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Group Health Insurance

WHO CAN JOIN THE PLAN?

Any bona fide member of CCRP and their dependents residing in Jamaica

WHO IS THE INSURER?

The health insurance plan is underwritten by Sagicor Life Jamaica Ltd and managed by Gallagher Insurance Brokers Jamaica Ltd.

HOW MANY HEALTH PLANS DOES CCRP OFFER?

There are two (2) group health plans that the CCRP currently offer to their members. There is a comprehensive group health plan #46339-01 and a Group Major Medical plan #45759. The difference between both plans is that the comprehensive group health plan offers complete medical insurance coverage including prescription drugs, dental and optical benefits. While the Major Medical plan offers only coverage for major occurrences being surgery, hospitalization & diagnostic services. Additionally the major medical plan carries an annual deductible of $100,000 that a member must satisfy before being able to access coverage.

CAN I TRANSFER FROM THE COMPREHENSIVE PLAN TO THE MAJOR MEDICAL PLAN?

Yes, existing members currently covered under the CCRP comprehensive plan (46339-01) can transfer to the major medical health plan (45759).

WHY WERE THE PREMIUMS INCREASED FOR THE COMPREHENSIVE GROUP HEALTH PLAN #46339

On an annual basis the insurer reviews the claims utilization of the scheme and assess if the premium rates are adequate to sustain the plan for the upcoming policy year. The claims usage report for the review period was extraordinarily high and consequently premium rates were increased to ensure that the health plan remains viable.

HOW, WHEN & WHERE DO I PAY PREMIUMS?

Premiums are payable quarterly, semi-annually or annually basis. There are several options to remit premium payments. Payments can be made at Gallagher Insurance Brokers Ja. Ltd, Paymaster Ltd or online bank transfer. We accept debit/credit cards, cheque or cash.

Premiums become due on the following dates, however members can remit premiums prior to the due date:

PAYMENT PERIODPREMIUM DUE DATE
Quarter One (Dec – Feb)December 1st
Quarter Two (Mar – May)March 1st
Quarter Three (Jun – Aug)June 1st
Quarter Four (Sep – Nov)Sept 1st

 

WHAT HAPPENS IF I CANNOT MAKE PREMIUM PAYMENTS ON TIME?

Regrettably, you will be taken off the scheme and can only be reinstated subject to proof of insurability. It is very important to ensure payments are made on time and kept up-to-date.

WHAT HAPPENS WHEN A MEMBER LEAVES AN AGE BAND WITHIN THE POLICY YEAR?

The member will be transferred to the next age band category at the policy renewal / anniversary date and premium adjusted accordingly.

WHAT DOES CO-INSURANCE MEAN?

This means that your comprehensive health plan typically covers 80% of most medical expenses and the insured is responsible for the balance of 20%. However for Prescription drugs, the plan will pay a co-insurance of 60%-40% when in major medical.

WHAT DOES MM DEDUCTIBLE MEAN?

This is the initial amount which you must pay after benefits have been exhausted under the basic plan, thereby making you eligible for benefits under Major Medical. This may be a one-time payment or an accumulation of payments over the policy year. The deductible is paid to the provider during the normal course of accessing services, should as prescription drugs or diagnostic services.

WHAT DOES ‘MM’ MEAN?

The abbreviation ‘MM’ stands for Major Medical – Major Medical is the provision of additional protection to meet the expenses of serious illnesses and accidents. These benefits are combined with the basic plan benefits to offer a more comprehensive coverage for major illnesses and accidents without which an insured would incur significant out of pocket expenses. Major Medical extends to coverage of all reasonable medical expenses and operates on a coinsurance basis, with the plan covering 80% of costs and the insured meeting the balance of 20% in some benefits of the plan.

WHAT DOES R&C MEAN?

This is an abbreviation of Reasonable & Customary charges, which is applied by each Insurance Company primarily to surgical, hospitalization & major medical charges. It refers to a charge for medical care which is considered reasonable and customary to the extent that it does not exceed the general level of charges being made by others of similar standing in the locality where the charge is incurred when furnishing comparable treatment or services, to individuals of the same sex and comparable age, for a similar disease or injury.

WHAT IS MEANT BY A ‘CAP’ ON SURGERY BENEFITS & WHY?

