NWT creates online benefits calculator in bid to make proposal clear

The NWT government has created an online calculator and again pushed back a feedback deadline after sustained criticism of proposals to change health benefits.

The territory is proposing changes to the benefits system that covers people who can’t access health coverage through work or other forms of government insurance.

Estimating that 2,200 NWT residents have no access to benefits, the territory says its proposal “will ensure all residents in need of health benefits can get them.”

But some residents say the territory has glossed over the way its proposal, which eliminates the Specified Disease Conditions program, would require that some people with serious existing conditions pay out of pocket before benefits kick in.

The NWT Disabilities Council is the latest group to criticize the proposal.

Denise McKee, the council’s executive director, said the GNWT’s suggested new approach “would result in embedded discrimination, is oppressive, and does not reasonably … understand the dire impacts to people with disabilities.”

McKee said the proposal could result in low-income families having to pay deductibles and co-pays out of pocket, exhausting third-party insurance prior to receiving territorial benefits.

The disabilities council also worries that the proposal appears to demand that people sign up for third-party insurance, which can be hard or impossible to acquire with certain conditions. The council says preventing people from accessing government benefits if their pre-existing condition results in an inability to acquire third-party insurance would threaten a Charter violation.

“Even where insurance is approved, residents with pre-existing medical conditions may be subject to higher premiums and deficient coverage vis-à-vis residents without pre-existing conditions. This can have multiple negative consequences,” the council wrote.

Lastly, the council said providing “no cap to out-of-pocket expenses for medical supplies and equipment required for the maintenance of one’s medical condition or disability is antithetical” to the point of providing benefits.

“It creates a real risk of poorer health outcomes, decreased labour force participation, increased social isolation, and increased reliance of state-sponsored supports,” the council concluded.

More comic-book examples

On Thursday, the Department of Health and Social Services pushed back its feedback deadline to November 23, having already moved the deadline once after earlier criticism.

That criticism focused on the absence, in literature accompanying the proposal, of any examples that highlighted the ways in which some people might have less access to benefits. All the examples focused on residents whose access would increase.

“Additional examples, along with a calculator tool, have been developed to help residents understand how the proposed changes will affect them,” the territory stated in a news release.

“A virtual town hall will be held in mid-November to explain the proposed changes and to answer residents’ questions. Details on the town hall event will be provided in the coming weeks.”

More: The GNWT’s health benefits proposal feedback webpage

The GNWT’s website for the proposed changes now includes several extra comic-strip examples, which attempt to address several scenarios critics of the proposal had raised.

The online calculator, meanwhile, asks residents for basic details related to income and circumstances – then displays your annual deductible, family maximum, and co-payment.

The deductible is the amount you have to pay in drug costs before benefits from the territory kick in, at which point many people will be asked to pay a co-payment until they hit the family maximum, after which the benefits program covers all drug costs for the remainder of that year.

A single resident with a $40,000 annual income has a no deductible. They immediately receive benefits according to the calculator, paying a 30-percent co-payment until reaching an annual expenditure of $600, at which point the benefits program takes over in full.

A resident earning $70,000 has a deductible of $1,100, meaning they pay that sum in drug costs before the co-payment process kicks in. The annual maximum for them is $2,000, at which point the territorial program pays in full for the remainder of the year.

A household with a net income of $200,000 has a deductible of $8,000, the calculator states: if that’s you, you pay out of pocket up to $8,000 each year. After that, there is no co-pay – when the $8,000 cap is hit, the territory’s benefits program pays after that.

The territorial government adds a disclaimer that the calculator is only a tool used to estimate costs. The tool “represents current proposed changes … and is not intended to address all unique situations,” the website states.