Employer Obligations Elisabeth Kast Compliance Officer 24 th - - PowerPoint PPT Presentation

Health Insurance & Employer Obligations

Elisabeth Kast Compliance Officer 24th January 2018

Overview

• 1. What is the Bermuda Health Council?
• 2. Compliance Quiz
• 3. Relevant Legislation
• 4. Monitoring and Enforcing Compliance
• 5. Employer Liability
• 6. Penalties for Non-Compliance
• 7. Case Example

What is the Bermuda Health Council?

 Quasi-Autonomous Non-Governmental Organisation (QUANGO)  Established by Bermuda Health Council Act 2004. Operational since 2006.  Mission: To regulate, coordinate, and enhance the delivery of health services  Vision: Achieving a quality, equitable and sustainable health system  Activities are focused on health economics and regulation  Structure:

• Board – 15 members
• Secretariat - 10 staff

Compliance Quiz

 Yourself, as an employee of the company?  A consultant you hire for four weeks?  Someone who works three days or 21 hours per week?  The non-employed spouse of an employee?  Child(ren) of an employee?

Relevant Legislation

 Health Insurance Act 1970

• Compulsory health insurance for employees and non-employed

spouse

• Licensed insurer reporting to BHeC of non-compliant employers
• Lawful deductions of no more than half premium amount
• Employee obligations to inform employer of spouse employment

status

• Recovery of damages for medical bills during period of non-coverage
• Duty of employer to provide information to employee regarding

status of health insurance policy

Relevant Legislation Continued

 Health Insurance (Inspection of Records) Regulations 2015

• Power of Inspectors
• Maintenance of records of employment and wages
• Policy information for employees
• Start and end dates of employment
• Information on spouse
• Wage deductions
• Payments to insurer

 Health Insurance (Exemption) Regulations 1971

• Less than 15 hours per week
• Less that 2 months per year
• Full-time student

Monitoring and Enforcing Compliance

Sources of Information:

 Insurer reports (monthly)  Public Inquiry  Government Legislated Authorities

Actions:

 Calls to employers  Warning letters  Website List  Inspections  Court

Employer Liability

An employer:

• is liable for the total cost of health insurance premium
• may deduct half of the premium amount from employee

wages for employee and non-employed spouse

• must promptly provide employees with insurance

information in writing

• must pay medical bills during periods of non-coverage

Penalties for Non-Compliance

Offences include:

• Unlawful deductions
• No active health insurance policy
• Not informing employees
• Failure to provide records

Penalties include:

• Fines
• Imprisonment

Employers are responsible for all medical expenses incurred by employees during period of non- coverage

Case Example

 Employee initiated complaint  No deductions from employees pay  Employees never informed about health insurance  Employee involved in serious accident, Employer fined $1,500 in criminal court  Employee to recoup up to $800,000 in damages

Questions?