This is the maximum amount that the insurer will pay for any one surgery, including surgeon fees, assistant surgeon & anaesthetist. The insurer will apply the reasonable and customary charges up to a maximum of $1,500,000 per surgery. This has been implemented to assist with the sustainability of the health plan.

WHAT IS MEANT BY PRE-AUTHORIZATION?

Pre-Authorization is the written approval granted by the insurer confirming that they will undertake payment of a specific medical procedure. A quotation is usually submitted to the insurer by a provider seeking authorization of said procedure and the amount the insurer would reimburse.

HOW DO I MAKE A CLAIM?

Members can submit a completed health claim form and original receipt directly to the insurer or they may submit their claims to Gallagher Insurance Brokers. Claims can also be submitted electronically by email to Gallagher. We encourage members to ensure that the claim form is thoroughly completed including their name, policy number, diagnosis and signature with receipt attached.

ELECTRONIC REIMBURSEMENT OF CLAIMS / ELECTRONIC FUNDS TRANSFER FORM (EFT)

To facilitate speedy claims settlement the insurer has implemented electronic funds transfer (EFT) of health claims’ reimbursement. This means that all payments made by the insurer are directly deposited to the member’s bank account. Kindly ensure that an EFT form is completed and submitted to Gallagher Insurance Brokers.

NATIONAL HEALTH FUND (NHF) / JAMAICA DRUGS FOR ELDERLY PROGRAMME (JADEP)

The NHF Card Programme provides subsidies to every person living in Jamaica at any age for the treatment of 17 chronic illnesses. The NHF Card helps you to pay for a select list of prescription drugs, respiratory devices, diabetic supplies and diagnostic tests via their participating pharmacies, laboratories or doctors’ offices. The NHF covers a fixed amount of the total cost, and CCRP members only pay the balance. The NHF Card can also be combined with your CCRP health insurance card to cover prescription costs. The NHF is always the first payer, and after the first amount is paid your health insurance will be applied to the balance allowing you to pay even less out of pocket. (https://www.nhf.org.jm/the-nhf-card/about-the-nhf-card)

WHAT IS THE AGE LIMIT TO JOIN THE GROUP INSURANCE SCHEME?

An individual is eligible to become a member of CCRP at the age of 50 years or over and will then be eligible to apply for the group health coverage. The maximum entry age for CCRP members who wish to enroll on the scheme is 80 years old. Members over age 80 will not be eligible to join the scheme.

HOW DOES THE SCHEME OPERATE?

This scheme offers full comprehensive group health insurance coverage with benefits such as (i) Doctor’s visits (ii) Prescription drugs (iii) In hospital expenses (iv) Surgical benefits (v) Specialists/Consultation Visits (vi) Lab and Diagnostic Services and the usual range of other related medical benefits including dental and optical. There is also a major medical limit that is renewed annually.

CAN I ADD DEPENDENTS TO MY HEALTH PLAN & WHO ARE ELIGIBLE DEPENDENTS?

Yes a member can add dependent(s) to their health plan. A dependent is classified as the spouse (opposite sex), married or unmarried of a member, and children of the union, step- children, foster children and legally adopted children to maximum age of 26 years.

WHAT IS THE APPLICATION PROCESS?

All new applicants will be subject to proof of insurability. (i.e. each new applicant will be required to complete a medical questionnaire and will be assessed by the insurer before approval is given and coverage granted). However new members just joining the CCRP at age 50 will be allowed to enroll on the group health plan without proof of insurability if done within the first three (3) months of their 50th birthday.

WILL A SWIPE CARD BE AVAILABLE?

Yes, new members are provided with both a benefit card and a swipe card. Cards will be used to cover the usual expenses including dental and optical but subject to the limits in the schedule of benefits. In the case of major surgeries and hospitalization, pre authorization applies.

HOW DOES THE INSURER TREAT PRE-EXISTING CONDITIONS?

There is a waiting period of six (6) months for all pre-existing medical conditions. This means that there will be no coverage for conditions deemed pre-existing for the first six (6) months from the effective date of joining the plan.

IS THERE A MAXIMUM BENEFIT PAYABLE?

Yes, the group health policy has a major medical-plan year maximum of J$3,500,000 per annum which is renewable on the anniversary of the policy.

IS THERE LIFE INSURANCE COVERAGE/ DEATH BENEFIT AVAILABLE?

