The Antigua Hotels and Tourist Association in partnership with the Antigua and Barbuda Workers Union signed a Memorandum of Understanding with State insurance in May 2013 to provide health insurance for hotel industry workers. Effective October 2013 all hotels under the AHTA’s collective agreement with the ABWU must provide health insurance under this scheme to their employee’s. However the Group Health Plan is open to all AHTA members.
The terms below are applicable to workers under the AHTA’s Collective Agreement. Companies not under the Collective Agreement offering the health insurance may offer alternative conditions. The coverage and costing remain the same.
Who Is Eligible?
All full time permanent employees under the Collective Agreement having completed their probationary period are to be enrolled in the health plan. This does not apply to contract workers.
However….Employees may opt out for the following reasons:
1) Where an employee is covered by another health plan, i.e. through a partner’s employment and can produce proof of this insurance.
2) Where an employee is working in two properties, in this case the employee must designate a primary employer who will pay into the health insurance whereas the secondary employer will be exempt.
3) Where the employee can provide other strong reasons why they should not be enrolled. This is left to the appreciation of the employer.
In all cases to opt out the employee should complete the Opt-Out form which can be downloaded here and present it to their HR Department
How much does it cost?
The AHTA & ABWU have agreed to a basic insurance package to ensure that all employees have medical coverage at an affordable rate. The monthly cost is to be borne 60% by the employer and 40% by the employee.
The monthly cost is as follows:
Employee – $83.25 (split $49.95 paid by employer & $33.30 by the employee) The weekly deduction works out to $7.69
Employee plus one – $151.20 ( additional cost is borne 100% by the employee -$49.95 paid by employer & $101.25 by the employee )
Family – $251.20 ( as above -$49.95 paid by employer & $201.25 by the employee )
In all cases the employer is only liable for the cost of the employee – that is $49.95 per month.
We have negotiated an improved plan (Level 2) with State Insurance for any persons wishing to pay for an upgraded package.
The additional monthly cost is $30.00 which is to be borne by the employee. The upgraded package total costs per month including life insurance are as follows:
Employee – $113.25
Employee plus one – $181.20
Family – $281.20
For full details of coverage at level 1 click here
For full details of coverage at level 2 click here
How does it work?
Upon enrollment all employees will be presented with an insurance card. State Insurance has a wide network of Doctors and Pharmacies. At these places an employee may present the card and only pay the excess over and above the coverage. For example under level 1 if an employee visits a doctor in the network and pays EC$120.00, the insurance will cover EC$72.00 ( 80% to a maximum of EC$90.00) and the employee will pay only EC$48.00. If the employee had chosen insurance at level 2 he/she would only be required to pay EC$24.00 to the Doctor. At the network pharmacies the employee will only pay 20% of the prescription cost upon presentation of the insurance card.
At the initial enrollment there was no waiting period for any service whether it be medical, dental or vision however going forward the following will apply.
1) For new employees there will be no waiting period. The insurance card will be issued as soon as the first payment is received from the employer and can be used right away. Employees should be enrolled as soon as they have completed their probationary period.
2) Employees that did not enroll at sign up and now decide they wish to participate they will be subject to a three month waiting period.
3) An exception to #2 is in the instant where an employee was insured with another provider and decides to roll over to SIC. In which case upon proof of the previous insurance the waiting period will be waived.
4) Employees who decide to bring spouse or dependents onto the scheme, these will be subject to a three month waiting period.
A list of network Doctors can be found here.
Elsewhere out of network full payment must be made and a claim submitted to State Insurance on a claim form. Reimbursement usually takes around 3 weeks.