The National Insurance Scheme (NIS) will have to find a way of getting annual contribution statements sent directly to employees, Board Chairman Dr Roger Luncheon said yesterday.

He said that sending the statements to employers “would not logically” lead to them reaching the employee. “We have to look at other ways,” Luncheon added. “The system that is set up for it going to the employer is the most rational one… So that would not be abandoned but we see the weakness, whether it is cockishness or sometimes the employer did not pay the… money.”

Luncheon was at the time responding to concerns raised by members of the Parliamentary Sectoral Committee on Economic Services at a meeting held yesterday in the committee room of Parliament Building.

The board chairman led a team of NIS officials–including acting General Manager Doreen Nelson–and answered questions posed by the committee’s chairman, Gail Teixeira and members, PPP/C parliamentarians, Rev Kwame Gilbert, Fazil Khan and Dharamkumar Seeraj and PNCR MP Dave Danny.

Most of the questions from the committee members centred on medical benefits for pensioners and accurate contribution information given to employees.

The members of the committee were concerned about employers not giving the contribution statements to employees especially those who have been delinquent in paying the contribution and do not want the employee to find out.

“… Access to this information could become essentially an agreed upon feature in a Collective Labour Agreement,” Luncheon said.

The chairman said the scheme has improved its ability to swiftly deliver such information when a contributor approaches any office.

Even before the National Insurance and Social Security (Amendment) Bill 2009, which among other things mandates the scheme to issue annual contribution statements, the scheme said, it has been doing so.

And if a person wants to see his/her contribution for all of his/her working years, Nelson said s/he can visit the scheme’s Camp Street office and make such a request.

Nelson said the contribution schedules are sent to employers who are expected to give them to the employees but there have been discussions on getting the statements directly to the employees. However, NIS hit a dead end as it did not have the current addresses for most of the contributors. The scheme is working on a system where persons will be encouraged to update their data.

Danny stressed that there is need for employees to receive their contribution statements personally as some employers “out of spite” may want to put the statements “under the desk or in his garbage.” He also pointed out that in cases where persons have left the employ, they would not receive the statements.

Seeraj, who is the head of the Guyana Rice Development Board, told the NIS officials present that his entity was not in receipt of the annual contribution reports that are supposed to be issued to all NIS-paying entities.

He also said that among the top three issues raised by sugar workers during recent consultations was the fact that their NIS contributions were not up to date.

He then questioned how the NIS computerized programme–implemented recently with the aim of among other things reducing errors—was progressing.

In response, Nelson said all NIS offices are not computerised but a lot of work has been done to put all contributions in the system regardless of what comes on the contribution schedule. She said NIS has been sending contribution statements to all employers but did answer Seeraj’s specific question as to why his entity has not been receiving such statements.

With respect to GuySuCo, she said discussions have been ongoing as there was a longstanding issue of schedules being submitted with only a last name and the difficulty pinpointing who it was as there are many persons with the same name.

“Those kinds of things affect us when we don’t get the full set of information coming on the schedule, it takes time to clarify it,” she said.
Specialists

Meanwhile, on another issue, Khan suggested that the scheme’s specialists visit outlying areas to see contributors instead of them having to travel to Georgetown as it is very costly and the expense is sometimes more than what they would pay to see a private doctor in their area and purchase medication.

However, Luncheon said it was a reality contributors would have to face as the likelihood of the scheme ensuring specialists’ presence in different parts of Guyana would be an “enormous undertaking and indeed may very well lead to a situation of unacceptable redundancy” since the health ministry may already have such a specialist in the area.

Prior to yesterday’s meeting the committee sent several questions to the acting general manager, one of which was about the new policy on reimbursements for health claims which requires persons to pay and then claim from NIS. The committee questioned why the percentage of reimbursements paid to contributors was reduced; whether the change has resulted in long delays for claimants to obtain reimbursements and whether systems were put in place to improve the situation.

In response, NIS said there was a system in place of Sickness Benefit Medical Care Reimbursement that requires the qualified contributor to incur the associated expenses and recover from the scheme the approved rates of reimbursements. The scheme had initially implemented a Primary Health Programme which was expanded over time resulting in what became known as the Extended Medical Care.

“The arrangement resulted in medications for certain chronic conditions to be made available to pensioners and contributors.

‘This got out of hand in terms of costs as well as breaches in the dispensing of medication. This was disbanded,” the scheme said, while pointing out that it was not a funded programme. It resulted in persons having to comply with the sickness benefit medical care requirement that results in fixed percentage of reimbursement as against receiving drugs free of cost.

It was made clear that there has not been any reduction of the percentage of reimbursements paid to contributors or pensioners but rather there has been a change from free medication to that of purchasing and claiming a refund.

“This really is the crux of the matter. Measures are in place to expedite reimbursements,” the scheme stressed.
‘Over sixty’

Another sore point for the committee was the disallowing of medical coverage for persons over 60 with new diseases or complications resulting from pre-existing diseases.

According to the scheme, sickness benefit is paid to an insured person over 60 only if the medical condition existed prior to the person attainting that age and the person had qualified to receive the benefit.

First and foremost the pensioner must have been diagnosed by a doctor and worked on the day prior to the day of incapacity and must have made at least eight contributions during the period of 13 weeks prior to the week of the diagnosis. Once the requirements are met the pensioner would be reimbursed for as long as care and medication is required.

“Any complications resulting from pre-existing diseases would be honoured once the above conditions have been met. This, however, is a medical consideration.

‘A new disease or complication that arises after 60 cannot be considered because the insured person did not have same prior to attaining age sixty,” the scheme stressed.

However, Dr Luncheon acknowledged that the way the scheme operates now could be disadvantageous to persons who are suffering from chronic disorders who obviously would have had to have these disorders prior to them attaining the age of 60.

He reiterated that the scheme is not a policy-making body and as such is guided by its statues and decades of practice.

The board chairman dismissed a suggestion from Teixeira that maybe the scheme could advocate for its contributors to do annual medical check-ups as this would result in a more informed contributor and better responsible one. She opined that this would better help contributors to detect illnesses before they attain the age of 60.

Luncheon said the chairman’s point is valid for the entire country–most of who are not contributors to the scheme– and as such it should be the Ministry of Health that should be advocating such a policy.

And according to Seeraj there are persons out there who are aware of this policy who are visiting doctors and receiving  “reports stating conditions that they don’t have but are likely to have after 60; it is dishonest, but here is where you have the most vulnerable people who might need it the most are isolated from the existing scheme and there are people out there who from their enlightened position are taking steps to ensure that in the event that a condition does arise they are already diagnosed…”