Frequently Asked Questions

Why Do You Need Health Insurance?

You cannot predict the costs of your medical bills on a yearly basis. You purchase health insurance for the same reason you buy other kinds of insurance, to protect yourself financially. With health insurance, you protect yourself and your family in case you need medical care that could be very expensive. If you have insurance many of your costs are covered by a third party, the insurer, not by you. 

What is the major difference between group and individual insurance?

The major difference between group and individual insurance involves evidence of insurability. To purchase individual insurance, a person must answer a health questionnaire and undergo a medical examination to provide evidence of insurability to the insurance company. An insurer may decline coverage on the basis of the applicant’s personal habits, health, medical history, age, income or any other factors that bear on risk acceptance. On occasion, the insurer may issue a policy with limitations on coverage.

Group insurance is issued without the need of a medical examination or other evidence of individual insurability. This occurs because the insurer knows that it can cover enough individuals to balance those in poor health against those in good health. As the insurer underwrites additional group policies and increases the total number of individuals covered the risk to the insurer diminishes. The risk to the insurer can also be reduced by an increase in the size of the group. 

What are the advantages of group insurance over individual insurance?

Group insurance ensures that all employees, regardless of health, can be covered. Those with known health problems, who might otherwise be unable to obtain individual insurance can be covered automatically upon employment without evidence of insurability. Although some limits may be imposed on new hires for certain conditions that predate their enrollment in the plan, most employees can receive coverage as soon as they are eligible.

An additional advantage of Group insurance affords a lower cost per unit of protection than individual insurance, because the economies of scale resulting from selling, installing and servicing one plan covering many individuals. Further, group plans offer greater flexibility of plan design and typically provide more liberal benefits than individual insurance coverage

What is the CariCARE Brand?

The CariCARE family of Products represents our continuing commitment to provide Caribbean companies, both large and small, with quality group benefit programmes, competitive prices and superior customer service

What are some of the advantages of the CariCARE Advantage Plan?

This plan provides for better management of health care costs because it allows members to share in the cost of routine, lower cost medical procedures by means of co-insurance, while providing increased Major Medical Benefits in case of a catastrophic illness or accident. Because employees share from the beginning in the cost of their medical expenses when they are incurred, a comprehensive plan encourages more cost-effective health care.

Advantages include:

1. Higher Major Medical maximum
2. Optional Preventative Care Benefit
3. Flexible Plan Design
4. Sharing of the cost of rising health care charges

Who is eligible for coverage?

Eligible person who have completed the required probationary period are eligible to join the plan without evidence of insurability. However failure to do so within 31 days of becoming eligible would result in the requirement for satisfactory evidence of insurability to be provided. This also applies to eligible dependents. In special circumstances, the employer/organisation may waive the waiting period, however in those circumstances, evidence of insurability is required. To be considered an eligible insured for a group plan, the employee must work a minimum of 30 hrs a week. The following list provides the classification of companies for group insurance:

Will an insurance carrier deny certain employees coverage under a group health insurance plan?

Generally, insurers will not deny coverage to any full-time employee. Inherent in the principle of group insurance is the understanding that all employees can be covered. Typically carriers, require an employee to be actively at work on the day the employer-provider coverage becomes effective, and to have enrolled in a contributory plan within the time required.

How soon after submission of a claim will payment be made (turnaround time)?

The turnaround time on a claim depends on the complexity of the claim and the amount of information required for verification. Our Claims department is committed to submitting timely payments within 10 working days of receipt of the appropriate claims forms

Are all drugs covered under health care plans?

Generally, drugs available legally by prescription only from registered doctors and that are for the treatment of an illness or injury are covered, subject to applicable deductibles

Are alternative forms of medicine covered under my plan?

Some forms of alternative medicine are covered subject to the terms and conditions of your policy. Individuals wishing to utilize alternative medicine treatments should contact the Group Department before the course of treatment is started

What is a deductible?

A deductible is a specific dollar amount that an individual must pay (or satisfy) in a specified period before reimbursement for expenses begins. The deductible is the amount of eligible expenses which must be borne by the insured in each calendar year before any benefits are payable. Typically, the higher the deductible, the lower the costs of the health insurance plan

What is coinsurance?

The arrangement by which both the insured and the insurer share, in a specific ration, the covered losses under a policy. For example, the insurer may reimburse the insured for 80 percent of covered expenses, the insured paying the remaining 20 percent of such expenses as a coinsurance factor

What are Reasonable and Customary (R&C) fees?

Insurance plans will only consider a reasonable and customary fee that is standard for the geographic area in which the service was performed. If your doctor charges $1,000 for a medical procedure while most doctors in your area charge only $600, you will be responsible for the $400 difference. This is in addition to the deductible and coinsurance you would be expected to pay

What is a provider?

A provider is a hospital, health care facility, physician or other medical professional that provides health care services. Providers must be registered and licensed within the jurisdiction that they practice

Can I access care overseas?

Yes. Being a CariCare Plan Member provides you with your personal International Medical Card that affords you enhanced protection against Emergencies while travelling; or assistance for overseas treatment by PRE-ARRANGEMENT with the insurer. Your card ensures that all your eligible medical bills related to your emergency anywhere in the world are paid. A single phone call activates a series of events that lead to prompt and efficient medical care that can help you and your dependents in an emergency

What is the Canadian Medical Network (CMN)?

CMN is an international health management company that assists clients to successfully navigate an increasingly complex global health care system with ease and economy. We seamlessly integrate services among hospitals and physicians while actively advocating for patients. CMN provider overseas case management for the policyholders of Sagicor Life Inc.

Terms of Use