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GHI proposes changes in room rates, benefits
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Posted on Apr 24 2006
The NMI Retirement Fund Group Health Insurance program proposes to implement a uniform coverage rates for its members, beginning with its room coverage and maximum benefits.
Under the program’s proposal, it would adopt a $300 limit per day for on-island hospital room and board. This represents the maximum amount the program will pay for room and board and general nursing care while an employee is confined in an on-island hospital.
For on-island intensive care room and board, the proposed limit is $900 a day, while for an on-island skilled nursing facility, the limit would be $60 per day for 60 days.
For off-island facilities, the plan would shoulder 80 percent of the room rate.
Currently, the plan’s high-option rate for on-island hospital room and board is $300 while the low option is $250.
For on-island intensive care room and board, the high-option limit is $900 a day while low-option is at $750.
For on-island skilled nursing facility, the limit for high-option is $150 for 60 days; low-option is $125 per day for 30 days.
For other hospital charges such as operating room, drugs, x-ray, laboratory, and medical supplies, the plan’s proposed coverage is 80 percent.
Under the proposed amendments to the plan’s regulations, the program aims to reduce four-tier enrolment categories to three—single, couple, and family—and to delete “high option” and “low option” subcategories.
The program proposes to retain high option’s 80/20 contribution—80 percent government and 20 percent member.
Under the proposal, the plan aims to set the annual maximum covered benefits per enrollee at $100,000, while lifetime maximum benefits is $500,000.
For single, out-of-pocket maximum is $4,000; couple, $8,000; and family, $12,000.
The proposed changes to the plan’s rules and regulations are to take effective July 1, 2006.
