Challenges with Unimed Group Health Plan

THE UNIMED Group Health Plan is a plan established by the employer for both daily and monthly-rated employees in the public and teaching services. It is a benefit to all members of the teaching service. Members and non-members of TTUTA are on the plan.

TTUTA has a management role in Unimed which is exercised at the level of a management committee. TTUTA also facilitates the collection of claim forms and the subsequent distribution of settlement cheques after the carrier, M&M Insurance Brokers Ltd, settles the claim. These services are provided at all TTUTA offices throughout TT. It is noteworthy to emphasise again that these services are extended to members and non-members of TTUTA.

It has been years since members of the teaching service have been able to receive reimbursement of medical expenses in a timely manner from the Unimed plan. The employer, without fail, would religiously deduct the Unimed premium. The problem with this plan is acute and has led to high levels of frustration. What used to be a six-week turnaround is now a 13-month delay. This is an injustice to the members of the plan.

TTUTA is aware that the Education Ministry has not been consistently and effectively fulfilling its role in the process of enrolment of eligible employees and their family members. Our members are constantly reporting delays in enrolment emanating out of the ministry and in some cases the information submitted by the employee cannot be located anywhere within the confines of the ministry.

An employee is eligible to be a member of the plan upon completion of two years of continuous service. There should be an automatic trigger which would allow for the employer to enrol and deduct the contributions on a monthly basis. This is not the case. The delay or non-compliance places an undue disadvantage to the employee, not to mention denial of much needed contributions.

Medical services can be expensive and the expectation is that the promised reimbursements will be timely so that employees would be able to attend to further medical expenses, among other things.

TTUTA has made, and continues to make, robust representations on this issue because we recognise that the nation’s educators, who work hard under stressful conditions, are being disrespected and denied the use of their property.

As at January, the value of “claims settled – cheques not yet printed” stood at $31.3 million. Employees are paying the premium, paying the medical bills and are then asked to wait a year for payments on their claims.

The Unimed management committee is made up of representatives of the two unions (PSA and TTUTA), along with representatives of the employer (Personnel Department and Finance Ministry). The CPO appoints the chairman and three other members to the committee. Those people are from the Personnel Department, which is headed by the CPO. They report to and take instructions from the CPO.

As the representative of the employer and the officer ultimately responsible for the Unimed plan, the CPO has failed to deliver the promised benefits. Once again, the employer has not failed to collect the premiums. One questions the timely payment to the provider of the plan.

The CPO is well aware of the functioning of the plan and of the problems it faces. Even more so now, given the audit report which was completed this year. TTUTA has not been privy to this report but is well advised that both the CPO and the Minister of Finance have reviewed the report. We anxiously await the actions which will be derived and acted upon emanating from that audit report.

The plan administrator (M&M Insurance) has consistently reported a deficit and that cash flow does not allow for payment of all claims. This is due to a number of reasons, one being the rising cost of medical services and drugs. The last review and implementation of an increase in dues was approximately ten years ago.

The Personnel Department, the Finance Ministry and the management committee will have to do their respective duties in rectifying the issues affecting the plan. In the interim, what is being done to address the inordinate time in which claims are being settled and payments distributed?

TTUTA demands the answers to the many questions facing the Unimed plan. If every person who is being denied their money, the $31.3 million, comes out to ask these questions it would mean a shutdown of the country.