THE new CNMI Group Health Insurance Program offers more plans and health benefits at an affordable cost than the previous plan, Retirement Fund legal counsel Kathleen Troy-Rucker said.
Troy-Rucker said although some private health insurance companies still provide a higher and lifetime maximum coverage, the government group health benefits “are going to be better.”
Under the new program, a government employee can choose from four different plans:
• Self Only—the beneficiary is the employee;
• Self Plus One—the beneficiaries are the employee plus a single dependent;
• Self Plus Four—the employee plus four dependents; and,
• Self Plus Five Plus—the beneficiaries are the employee plus five or more dependents.
These plans are available in either the high option or low option benefits.
The high option offers an annual maximum of $100,000 benefit per enrollee or lifetime maximum benefit of $500,000 per enrollee.
The low option offers an annual maximum benefit per enrollee of $50,000 and $250,000 lifetime maximum per enrollee.
The employee’s minimum contribution is $4,000 and a maximum of $24,000 a year, depending on the plan.
Troy-Rucker reiterated that enrollment to the CNMI Group Health Insurance Program is optional.
“Any member who chooses not to participate in that program has that option,” she said.
She said the government’s health insurance package now offers a formula that allows enrollees a variety of choices.
Under the new program, majority of medications that patients in the CNMI are taking can be covered under the plan.
Co-payments for each prescription drug is $3 for generic brands, $7 for preferred brands and $15 for non-preferred brands for both the low option and high option plans.
“The prescription drug coverage, we think, is going to be very advantageous to a lot of people. The formula we’re going to implement contains a lot of prescriptions. So the majority of medications that patients in the CNMI are currently taking will be available,” Troy-Rucker said.
“There will be some really high cost medications that may not be available but the majority of medications are going to be available,” she added.
The new plan covers payments for facility services such as hospital room and board, intensive care unit and skilled nursing room and board. It also covers in-patient and out-patient hospital charges such as operating room, drugs, X-ray, laboratory and medical supplies.
