Department of Social Department of Social Insurance:Insurance:

PENSIONS SECTIONPENSIONS SECTION

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Work Responsibilities and Work Responsibilities and PersonnelPersonnel

Director, Social Insurance: Karen Daniels

Assistant Director – Pensions:Calvin White

ManagerCompliance:Sherie Wilson

Acting ManagerBenefits:Joy Joell

ManagerContributions:

Belvina Burt

Supervises:

• National Pensions Administration

•National Health Insurance

Supervises:

•Accounting, Computerization

•Financial Reporting

•Pension Benefits

•Compliance

•Contributions• Manages all compliance functions for CPF & HIP

•Supervises Team of 4 Inspectors

•Manages all aspects of benefits processing

•Supervises Team of 3 Benefits Processors

•Manages all aspects of contributions processing•Supervises Team of 5 Contributions Processors & Cashiers

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The Contributory The Contributory Pension FundPension Fund

Who to CallWho to Call• Contributions – Hot Line 295-Contributions – Hot Line 295-

5151 Ext 11175151 Ext 1117• Benefits – Joy Joell 295-5151 Ext Benefits – Joy Joell 295-5151 Ext

11291129• Compliance – Sherie Wilson 295-Compliance – Sherie Wilson 295-

5151 Ext 17875151 Ext 1787

Or Go OnlineOr Go Online• www.socialinsurance.gov.bmwww.socialinsurance.gov.bm

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The Contributory The Contributory Pension FundPension Fund

ContributionsContributions• Persons working 4 or more hours/weekPersons working 4 or more hours/week• Employer/Employee 50/50Employer/Employee 50/50• Only employed persons liableOnly employed persons liable• Contribution week Monday - SundayContribution week Monday - Sunday• Contribution year 1Contribution year 1stst Monday in Monday in

AugustAugust• One contribution per weekOne contribution per week• Deducted at time of paymentDeducted at time of payment• Current weekly rate $56.96/$28.48Current weekly rate $56.96/$28.48

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The Contributory The Contributory Pension FundPension Fund

BenefitsBenefits• Contributory old age pensionContributory old age pension• Widow’s allowance or widower’s Widow’s allowance or widower’s

allowanceallowance• Contributory disability benefitContributory disability benefit• Credits of contributionsCredits of contributions• Old age gratuityOld age gratuity

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The Contributory The Contributory Pension FundPension FundContributory Old Age PensionContributory Old Age Pension

• 65 Years of age65 Years of age• Minimum pension =/> 975 totalMinimum pension =/> 975 total• contributionscontributions• Full pension =/> 1,950 total Full pension =/> 1,950 total

contributionscontributions• Pro rated between 50% - 100%Pro rated between 50% - 100%• Benefit month 16Benefit month 16thth – 15 – 15thth • Paid in arrearsPaid in arrears• Payable for lifePayable for life• Payable in currency of choicePayable in currency of choice

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The Contributory The Contributory Pension FundPension FundWidow’s/Widower’s AllowanceWidow’s/Widower’s Allowance

• Married longer than 3 yearsMarried longer than 3 years• Surviving spouse under 50 years with no Surviving spouse under 50 years with no

children under the age of 16, benefit paid for 26 children under the age of 16, benefit paid for 26 weeksweeks

• Surviving spouse under 50 years with child or Surviving spouse under 50 years with child or children under 16 years, benefit paid until each children under 16 years, benefit paid until each child is 16 yearschild is 16 years

• A widow or widower who remarries or cohabits A widow or widower who remarries or cohabits with a man/woman as her/his spouse disqualifiedwith a man/woman as her/his spouse disqualified

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The Contributory The Contributory Pension FundPension Fund

Widow’s/Widower’s Widow’s/Widower’s AllowanceAllowance

• As each child attains 16 years he/she As each child attains 16 years he/she no longer qualifies for a benefit. no longer qualifies for a benefit.

• When surviving parent is under 50 When surviving parent is under 50 the widow’s/widower’s allowance the widow’s/widower’s allowance will stop at the end of the school will stop at the end of the school year in which the youngest child is year in which the youngest child is 16.16.

