IN response to complaints from many senior citizens, Government is updating the benefits provided to pensioners through the National Insurance Scheme (NIS).

Pensioners have been complaining for some time now that the medical benefits scheme of the NIGold Health Plan — which provides medical insurance for pensioners under the NIS — is too modest and not consistent with the increases in the cost of living in Jamaica. Additionally, they contend that the wait time to collect the cards and access the benefits is too long.

And in response to these concerns, the Plan is to be updated before the end of the year, the Ministry of Labour and Social Security told Sunday Finance last week.

“Discussions are currently taking place to determine if, when and by how much NIGold benefits may be increased in the near future,” disclosed Denzil Thorpe, Director of National Insurance at the ministry.

The NIGold Health Plan provides basic benefits that are complementary to other health programmes including the National Health Fund (NHF), the Jamaica Drugs for the Elderly Programme (JADEP) and the free health care policy in the public hospital.

However, pensioners have indicated that while appreciative of the benefits of the plan, the allowance for some items, especially prescription drugs at $4,000 per year, dental and optical at $2,000 per year, and diagnostic services at $3,000 per year, are very inadequate. Others say that the processing of the NIGold cards has taken too long and is therefore another hindrance to accessing the health care services the card is meant to make more affordable.

Sushil Jain who is a NIS pensioner said he registered to receive the card since August 2009 but waited over six months to receive it in the mail.

“Since the acquisition of Blue Cross by Sagicor Life of Jamaica, there are considerable delays in providing this insurance and the cards. Meanwhile, the pensioners are unable to access the medical insurance benefits,” Jain informed Sunday Finance.

Sagicor has been the administrators of the Plan since January, 2009, when it acquired the insurance portfolio of original administrators Blue Cross of Jamaica (BCJ). And Thorpe said that the long lag time between pensioners signing up and receiving benefits was a result of challenges in the transition from BCJ to Sagicor. He said issues such as how the data was transmitted to Sagicor by the ministry resulted in the delay of the new pensioners getting their swipe cards.

“Thankfully, these issues have now been resolved and the first of two batches of new pensioners have already started receiving their cards in the mail,” Thorpe said.

In response to the issue of the inadequacy of the provisions, Thorpe said that given that all the NIGold benefits are paid from the NHF, which is funded by the contributions the pensioners would have made over their work life, the benefits are set to protect the viability of the NHF and its core function — which is to pay the NIS pensions.

“Potentially, if all 91,000 NIS pensioners accessed their maximum allocation of $4,000 for drugs, $3,000 for diagnostics and $2,000 for dental and optical, the NHF could pay out well over $800 million annually in claims on just those benefits alone,” Thorpe said. “Care must be taken in setting the benefit levels to ensure that the viability of the NHF is not jeopardised by the provision of these benefits,” he added. He said for this reason, the NIGold benefits have remained at the same levels since its introduction in 2003. At that level, the NHF has paid approximately $280 million per year since 2005, in NIGold benefits. Thorpe said $281 million has already been spent as at December 2009, for the 2009-2010 period.

However pensioners note that the costs of health care and other necessities have not remained constant. For example, the maximum amount allowed under the Plan for a surgeon’s fee is $30,000. However, a simple orthopaedic surgery can cost $100,000 today.

The Plan allows for Sagicor to pay 90 per cent of the cost of the service up to the amount stipulated, while the beneficiary pays the remaining 10 per cent. This means that at $100,000, Sagicor would pay $27,000 (90 per cent of the maximum $30,000 allowed). The patient would be required to pay the remaining $3,000 (10 per cent of the maximum 30,000) in addition to the remaining $70,000, making the total payment $73,000 for the procedure.

However, Thorpe said that the NIGold is to be added to the ‘co-ordination of benefits’ system, which allows beneficiaries of more than one government run health plan to access all their benefits from each plan, with one swipe card.

“This will allow the beneficiary to pay less out of pocket for goods or services received,” he said

Other upgrades to the NI Gold system includes the re-introduction of specially branded cards which will include the pensioner’s photograph. This can be used as a form of identification, particularly when dealing with pension transactions. The ID will not replace or become recognised as a national ID, but will assist the pensioners who have no other form of picture identification to transact business, Thorpe disclosed.

“As usual, pensioners will be advised in the print and electronic media when registration at EOJ (Electoral Office of Jamaica) offices for this exercise will commence,” Thorpe said.

But while some pensioners want more benefits, there are those who don’t want any. There are reports that thousands of pensioners who signed up for the health coverage which is provided by the Government of Jamaica, have not collected their health cards. Thorpe said the number is more like 2,100 persons.

“Approximately three per cent of the over 70,000 Sagicor swipe cards printed were returned from the post offices unclaimed,” Thorpe said. “In the interest of time and to prevent any fallout to the pensioners, Sagicor printed the first such cards using the old BCJ database. This resulted in some cards being printed for beneficiaries who have since been removed from the Plan, and some cards being printed twice.”

He said this issue has also been resolved.