Backgrounder: Policy changes proposed for NHI Bahamas
Nassau, The Bahamas – January 30, 2019
The National Health Insurance Authority (NHIA) was established April 2016. The purpose of NHIA is to achieve a shared goal of Universal Health Care. Subsequently, NHI Bahamas was established. NHI Bahamas is a National Health Insurance Programme for The Bahamas introduced by the Government. NHI Bahamas aims to ensure that all legal Bahamian residents, no matter your income, age, island of residence or current health status, can receive affordable and accessible health care. A 14-member board was appointed in 2017. This board consists of nine voters and four ex-officio members. NHIA board members represent a broad range of interests, including the health sector, the commercial sector, civil society, trade unions, and the insurance industry. In 2017, enrollment for NHI Bahamas commenced and is ongoing. Nearly 50,000 beneficiaries have enrolled to date.
Managing Director, Graham Whitmarsh was appointed to the NHIA in February 2018.
In October 2018, the NHIA released the “NHI Bahamas: A Shared Responsibility” policy paper and began a 45 day consultation period which received an extension subsequently due to high interest from stakeholders and the public.
NHIA arranged private meetings with businesses, associations, unions and other large organizations across The Bahamas to get their feedback first-hand. Several town hall meetings were also held to hear directly from the public and to educate a broader audience on what was being proposed. In general, the feedback was overwhelmingly positive.
During the consultation period, 14 town hall meetings were coordinated where over 500 participants and 80 plus stakeholders were met throughout the islands of The Bahamas including New Providence, Grand Bahama, Exuma, Bimini, Abaco, Eleuthera, and Andros.
At the conclusion of the consultation period, the feedback gathered was broken into 10 distinct themes, which aims to address concerns to ensure the revised NHI program can be successfully adopted and implemented.
Key Components to the Policy Change:
The premium will no longer be shared 50/50. The employer will be able to collect up to 1.5% of monthly income, lowered from 2%, up to the standard premium rate with employers paying the remaining balance. This allows for a more equal distribution on average for employers, supports low income employees and causes high income earners to contribute more.
The mandate would apply for all employers, regardless of size on July 1, 2020 providing for a consistent start across the board. This address concerns made by business groups about artificial distinctions between large and small employers.
Raise Small Business Turnover Exemption
Raise the small business turnover exemption to $250,000 per year. This will provide further protection for small businesses and a competitive business environment for entrepreneurship in The Bahamas.
National Fee Schedule for High Cost Care
For high cost care procedures included in the Standard Health Benefit, there will be a National Fee Schedule which both the NHIA and private insurers would reimburse. This allows for the standard premium rate to be more easily adopted by private insurers and would simplify the risk equalization process.
Common Enrolment Period
The NHI policy team recognized the need to establish a common open enrolment period for both NHI and Approved Insurers with specific exemptions to be admitted outside of this period. This will enable the process of risk equalization to work in an orderly and efficient manner.
Expand Standard Health Benefit Package
Include coverage for pediatric cancers for beneficiaries under 12 years old.
Removal of Secondary Employer Contribution
The NHIA policy team recognized that it would be nearly impossible to track and collect these contributions. In addition, this will be a benefit to businesses as employers would no longer have to pay a contribution for employees they are acting as secondary employers for.
Use Self Reporting instead of Business License
The Department of Inland Revenue would no longer be responsible for compliance, relying instead on NHIA enforcement through periodic audits, employee reporting and reports from private insurers. NHIA will employ a compliance officer to be responsible for enforcement.
Short Term Contract Exemption
Employees who sign short term contracts which have a specified start and end date elapsing less than 120 days per year (including extensions) will be exempt. This is to address concerns from highly seasonal businesses.
Enhanced Annual Reporting
A direct recommendation from the BCCEC, the annual report would aim to identify and report on specific short and long-term key performance indicators for NHIA and the employer mandate.
The updated policy paper, which takes account of the feedback received during the consultation period, will be submitted to Cabinet for consideration and approval.
Stakeholders and members of the public can also review the policy changes by visiting www.nhibahamas.gov.bs
For more information on NHI Bahamas, visit www.nhibahamas.gov.bs.
Contact the National Health Insurance Authority: