Global Health Care Update

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1 Global Health Care Update September/October 2012 This bimonthly Update summarizes recent legislative developments and trends related to health care and highlights recently passed and pending legislation that may require employers to take action to comply with new rules or review existing plans. Recent Developments Americas The government of Quebec (Canada) announced the implementation of a new progressive health contribution, effective in Originally, the contribution was set at CAD 200 for 2012 and subsequent years (with an exemption for eligible seniors). Under the government s new progressive proposals, taxpayers with incomes of CAD 130,000 or more will pay an additional contribution that will reach CAD 1,000 for incomes of CAD 150,000 or more. As a result, four million taxpayers will pay nothing or a reduced contribution as of next year; while that paid by 1.8 million Quebecers will remain unchanged for this year and next. Nova Scotia and Alberta (Canada) have announced long-term care accommodation charges for In Nova Scotia, effective November 1, 2012, the cost for accommodation in long-term care will be based on 40% of a couple s combined income, down from the current 50%. The combined spousal income threshold will increase from CAD 18,064 to CAD 20,000. In Alberta, effective January 1, 2013, the regulated maximum accommodation charges in long-term care settings will increase to CAD per day for a private room (maximum monthly charge of CAD 1,785); CAD per day for a semi-private room (maximum monthly charge of CAD 1,545); and CAD per day for a standard room (maximum monthly charge of CAD 1,465). Asia Singapore s Central Provident Fund (CPF) will extend the minimum 4% annual interest rate for Special, Medisave, and Retirement Account holders through the end of As of 2014, the rate will be pegged to the 12-month average yield of 10-year Singapore government securities plus 1%, subject to the statutory minimum rate of 2.5%. The 4% interest rate has been in place since It was scheduled to expire at the end of 2009, but due to uncertainty in the global economy, the government extended the rate. Copyright 2012 Aon Hewitt Inc 1

2 Health Insurance in Switzerland There is no federal health insurance program. However, there are laws governing the requirements for a basic insurance system. Employers are not required to provide medical care benefits. Medical care benefits are provided through individual membership in health insurance funds. Membership in a health insurance fund has been mandatory in all cantons since 1996; there are around 90 health insurance funds throughout the country. Coverage and financing requirements for standard basic health insurance are as follows: Mandatory coverage for all residents within three months of birth or residency; Uniform levels of benefits for all basic insurance coverage; Uniform premium rates to be set by each health insurance provider for all insured adults residing within the same region or canton regardless of whether coverage is offered through individual or group contracts. There are two additional premium classes, one for children age 18 and younger and the other for students between age 19 and age 25; Patient coinsurance payments of 10% of charges up to an annual maximum of CHF 700 are applicable to all charges (including hospital treatment charges). Copayments for brand-name drugs are 20% if a generic alternative exits; A health insurance fund is allowed to vary premium amounts for optional cost-sharing features, including higher deductibles and restrictions on the choice of health care provider under health maintenance organizations (HMOs) and similar arrangements; Extension of coverage to include unlimited medically prescribed home nursing care and hospital visits, enhanced maternity benefits (for example, an increase from four checkup visits to seven visits), 50% of medically required transportation costs up to an annual maximum, and costs of certain immunizations and other preventive measures is possible through supplemental private insurance. Accident-related injuries covered under nonoccupational and occupational accident insurance for employed persons (workers compensation) are covered at an additional premium cost for pensioners, housewives, and children; Unrestricted choice of any health insurance provider recognized by the federal government. Selective underwriting and coverage exclusions and restrictions due to preexisting conditions are prohibited; Redistribution of federal and cantonal subsidies, resulting in the elimination of subsidies for middle- to high-income earners; and Risk assessment and equalization to prevent insurers of younger and healthy participants from reaping high profits. This methodology requires the transfer of funds from basic insurance providers with below average enrollments of women and the elderly to those providers with above average enrollments of these groups. Copyright 2012 Aon Hewitt Inc 2

3 Cost and Benefits Standard basic insurance covers hospitalization and medical costs provided by approved doctors and hospitals. Coverage of dental expenses is limited to treatments required as a result of specified diseases. Supplemental coverage is available, with benefits varying according to the level of coverage (private and semiprivate hospital room and board, unrestricted choice of physicians and hospitals, alternative medicine treatments, certain prescription drugs, and dental and vision care). Insureds are covered in the event of expenses incurred for emergency medical care outside Switzerland. The maximum amount that can be reimbursed is two times the normal amount covered by the health insurance fund for the same services provided in Switzerland. The premium rates for standard basic insurance coverage for insured adults vary widely. Although basic coverage levels between the health insurance providers are identical, the insurance funds can set up to three regional premiums within a canton, to reflect variations in their cost basis. The average premium increase for an adult (age 26 and older) in 2012 is 2.2%. According to the Federal Health Office, the average monthly premium for a basic policy including accident insurance is expected to be CHF 382 per adult in In order to change basic health insurance providers, three months advance written notification of coverage termination must be given. In addition, it is only possible to change providers at the end of June or December. Policies with a high deductible or with restrictions in the choice of doctors/hospitals can only be cancelled at year s end, subject to the three months advance written notice requirement. In case of premium increases, the notice period is reduced to one month. Changes in insurance coverage are allowed at the end of each calendar quarter and require written notification as well. Supplemental Coverage Unlike the premiums for standard basic insurance, insurance providers are free to base the premium cost of supplemental coverage on risk categories and to use more favorable rates for supplemental coverage offered through group contracts. Health Insurance in the Netherlands Health insurance in the Netherlands is a three-tiered system based on a combination of private insurance companies (either independently or under contract to the government) and public entities. Prior to 2006, about 64% of the population was covered for basic health care services by the first tier of the system (Ziekenfondswet (ZFW)), which was compulsory for persons with income below EUR 33,000. That portion of the population earning above the ceiling were supposed to have private health insurance, typically as a result of their employment. Less than 2% of the population had no health insurance. Due to rising national health care costs as well as concerns regarding equitable access to and choices for health care, the government passed the Health Insurance Act (ZVW) Zorgverzekeringswet)) to replace the ZFW for basic medical care and hospitalization, effective January 1, Copyright 2012 Aon Hewitt Inc 3

4 The second tier of insurance is the AWBZ, which covers long-term care and high-cost treatment. The AWBZ is compulsory for residents and nonresidents employed in the Netherlands independent of their income. It is run by state-appointed insurers. This plan covers long-term care and high-cost treatment. The third tier is voluntary health insurance, which covers treatments not covered under the first two, including dental care. Zorgverzekeringswet (ZVW) Health Insurance All resident individuals and nonresidents subject to Dutch payroll taxes are required to have health insurance. The only parties exempted from the requirement are military personnel in active service and conscientious objectors to insurance. The system consists of 41 private health insurance companies. The insurers are required to accept every resident in their area. A system of risk equalization prevents direct or indirect risk selection. The new system is financed by employer income-based contributions paid into a new Health Insurance Fund, nominal premiums paid by the employee directly to the insurer, and public funds. Enrollment Income-Based Contribution Employees are subject to an income-based contribution of 7.10% of covered pay up to EUR 50,064. The contribution is withheld from pay by employers and forwarded to the tax authorities. Employers are required to reimburse their employees in full for the income-based contribution. Employees are taxed on the premium. Most individuals receiving social security benefits are entitled to reimbursement of income-based contributions from the institutions that provide these benefits. For example, individuals that receive an unemployment allowance are reimbursed by the Social Insurance Benefits Institute (UWV), which provides the allowance. Retirees in most cases are not reimbursed for all or part of their income-based contribution. Fixed-Rate Premium All insured adults also are required to pay an annual nominal premium which is expected to average EUR 1,291 in The government contributes to the Health Insurance Fund to finance nominal premiums for children under age 18. The premium varies only by type of policy and the amount of personal excess (deductible). Insurers are not permitted to use experience rating in the determination of premiums. Low-income households are eligible for a health care allowance to compensate for the higher costs of coverage under the new system. Effective January 1, 2012, individuals are required to pay a compulsory excess of EUR 220 for medical expenses not covered under the general health package. In other words, for additional treatment, an individual pays the first EUR 220 in expenses. The compulsory excess does not apply to general practitioner care, natal care, maternity care, and dental care for youth up to age 22. Also, it does not apply to children up to age 18. The no claims refund of EUR 255 for individuals who did not claim any medical costs during the year was abolished as of January 1, Copyright 2012 Aon Hewitt Inc 4

5 Health Insurance Policies Enrollees select from three policy options: Contracted care (in-kind) policy An individual chooses from the insurer s own or contracted health care providers, and the insurer pays the provider directly; Cost reimbursement policy An individual receives care from providers outside the insurer s network, pays for the costs incurred, and receives a reimbursement from the insurer. The insurer may not establish a maximum for the reimbursement; however, it is not required to reimburse more than prevailing market standards; or Combination of contracted care and cost reimbursement policies. Insurers are permitted to offer personal excess plans under which the insured must pay the full deductible before the insurance company begins paying expenses. Deductibles are typically structured in EUR 100 tranches. The insurance company may set discounts applicable to each tranche at its discretion, but discounts must be available to all policyholders on an equal basis. Insurers are permitted to offer an additional premium discount based on the number of years in a deductible plan. Insurance policies have a term of one year. If an insurance provider raises its premiums during the policy year, individuals are permitted to change companies. Individuals are required to inform their insurer immediately of any circumstances that might result in the termination of their policy, such as expatriation or moving outside of the insurer s area of activity. Individuals who wish to change insurers must select a new insurer and cancel the prior contract by January 1. Consumers may change insurers in January; however, they may be subject to a pro-rated annual premium on the cancelled policy. Benefits Standardized basic coverage includes: Medical care, including hospitalization (up to 365 days) and specialists; Dental care for children (up to age 22); Specialist dental care and dentures for adults; Pharmaceuticals; Maternity and postnatal care for up to ten days after childbirth; Ambulance and transportation costs; and Some rehabilitation services. Copyright 2012 Aon Hewitt Inc 5

6 The maximum reimbursement for pharmaceuticals is based on the average price of groups of medicines that are therapeutically interchangeable. Individuals are responsible for any difference in price between the maximum reimbursement and more expensive drugs. There is no reimbursement limit for covered drugs for which a substitute is not available. National Health Insurance (AWBZ) Second-tier premiums are based on a percentage of salary up to a ceiling and are paid in full by the employee. All covered residents and nonresidents employed in the Netherlands are eligible if they require medical care not provided by ZVW health insurance or, if applicable, after exhausting private coverage. Benefits include special or prolonged (generally over one year) nursing and treatment in mental institutions and homes for the blind and for the disabled, as well as prescription drugs. Private Health Insurance Supplemental plans are available on an individual basis or collectively via an employer plan or similar group arrangement. Insurance companies are not required to accept all applicants for supplemental insurance. Companies are free to determine the scope of coverage and premium levels for supplemental policies, as prescribed under the general rules for the insurance industry. For group employer plans (and group plans in general), the maximum allowable group discount is 10% per employee or group member. The only factor on which group discounts may be based is the number of participants. The same discount and premium must apply to like-sized groups. * * * * For more information on the topic and countries in this newsletter, please refer to the Aon Hewitt Country Profiles eguide. You can learn more about the Country Profiles eguide here. Copyright 2012 Aon Hewitt Inc 6

7 About Aon Hewitt Aon Hewitt is the global leader in human resource solutions. The company partners with organizations to solve their most complex benefits, talent and related financial challenges, and improve business performance. Aon Hewitt designs, implements, communicates, and administers a wide range of human capital, retirement, investment management, health care, compensation and talent management strategies. With more than 29,000 professionals in 90 countries, Aon Hewitt makes the world a better place to work for clients and their employees. For more information on Aon Hewitt, please visit Copyright 2012 Aon Hewitt Inc. This document is intended for general information purposes only and should not be construed as advice or opinions on any specific facts or circumstances. The comments in this summary are based upon Aon Hewitt's preliminary analysis of publicly available information. The content of this document is made available on an as is basis, without warranty of any kind. Aon Hewitt disclaims any legal liability to any person or organization for loss or damage caused by or resulting from any reliance placed on that content. Aon Hewitt reserves all rights to the content of this document. Copyright 2012 Aon Hewitt Inc 7

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