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The Contributory The Contributory Pension FundPension Fund

Widow’s/Widower’s Widow’s/Widower’s AllowanceAllowance

• Surviving spouse > 50 years when Surviving spouse > 50 years when youngest child is 16, the youngest child is 16, the widow’s/widower’s allowance paid widow’s/widower’s allowance paid until the surviving spouse is 65 years.until the surviving spouse is 65 years.

• At 65 the surviving must decide At 65 the surviving must decide whether to retain the allowance or whether to retain the allowance or accept her/his pensionaccept her/his pension

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The Contributory The Contributory Pension FundPension Fund

Disability BenefitDisability Benefit• Unable to work due to physical or Unable to work due to physical or

mental disabilitymental disability• 18 years/gainfully employed 18 years/gainfully employed

immediately preceding the date of immediately preceding the date of the incapacitationthe incapacitation

• Persons must be incapacitated for a Persons must be incapacitated for a continuous period of 52 weekscontinuous period of 52 weeks

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The Contributory The Contributory Pension FundPension Fund

Disability BenefitDisability Benefit• The yearly average of contributions The yearly average of contributions

paid by the incapacitated person is paid by the incapacitated person is not less than 25not less than 25

• Incapacity must be certified by Incapacity must be certified by physicianphysician

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The Contributory The Contributory Pension FundPension Fund

Widow’s/Widower’s GratuityWidow’s/Widower’s Gratuity• Widow/widower ineligible for Widow/widower ineligible for

widow’s/widower’s allowance, widow’s/widower’s allowance, • Equal to the total value of all Equal to the total value of all

contributions paid by the deceased contributions paid by the deceased spouse.spouse.

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The Contributory The Contributory Pension FundPension Fund

GratuityGratuity• Age 65 yearsAge 65 years• Person does not qualify for a Person does not qualify for a

contributory old age pensioncontributory old age pension• A lump sum one time payment of the A lump sum one time payment of the

contributions paid by the employer contributions paid by the employer and employee – without interestand employee – without interest

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The Contributory The Contributory Pension FundPension FundDisqualificationDisqualification

A person receiving any benefit under A person receiving any benefit under the Contributory Pensions Act, 1970 the Contributory Pensions Act, 1970

is disqualified for continuing to is disqualified for continuing to receive such benefit where he/she is receive such benefit where he/she is

undergoing imprisonment or undergoing imprisonment or preventive detention in pursuance of preventive detention in pursuance of a sentence passed on conviction for a sentence passed on conviction for

an offence.an offence.

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• How much will my pension be?How much will my pension be?– Based on the average # of Based on the average # of

contributions.contributions.

• Why haven’t I received my pension?Why haven’t I received my pension?– Pension is paid on the 15Pension is paid on the 15thth..

• Can I take my money when I leave?Can I take my money when I leave?– Pension is payable at 65.Pension is payable at 65.

• Can I receive pension outside Can I receive pension outside Bermuda?Bermuda?– Yes except for non-contributory.Yes except for non-contributory.

Frequently Asked Frequently Asked QuestionsQuestions

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• If I die where does my money go?If I die where does my money go?– To your spouse. If no spouse stays in fund.To your spouse. If no spouse stays in fund.

• Do I get interest on my money?Do I get interest on my money?– No.No.

• Am I eligible for War Veterans Pension?Am I eligible for War Veterans Pension?– Yes, if you are Bermudian and served in the Yes, if you are Bermudian and served in the

Second World War.Second World War.

• Can I receive pension outside Bermuda?Can I receive pension outside Bermuda?– Yes except for non-contributory.Yes except for non-contributory.

Frequently Asked Frequently Asked QuestionsQuestions

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• Can I get pension earlier than Can I get pension earlier than 65?65?– No.No.

• What happens if I do not qualify What happens if I do not qualify for a pension?for a pension?– You will receive a gratuity and can You will receive a gratuity and can

then apply for a Non Contributory then apply for a Non Contributory Pension.Pension.

Frequently Asked Frequently Asked QuestionsQuestions

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Q & AQ & A

Health Insurance Health Insurance PlanPlan

Dept. of Social Insurance Senior’s DayDept. of Social Insurance Senior’s Day

Thu. June 12, 2008Thu. June 12, 2008

Collin J. AndersonCollin J. Anderson

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Top 10 Questions

1. What benefits does HIP cover?

2. I have always paid my premium, but why has HIP not paid all my bill?

3. Why does my premium increase every year?

4. My Doctor said HIP hasn’t paid yet, why is that?

5. Why does my prescription drug benefit run out?

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Top 10 Questions (cont.)

