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- What is the Standard Health Insurance Contract?
- The Standard Health Insurance Contract (SHIC) is the minimum contract of prescribed health care benefits established in the Health Insurance Regulations (2013 Revision) and sold by approved health insurance companies.
- Who is responsible for providing health insurance coverage?
- Employers are responsible for providing health insurance for all of their employees, the employee’s unemployed spouse and any of the employee’s dependent children who reside in the Cayman Islands. The health insurance coverage must be obtained through an approved health insurance company. A self-employed person must provide their own cover with an approved health insurance company and their unemployed spouse and dependent children should also be covered.
- Who pays the premiums?
- The Health Insurance Law states that an employer shall be liable to pay the total cost of the premium of the Standard Health Insurance Contract (SHIC) but shall be entitled to recover directly from the salary, wage or other remuneration of each employee, 50% of the cost of the premium. The employer is not required to contribute to the premiums for the employee’s dependent children or unemployed spouse and can deduct those amounts as arranged with the employee.
- What can I do if I cannot afford health insurance?
- If a person, because of limited or inadequate financial resources is unable to pay for their health care services or pay for health insurance cover, an assessment of their financial circumstances can be carried out by the Department of Children and Family Services to determine their eligibility for assistance.
- What happens if an employee refuses the insurance coverage offered by an employer?
- The Health Insurance Law requires that every person resident in the Cayman Islands have, at a minimum the Standard Health Insurance Contract (SHIC). If an employee refuses health insurance provided by the employer, the employer should document the reasons why the employee refused the health insurance coverage and seek to verify if the employee has health insurance cover through another source. If the employer determines that the employee does not have other health insurance cover, the matter should be reported to the Health Insurance Commission.
Note: Under Section 10 (1) of the Health Insurance Law (2013 Revision) entitled “Employee to provide information to employer, every employee shall keep his employer informed of all facts related to the employer’s liability under section 5(2) of the law and any change of circumstances which would affect the employer’s liability under that section. An Employee who contravenes this section of the Law is liable to their employer for any expenses incurred by the employer for which he would otherwise not have been liable.
- If I hire a new employee, when do I have to take out health insurance coverage on that employee?
- Health Insurance coverage should be taken out immediately. An employer, within fifteen days after the commencement of an employee’s employment with that employer, shall give a written statement to the employee consisting of-
- the name and address of the approved insurer with whom the employee’s standard health insurance contract has been effected;
- the effective date of cover under the contract; and
- the insurance number of the health insurance contract.
The Health Insurance Commission recommends that the employer have the employee fill out the Health Insurance Enrollment Application (HIEA) form at the time of effecting the employment contract and submit the HIEA to the approved health insurance company on the first day that the employee commences employment.
- Under the law, do I still have to pay for medical services in full and then submit my claims to my approved insurer?
- The law makes it the responsibility of the health practitioner or the health care facility to submit claims to the approved health insurance company for payment. Patients are required to present their health insurance identification card at the time of seeking treatment and the patient will be responsible for paying any deductibles, coinsurance amounts and any charges exceeding the standard fees at the time of treatment.
- My health insurance policy includes a deductible and coinsurance. What does this mean?
- A deductible is the initial dollar amount you must pay out-of-pocket each calendar year before an insurance company pays its share. This is usually a flat dollar amount.
Coinsurance is the share or percentage of covered expenses you must pay after you have paid the deductible. For example, your policy may pay 80% of expenses after you have paid the deductible. You would then pay the remaining 20% as coinsurance until a maximum out-of-pocket expense is reached.
- I am employed at two different places, who is responsible for my health insurance coverage?
- If a person is employed by more than one employer, then insurance must be effected on his behalf by his principal employer. Where a person is employed by two or more employers, the principal employer of that person shall be deemed to the employer who employs tat person for the most hours each week. Where each employer employs him for a similar amount of hours a week, the principal employer shall be that employer which first retained the services of the employee.
- What happens if a person is refused coverage?
- If a person is refused health insurance coverage by two or more approved insurers, that person becomes an uninsurable person under the law. That person may then make an application for coverage with the Cayman Islands National Insurance Company (CINICO), an independent government-owned health insurance company, established to provide health insurance for those persons unable to obtain coverage either for health reasons or financial reasons. this person is still encouraged to seek coverage wherever possible to reapply with their employer's group plan, if eligible, at a later date (for example: if a person is denied coverage due to being overweight and the extra weight is lost and kept off, the employee may usually reapply after a prescribed period of time).
- What happens to my health insurance coverage upon termination of employment?
- Your health insurance coverage terminates on the first day of the month following the date of termination of employment. If you remain resident in the Cayman Islands and if you do not become insured under any other employer, upon your request to your former employer, your coverage can continue for a period of three (3) months. In these circumstances, the employee will be responsible for the full amount of the premium. It is recommended that arrangements be made with your employer for payment of the premiums at the time of the termination of employment.
- How much time do Healthcare facilities and doctors have to file a claim?
- The law stipulates that health care providers and health care facilities must submit claims to the approved insurer within 180 days of the date of treatment. If the claim is not submitted within this 180 day time frame, the health care provider may be denied payment by the approved insurer and the provider cannot seek payment from the patient. The same time frame applies to individuals filing a claim on their own behalf.
Last Updated: 08-Nov-2016