Plans vary from the basic SHIC to very comprehensive major medical world-class premium plans. The Cayman Islands Monetary Authority and the Health Insurance Commission license and regulate the health insurance companies together.
The SHIC plan is the primary Government-regulated contract and covers about a quarter of Cayman’s residents. However, most employers offer higher than mandated coverage and all other health insurance plans are based around the Health Insurance Laws & Regulations, including the outline of the basic SHIC benefits. In 2013 these were increased and now cover at minimum up to CI$100,000 major medical per annum with a CI$1,000,000 lifetime maximum for each person. This includes hospital, surgical, chemotherapy and radiation services along with emergency care.
All SHIC plans have limited local outpatient benefits and any overseas care is usually restricted to the kind of major care unavailable in Cayman. The more comprehensive plans offer wider access to overseas services, larger per annum and lifetime allowances (e.g. CI$500,000, CI$1,000,000 and CI$2,000,000 or higher could be available within a calendar year), fuller prescription coverage, more outpatient services and options for dental, optical and/or life insurance benefits.
The cost of insurance plans will vary with age, gender, benefits and employer size. For example, a basic SHIC plan without dental and vision currently costs in the vicinity of CI$167 per month, for a couple CI$300-CI$500 and for a family CI$500-CI$610, with higher rates possible based on ages and risks of the insured person(s). If you would like to add dental and vision coverage, then that costs approximately CI$30-CI$75 more per month per individual. However, the SHIC benefits are basic, so make sure to ask for a summary of coverage benefit outline from your company.
Many companies will also offer an enhanced or premium plan as their main plan or as an option, but the cost for this can be in the region of CI$450-CI$1,200 per individual per month, with double this rate per couple and triple this rate for a family. Make sure to ask how much of this you will be expected to pay. If a Caymanian resident cannot afford to cover themselves or their dependants on a health insurance policy, they should apply to the Needs Assessment Unit (www.nau.gov.ky) for assistance with coverage or shortfalls in their benefits.
For the basic SHIC plan, the insurance companies will ask for 12 months of medical history plus details on any current conditions or medication. For upgraded policies, the applications may require a more extensive medical history, thus it is a good idea to bring copies of your medical records with you and those of your dependants. This will also help your new or existing Cayman doctors provide you with their best care. If you have chronic medical conditions or immediate surgical needs, expect that these could be restricted to the minimum benefit levels on your coverage if you are not ‘portable’ from another Cayman plan. We recommend that people coming from overseas with medical issues should request that their proposed employer seek a pre-approval of their insurance as part of their decision-making process to ensure they are able to obtain the coverage levels they need.
Health insurance rates depend on the size of the group, the age of the employees, the types of pre-existing conditions and whether it is a SHIC, mid-tier or premium plan. Rates will increase each year due to inflation plus if there are on-going major claims. The good news is that premium plans always offer global coverage, and the benefits are very extensive. The basic SHIC plan mainly provides on-Island care, and usually will only offer overseas care when treatment is not available in Cayman. The coverage for dental, prescriptions, out-patient doctor’s visits or diagnostic procedures is also limited.
Insurance can be purchased by residents on an individual or family basis, or you could be enrolled on group coverage via your employer. Employer groups, especially those with over 10 employees, will have a greater variety of plan options to choose from. Individuals and employers may work directly with these various insurance companies or secure the services of an independent broker to evaluate their insurance options. The insurance companies pay the brokers for the assistance they deliver so most brokers’ services are at no cost to the client. Some brokers may be agents of a particular insurance company, or may only acquire quotes from just one or a very limited number of insurers, so you may wish to query which insurers they work with before choosing.
Once you have been with a Cayman insurer for 12 or more months with no more than a three-month break in coverage, and even if you have developed problems in the meantime, the next insurer cannot add new restrictions to a similar level of coverage. The only exceptions are cases of non-disclosure on the application form or if you are seeking a large upgrade in your coverage. Since pre-existing conditions may be restricted, be sure to check before cancelling your insurance at home, as you could potentially get global coverage on your existing health insurance to cover you in Cayman. However, you are still required by law to have a minimum SHIC plan from a local provider and then you will coordinate benefits between the two health plans.
The high cost of our health insurance has been known to discourage people from retiring here. Keep in mind that under some group plans, the amount available per annum may reduce upon retirement and most employers in Cayman do not extend health insurance benefits to retirees.
Employers or individuals seeking coverage may consider using a broker’s services to see which insurance plan would work best. They don’t charge, they do all the leg work and serve as your advocate for claims matters too. However, some brokers may be agents of a particular insurance company, or may only acquire quotes from just one or a very limited number of insurers, so you may wish to query which insurers they work with before choosing. Your doctor, pharmacist and/or dentist may also have some valuable advice as well.
If any employer or individual wishes to obtain extra coverage over and above that which the company that employs them provides for, including the Government, they are able to do so, but beware that the Health Insurance Commission cannot regulate the rates charged. All medical payments by insurers are based on the Standard Health Insurance Fee (SHIF) schedule, which can be found at www.dhrs.gov.ky. (Look for the ‘Standard Health Insurance Fees’ on the Health Insurance Commission page.) You can find the details of various Insurance Benefits, rates, claim forms and packages on the insurers' websites. For instance, see CG Coralisle's forms, (previously known as CG Britcay.)