6. How do I obtain my prescription drug balance?

7. How do I obtain my HIP policy number or ask general questions?

8. Can I pay my HIP premium online?

9. What is the difference between HIP and GEHI?

10.Does HIP offer Dental coverage?

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1. What Does HIP Cover?1. What Does HIP Cover?

HIP benefits include:HIP benefits include:a.a. Standard Hospital Benefits &Standard Hospital Benefits &b.b. Supplemental Medical BenefitsSupplemental Medical Benefits

Please collect one of our brochures at the HIP table in the rear

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A. Standard Hospital BenefitsA. Standard Hospital BenefitsKING EDWARD VII MEMORIAL HOSPITALKING EDWARD VII MEMORIAL HOSPITAL

• In-patient Stay (public ward rate)In-patient Stay (public ward rate)• Out-patient treatment:Out-patient treatment:

• Emergency treatment (ambulance-in)Emergency treatment (ambulance-in)• LaboratoryLaboratory• Nuclear MedicineNuclear Medicine• Diagnostic ImagingDiagnostic Imaging

X-rayX-ray UltrasoundUltrasound C.T. ScanC.T. Scan M.R.IM.R.I

• Rehabilitation Treatment UnitRehabilitation Treatment Unit• Home Health Care Home Health Care • Kidney Transplants (up to $30,000)Kidney Transplants (up to $30,000)• Dental treatment for persons with medical or mental illnessDental treatment for persons with medical or mental illness• Artificial Limbs & Appliance (life-time benefit of up to $15,000)Artificial Limbs & Appliance (life-time benefit of up to $15,000)

....AND .....BENEFITS ARE PORTABLE OVERSEAS !!!....AND .....BENEFITS ARE PORTABLE OVERSEAS !!!

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Mid-Atlantic Wellness InstituteMid-Atlantic Wellness Institute

In-patient treatment (40 days per year)In-patient treatment (40 days per year)

In-patient detoxification (alcohol and heroin)In-patient detoxification (alcohol and heroin)

included under Mid-Atlantic per diem. included under Mid-Atlantic per diem.

Unlimited out-patient treatmentUnlimited out-patient treatment

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Standard Hospital Benefits (cont.)Standard Hospital Benefits (cont.)SERVICES AT SERVICES AT PRIVATEPRIVATE FACILITIES FACILITIES

DIAGNOSTIC IMAGINGDIAGNOSTIC IMAGING

Bermuda Tb., Cancer & Health AssociationBermuda Tb., Cancer & Health Association

Bermuda Healthcare Services Ltd.Bermuda Healthcare Services Ltd.

Bermuda Eye Institute (Dr. L. Teye-Botchway)Bermuda Eye Institute (Dr. L. Teye-Botchway)

Dr. Charles DyerDr. Charles Dyer

Dr. Alicia StovellDr. Alicia Stovell

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What are SHBs?What are SHBs?Standard Hospital Benefits (Standard Hospital Benefits (SHBSHB) = treatment ) = treatment

in hospital in Bermuda (in hospital in Bermuda (All local insurers must All local insurers must provide SHB at minimum)provide SHB at minimum)

Additional benefits beyond this are known Additional benefits beyond this are known variously as ‘supplemental’ benefits or ‘major variously as ‘supplemental’ benefits or ‘major

medical’medical’The Bermuda Health Council (The Bermuda Health Council (BHeCBHeC) has remit ) has remit

over SHB determinationover SHB determination

HIPHIP = SHB + Supplemental Medial Benefits = SHB + Supplemental Medial Benefits ((SMBSMB))

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B. Supplemental Medical BenefitsB. Supplemental Medical Benefits

Physicians & SpecialistsPhysicians & SpecialistsFour (4) Office Visits per year Four (4) Office Visits per year (at $42 each)(at $42 each)

Home Visits (up to 4 visits per month)Home Visits (up to 4 visits per month) ($82) ($82)

Pre-admission consultation Pre-admission consultation ($100)($100)

