Health insurance benefits for gov’t pensioners
THERE HAS been ongoing concern about the level of pension paid to government employees who have gone into retirement and its implications for their standard of living.
Also important to the retiree is the funding of healthcare, which the government has provided for since December 1995 through GPASO or the Government Pensioners Administrative Service Health Scheme.
GPASO is a comprehensive contributory health insurance scheme operated by the government of Jamaica through the Ministry of Finance and the Public Service. It is managed by Sagicor Life Jamaica Limited on behalf of the government of Jamaica, in collaboration with the Government Pensioners Association.
The following are eligible for membership and thus benefits: pensioners 55 and over, people who retired from employment because of ill-health, regardless of the age of retirement, the pensioner’s spouse, widows and widowers over 55 who are currently in receipt of a pension, government pensioners in receipt of a pension from local government and central government, including teachers, nurses, police officers and civil servants, and retirees of some approved statutory bodies. Also eligible for benefits are the dependent children under 19 and physically challenged children of the pensioner.
The government of Jamaica pays 80 per cent of the premium and the pensioner pays 20 per cent monthly in the course of the contract year which runs from December 1 to November 30. The contract is renewed each year unless the payment of the premium stops.
Application for membership goes directly to the administrator, Sagicor Life, but officers proceeding on retirement and who have elected to receive the alimentary allowance and advance on gratuity may apply to the GPASO through their personnel unit.
Pensioners also have the option to enrol in a supplemental health plan, Medigap, which covers hospitalisation costs on the individual plan. The individual plan covers the pensioner only and the family plan covers the pensioner and the pensioner’s resident spouse – married or unmarried.
The health insurance plan gives a wide range of benefits to its members, including access to doctors, specialists, dentists, laboratories, pharmacies, opticians and hospitals. Hospital services include room and board, out-patient services, intensive care, diagnostic services and overseas emergency services. The latter is for pensioners only.
The Minister of Finance and the Public Service, Dr Nigel Clarke, recently announced increased benefits to take effect on September 1, 2023, but without an increase in the premium. The increase applies to the full-house benefit for plan members and widows, which will increase by 40 per cent to $28,000, and by 30 per cent to $52,000 for the family plan.
To enrol, pensioners need to complete the enrolment form, pension deduction form, present a certified copy of their birth certificate and/or the marriage certificate. A birth certificate is also required when adding or changing a spouse dependent. A marriage certificate is also required in the case of adding a name or changing a spouse through marriage.
In addition to the benefits that can be derived from the GPASO, pensioners have access to many benefits under the NI Gold Insurance Plan offered by the National Insurance Scheme, for which all recipients of its pensions are eligible. Members are not required to make contributions or pay premiums but can enjoy benefits such as in-hospital room and board, surgeon’s and assistant surgeon’s fees, anaesthetist’s fees, doctor’s office and home visits, diagnostic services, prescription drugs and dental and optical expenses.
Government pensioners should also bear in mind that every person living in Jamaica is eligible to become a member of the National Health Fund (NHF), which does not require contributions or premiums to be paid and provides for prescription drugs for a specific list of chronic conditions. Individuals must apply for membership, though. Application forms may be collected from a doctor, hospital, pharmacy, health clinic and an NHF office.
All these provisions for meeting health-related expenses are significant for pensioners, whose pension is generally less than the salary or income they used to earn before retiring, thus putting them at risk of experiencing a lowering of their standard of living relative to that enjoyed during their working years.
It is prudent for government pensioners and all pensioners to put themselves in a position to benefit from the programmes which are available to cover some of the costs associated with health issues, so that they have more to direct to other expenses. In fact, without these schemes, notwithstanding the fact that they do not cover the entirety of the pensioner’s health-related expenses, some pensioners could find themselves in a position in which they might not be able to attend to their health problems.