Yes, CCRP members are also offered the option of life insurance coverage of $500,000 per person, with quarterly premium of $7,380.00 per person. There is a waiting period of twelve (12) months from the effective date of coverage before any benefit will be payable, except for Accidental Death.

Automobile Insurance

WHO CAN BENEFIT FROM THE JNGI SilverShield?

Members of CCRP (Proof of membership required).

WHAT TYPE OF INSURANCE COVER IS OFFERED UNDER JNGI SilverShield?

Comprehensive Motor Insurance is offered under JNGI SilverShield

WHAT IS THE MINIMUM VEHICLE VALUE REQUIRED FOR COVERAGE UNDER JNGI SilverShield?

The minimum vehicle value required us One Million Dollars ($1,000,000.00)

WHAT IS THE MAXIMUM AGE OF VEHICLE THAT MAY BE INSURED?

JNGI will insure vehicles up to 15 years old; all others (will) be referred to JNGI for special consideration.

WHERE CAN I PURCHASE JNGI SilverShield?

JNGI SilverShield can be purchased from Gallagher Insurance Brokers or JNGI.

WHAT DOCUMENTS ARE REQUIRED FOR INSURANCE?
  • Completed Proposal Form
  • Certificate of Registration
  • Certificate of Fitness
  • A Valuation Report from a JNGI Approved Valuator is strongly recommended
  • Dealers Purchase Invoice/Bills of Lading, should be submitted for brand new vehicles
  • Medical Certificate for Drivers over 80 years of age
  • Drivers Licence for persons who will be driving the vehicle
HOW CAN I ACCESS THE LIST OF APPROVED VALUATORS?

Visit the JNGI Jamaica website: www.jngijamaica.com.

WHO IS AUTHORIZED TO DRIVE THE VEHICLE UNDER THIS POLICY?

The Policyholder or the insured (CCRP Member) must be the Principal Driver but others are permitted to drive provided their names are declared to JNGI beforehand.

WHAT IS THE MAXIMUM AGE LIMIT FOR THE INSURED UNDER THIS POLICY?

The maximum age under this policy is eighty (80) years old. However if the member is over 80 years old and provides a Medical Certificate from his or her doctor stating that they are fit to drive, Insurance will be allowed.

IF I AM INVLOVED IN AN ACCIDENT AND I AM NOT AT FAULT, WILL I STILL BE RESPONSIBLE TO PAY AN EXCESS?

Yes, an Excess otherwise called a deductible, is the first portion of a claim for damage to your vehicle. You are responsible for paying this amount regardless of who is at fault.

WHAT OTHER ADDITIONAL BENEFITS ARE AVAILABE UNDER JNGI SilverShield?
  • Excess Buy Back -  for a small additional premium, your excess will be significantly reduced Accident Forgiveness – For your first accident, any claim made under your policy will not affect your No Claims Bonus for the following policy period.
  • Uninsured Driver- If you are involved in an accident with a third party who has no insurance or whose insurance policy is breached and the accident was not your fault, JNGI will pay for the damage to your vehicle without applying the Excess/Deductible.
  • Complementary JAA Membership – Benefits: Accident Response and Emergency Roadside Assistance, Vehicle Examination and Document Renewal Services. 
IF A MEMBER HAS HAD AN ACCIDENT IN THE LAST THREE YEARS WILL THEY BE ALLOWED TO TAKE OUT THIS POLICY?

Any Insured or additional drivers with an accident or claim within the last three (3) years will be referred to JNGI for special consideration.

HOW MANY DISCOUNTS ARE ALLOWED UNDER JNGI SilverShield?

A maximum of four (4) Discounts are allowed, including your No Claim Discount which you can transfer from another insurer to JNGI.

IS PROOF OF NO CLAIM DISCOUNT NEEDED FROM MY LAST INSURER?

No, all that is needed is a copy of your latest Renewal Notice, as long as it was received in the last twelve (12) months. In the event where the Renewal Notice cannot be produced a No Claim Discount letter will be required.

WHAT ARE MY PAYMENT OPTIONS?
  • 50% deposit, balance due in 30 days.
  • Flexi Payment plan; 50% deposit + fee of 1747.50, balance due in 3 months.
  • Premium Financing through JN Finance or any of our other approved financiers.
  • Pay your premiums online using our Easy Payment options through JN Live, Scotia Online or NCB ELink.