GPs In-patient visits GPs In-patient visits (up to $704)(up to $704)

Anesthesia (in hospital) Anesthesia (in hospital) (up to $1,042)(up to $1,042)

Internal Medicine Specialists Internal Medicine Specialists (up to $1,461)(up to $1,461)

Surgery (in hospital) Surgery (in hospital) (up to $1,880)(up to $1,880)

ObstetricsObstetrics ($3,061) ($3,061)

PRESCRIPTION DRUGSPRESCRIPTION DRUGS up to $1,200 per year up to $1,200 per year

(for persons 65 years +)(for persons 65 years +)

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Supplemental Medical (cont.)Supplemental Medical (cont.)Private Laboratory FacilitiesPrivate Laboratory Facilities

Lab Test BenefitsLab Test Benefits::

• C&S WestC&S West

• Central DiagnosticsCentral Diagnostics

• Family Medical ServicesFamily Medical Services

• Island Health ServicesIsland Health Services

• Point Finger Road Medical Point Finger Road Medical LabLab

• Woodbourne Medical LabWoodbourne Medical Lab

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Supplemental Medical Benefits (cont.)Supplemental Medical Benefits (cont.)CARDIAC SERVICESCARDIAC SERVICES

Cardiac Investigations Cardiac Investigations and diagnostic and diagnostic

services at non-services at non-hospital facilitieshospital facilities

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2. 2. I paid HIP, shouldn’t HIP pay all my medical bills?

HIP is designed to be a HIP is designed to be a basicbasic health insurance plan. health insurance plan.

HIP is not major medical. HIP is not major medical. Benefits are limited to ensure the Benefits are limited to ensure the

premium is affordable.premium is affordable.

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Bermuda’s Health Insurance System

STANDARD HOSPITAL BENEFITS(minimum health care required for all working persons HIA 1970)

Premium = $164.36/mo

App Schemes

selfInsure

GEHI(major

medical benefits)Premiu

m = $400+/mo

COMMERCIAL INSURERS

(major medical benefits)Premium = $400+/mo

HIPPremium =

$218.61/mo or $201.50 for

o/65

KEY

SHB ex MRF= $164.36

MRF = 22.84

SHB = 187.21

SMB = 14.29 to 31.40

MM = 200+

SHBs paid via Mutual Reinsurance Fund Premium = $22.84

Market Share

Depth of Coverage/ Scope of Benefits

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3. Why does HIP premium increase every year?

Premiums increase to cover rising claims Premiums increase to cover rising claims costscosts

Medical inflation contributes to increasesMedical inflation contributes to increases Hospital rates in Bermuda increase between Hospital rates in Bermuda increase between

4 and 7 % annually4 and 7 % annually In years where claims losses are lower, new In years where claims losses are lower, new

benefits are normally addedbenefits are normally added One of HIP’s goals is to be financially prudentOne of HIP’s goals is to be financially prudent

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HIP Premium 2008HIP Premium 2008 Under 65 = $218.61 Under 65 = $218.61 Over 65 = $201.50 Over 65 = $201.50

Over 65 (Non-subsidy) = $694.61Over 65 (Non-subsidy) = $694.61

Standard Premium 2008Standard Premium 2008• SHB Premium = $187.21SHB Premium = $187.21

• (Inclusive of 2008 MRF Premium of $22.84)(Inclusive of 2008 MRF Premium of $22.84)• SHB Non-subsidy, over 65 = $680.32SHB Non-subsidy, over 65 = $680.32

• Deductions Regs. = $21.60Deductions Regs. = $21.60

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4. My Doctor said HIP hasn’t paid yet… Why?

HIP has stated publicly that it had HIP has stated publicly that it had administrative problems over the years.administrative problems over the years.

In 2007, HIP implemented an aggressive plan In 2007, HIP implemented an aggressive plan to address claims arrears.to address claims arrears.

