall behind in paying their FutureCare premiums will have their prescription drugs payments suspended.

And FutureCare clients who do not pay within 90 days of notification will have their policies terminated.

The coverage will be restored once arrears are paid up, and those whose policies are discontinued can reapply, a Health Department spokesman said.

The spokesman explained: “It is standard practice for any health insurer to suspend paying claims when a premium has not been paid. This is ordinarily resolved through reminders to the policy holder, and it is not unique to FutureCare.

“The general public understands this. As with utility bills, cell phone, or any other bill, if a bill is not paid, after a time the service is normally suspended.”

FutureCare's pharmacy benefit covers 80 percent of the bill for prescription drugs, up to a yearly maximum of $2,000 per calendar year. If a policy holder falls more than 30 days into arrears, the benefits lapse, and they must pay full cost for prescriptions.

“The pharmacy claims for persons in arrears with premium payment have always been rejected upon receipt by FutureCare,” the spokesman added. “However, the pharmacies now have more accurate information about who is current with their premium. This allows them to charge seniors who are in lapse status at the point of issuing the prescription drugs instead of receiving a rejection notice from FutureCare and then having to pursue seniors for the full payment of the drugs.”

Letters warning of the suspension were sent out to FutureCare policy holders earlier this year, leaving One Bermuda Alliance seniors' advocate Louise Jackson to decry the get-tough policy as a first.

The Department called Mrs Jackson's assertion “incorrect”.

“Pharmacy claims under FutureCare have consistently been denied when persons are in arrears with premium payment,” the spokesman told

The Royal Gazette. “Pharmacy claims were denied under HIP (when it had a prescription drug benefit) when persons were in arrears with premium payments. All other medical claims for individuals on FutureCare were and continue to be denied for non-payment of premium.”

Once seniors catch up in payments, receipts for prescriptions will be reimbursed for FutureCare's portion, he said. This does not represent a change in rejecting claims, the Health Department spokesman said.

“Previously, policyholders claimed first, even though they were behind with premium and pharmacies pursued them for payment after claims were rejected. Now pharmacies don't issue prescription drugs for policyholders with premium arrears until they receive full payment.”

The move follows the announcement of a 7.7 percent hike in the Standard Premium Rate (SPR), which will increase expenses for health insurance packages across the board including FutureCare. Premiums for HIP and FutureCare have not yet been announced.

An actuarial report from the Bermuda Health Council is expected in the next few weeks, with indications of how much healthcare costs can be expected to rise in the fiscal year ahead.

Health Minister Zane DeSilva said in the House of Assembly this week that the report suggested the SPR could have risen significantly more without caps on spending. The spokesman said that part of the increase was due to additional funding for the Mutual Reinsurance Fund due to “diminished reserves, and to provide for the low-cost public insurance plans”.

The cap on the SPR allows for a two percent increase in local and overseas healthcare use.

Explained Bermuda Health Council CEO Jennifer Attride-Stirling: “The SPR includes the Standard Hospital Benefit (hospitalisation) and Mutual Reinsurance Fund (specific high dollar value claims in the SHB). However, while the SPR will go up 7.7 percent, each insurer may apply that increase differently to their policies, because they also have the supplemental benefits, or major medical, to price, and the SPR is only a portion of the overall premium.”

The increase will add about $19 a month to insurance plans.

Dr Attride-Stirling added that the Bermuda Health Council will publish its yearly actuarial report later on this month.

Useful websites: www.bhec.bm, www.bermudahospitals.bm, www.hip.gov.bm.

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Published March 09, 2012 at 8:00 am (Updated March 09, 2012 at 8:34 am)

Government confirms strict rules overt FutureCare premiums defaulters

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