The package of benefits for the NHIP is very generous and comprehensive. It includes:
- All essential medical services, most of which are provided by the new health care facilities managed by Interhealth Canada on Grand Turk and Provo
- Access to the primary care clinics which the government is upgrading and will continue to manage on the Outer Islands
- Government’s continued provision of public health services directly such as immunizations and wellness programs.
Benefits will be structured on social principles of equal access to comprehensive health care services for all residents. Unlike private insurance there will be no exclusions or waiting periods for pre-existing conditions; and no deductibles or co-insurance.
Who is covered?
Like the National Insurance Board, enrollment in the NHIP is mandatory for all those who are employed or reside in the TCI including:
a. Belongers, resident in the islands
b. Expatriates employed by the government or any government agency or any statutory body
c. Expatriates on current work permits or temporary work permits
d. Permanent resident cardholders with a right to work
e. Pensioners that satisfy all eligibility requirements
f. NIB non-contributory old age pensioners
g. Indigents enrolled with the Social Development Department
i. Dependents of any person referred to in (a), (b), (c), (d)
Mandatory enrollment is important for ensuring fairness and equity; and for keeping contributions as affordable as possible. This allows everyone to share in contributing to the costs of health care and having access to medical services when they need them.
What is covered?
• Outpatient specialty care and day surgery
• Hospital services including all drugs on the approved drug list
• Diagnostic services
• Ambulance services
• Maternity care
• Outpatient drugs for selected chronic conditions
If you use the Interhealth Canada facilities or the government clinics, your care will be almost free. You will only have to make a small co-payment at the time of service. For most services this co-payment is anticipated to be around $10. Co-payments will allow everyone to have access to needed care; but should prevent over-utilization of services that are not medically necessary.
NHIP and Private Health Care
Some of you see private doctors now and pay out of your own pocket for this care or bill your private insurer. You will continue to have the option to see your private doctor and have it covered by your private insurance or to pay directly. NHIP will also contract with private doctors who choose to be enrolled in the Plan. If your doctor joins the plan, NHIP will reimburse the provider at a rate of $35.00 per visit.
Making the Plan affordable
To make the Plan as affordable as possible, the NHIP will need to limit benefits for care outside of the Turks and Caicos Islands. This will not compromise quality of care, since the two new hospital complexes managed by Interhealth Canada will offer many of the services, at world-class standards, that are now provided overseas.
If highly specialized procedures such as advanced cancer therapy cannot be provided by Interhealth Canada on the Turks and Caicos Islands and need to be referred out of the Turks and Caicos Islands, NHIP will cover your costs overseas. Treatment abroad will be limited to emergencies and essential services that cannot be provided on the Islands. Co-payments will apply to overseas care.
You can continue to purchase private insurance coverage which may give you greater access to US providers depending on the plan that you choose.
During the first seven months of operations, NHIP ceded $896,103.70 for reinsurance premiums. It recovered $655,469 for four claims: motor vehicle accident, cancer treatment, bone marrow transplant and premature baby; which exceeded the NHIB risk retention of $150,000 per claim. Two claims are ongoing with the beneficiaries still receiving care and the expected total claim recovered (as reserved by the reinsurance company) is an additional $480,061 for a total of $1,135,530.