Most Doctors and service providers have Most Doctors and service providers have reported improvements in HIP’s claim reported improvements in HIP’s claim paymentspayments

The arrears project is nearing an end in the The arrears project is nearing an end in the next two months…next two months…

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HIP hired 15 new staff members in 2007

ASSISTANT DIRECTORHEALTH INSURANCE*

ACCOUNTING &ADMINISTRATIVE

MANAGER*CLAIMS MANAGER*

CASHIER* ACCOUNTS* CLAIMS CLAIMS*

CLAIMS*

CLAIMS*

ACCOUNTS RECEIVABLE*

PAYMENTS CLAIMS

CLAIMS

CLAIMSCLAIMS

AUDITAUDIT

CUSTOMER SERVICES

CLAIMS

CLAIMS CLAIMS

CLAIMS

CLAIMS CLAIMS

* = permanent staff

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Outstanding Claims by Fiscal Year

$1,326,613.23 59%

$633,365.26 29%

$63,571.773% $178,524.46

8%

$15,856.001%

Prior to 05-06 FY 05-06 FY 06-07 FY 07-08 FY 08-09

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HIF & MRF PAYMENTS

0

500

1000

1500

2000

2500

3000

3500

Thousands

AMOUNT ($) N/a 1,818,362. 114,047.57 0 165,524.70 3,558,741. 92,848.80 132,262.74 765,713.88 2,884,191. 1,776,495. 1,935,436.

AMOUNT ($) 1,603,589. 1,785,955. 3,107,529. 2,510,122. 1,763,748. 129,666.13

JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC

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Claims Payment Progress

CLAIMS TYPECLAIMS TYPE JUNE 2007JUNE 2007 JUNE 2008JUNE 2008

Hospital (BHB)Hospital (BHB) 3 months 3 months arrearsarrears

Current (since Current (since Sep. 2007)Sep. 2007)

PharmacyPharmacy CurrentCurrent CurrentCurrent

Physicians & Physicians & FacilitiesFacilities

$2 to $2.5M$2 to $2.5M

arrears arrears

$1 to $1.5M$1 to $1.5M

arrearsarrears

Overseas Overseas (Portability)(Portability)

Argus, Colonial, Argus, Colonial, BF&M, LCCA, British BF&M, LCCA, British

American & GEHIAmerican & GEHI (approx. $7.54M)(approx. $7.54M)

BF&M & BF&M &

LCCA at 50%LCCA at 50%

(approx. $3M)(approx. $3M)

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5. Why does my prescription drug benefit run out?

HIP provides a prescription drug benefit of HIP provides a prescription drug benefit of $1,200 per annum to Seniors$1,200 per annum to Seniors

This is an extremely costly benefit for the This is an extremely costly benefit for the Fund to sustainFund to sustain

This benefit, like all HIP benefits, must be This benefit, like all HIP benefits, must be limited to maintain the financial balance of limited to maintain the financial balance of FundFund

Currently, prescription drugs required beyond Currently, prescription drugs required beyond the $1,200 limit must be paid out-of-pocketthe $1,200 limit must be paid out-of-pocket

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6. How do I obtain my prescription drug balance?

A. You can obtain this information today at the HIP table in the rear

B. You can obtain this information any other time by calling: 295-9210

C. Also, all local pharmacies receive this information from HIP on a regular basis

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7. How do I obtain my HIP policy number or ask general questions?

You can obtain this information today at the HIP table in the rear

Or Call HIP at: 295-9210

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8. Can I pay my HIP premium online?

Online payments are now possible for Online payments are now possible for HIP premium payments through HIP premium payments through EasypayEasypay and and Bank of BermudaBank of Bermuda online online banking and ATMs.banking and ATMs.

Butterfireld Direct is a payment option Butterfireld Direct is a payment option that will be available shortlythat will be available shortly

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9. What is the difference between HIP and GEHI?

GEHI is health insurance for GEHI is health insurance for government employees and retirees government employees and retirees only.only.

HIP is the health insurance offered to HIP is the health insurance offered to the public by Bermuda Government as the public by Bermuda Government as an affordable option to meet your basic an affordable option to meet your basic healthcare needs.healthcare needs.

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10. Does HIP offer Dental coverage?

Starting Starting August 1, 2008August 1, 2008, HIP will be , HIP will be adding three (3) additional benefits:adding three (3) additional benefits: Basic Dental;Basic Dental; Specialist procedures outside the hospital;Specialist procedures outside the hospital; Increased Kidney Transplant benefit.Increased Kidney Transplant benefit.

You can obtain more information at the HIP table…

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Q & AQ & A