Health insurance is a type of insurance coverage that covers the cost of an insured individual’s medical and surgical expenses. In Cayman, this is categorised into one of two types: private or public. Every resident of the Cayman Islands is required, by law, to have at minimum health insurance which covers basic medical expenses. Employers are mandated to provide a Standard Health Insurance Contract (SHIC) plan for all their workers from their very first day of employment, regardless of the type or length of their work permits.
This requirement extends to any unemployed dependent spouse and child(ren) living on-Island. The same provisions also apply to the self-employed, those in a partnership and those with permanent residency without the right to work.
Legally, an employer only has to pay half of the single premium, based upon the lowest-costing plan made available to the staff, and the employee pays the other 50%. Given that premiums can change year to year, always do your research, and negotiate with your employer that they pay more than the minimum contribution level; particularly in relation to the cost of your dependants, (for which you might have to pay 100%) and any premium differentials for upgraded benefit packages.
Insurance can be purchased by residents on an individual or family basis, or you could be enroled 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.
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 Cayman doctors to 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. 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.
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 so make sure you coordinate the benefits between the two health plans.
Plans vary from the basic SHIC to very comprehensive major medical world-class 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 to have dental, routine 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 per employee, whereas a medical plan with enhanced outpatient benefits typically runs 20-30% higher than SHIC. More comprehensive benefits, including doctor and specialist visits, extra preventative care, dental, vision and prescription coverage can cost up to CI$500-$900 per month, per individual, and about CI$450-$850 without dental and vision. The premium rates are roughly doubled for a couple, and about tripled for a family rate. As a general rule, adding one dependant is about twice the single monthly costs, and adding two or more dependents is usually in the range of three times the employee-only monthly premiums.
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 at the typical ‘retirement age’ and most employers in Cayman do not extend health insurance benefits to retirees.
Most medical and some dental practitioners accept local insurance ‘on assignment’ provided that the insurance company guarantees payment and the deductible, if applicable, has been met. This means that the doctor or dentist will claim work done directly from the insurance company on your behalf. Anything not paid by your insurance company is your responsibility. If any employer or individual wishes to obtain additional coverage above what is given by the company with which they are employed, or 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.) Medical providers are not required to charge within the SHIF fees, and balances above the SHIF fees are the patient’s responsibility. For large medical services, it is not unreasonable to ask for a written quote, which is called a ‘predetermination of benefits’ or ‘preapproval for medical necessity’.
If a retiree or visitor to Cayman requires medical assistance on the Island they will usually pay upfront for services, keep all receipts and submit a claim once they return to their home country. The receipts will usually need to be fully itemised with diagnosis information and include international disease codes. As a visitor you should request that a claim form be completed using Cayman’s standard claim form. It is advised that you call your insurance provider before travelling to Cayman to verify how your benefits will work here. You may also wish to check if your insurance network extends to any local providers. It is possible that insurance companies have already set up a relationship with local providers, which can save you out-of-pocket costs. However, it is not mandatory for medical facilities to accept overseas insurance. Residents who will have relatives visiting are recommended to inquire about their visitors’ insurance too. If your visitors’ insurance will not cover them whilst in Cayman, they should be encouraged to seek a travel policy to protect them.
For detailed information on understanding health insurance for kids – covering everything from having a baby all the way to what happens to insurance when a child leaves for college abroad – go the the Health Insurance article on the Cayman Parent website.