Health insurance in the Cayman Islands

In the Cayman Islands, health insurance is required by law for all residents.

It can be purchased on an individual or family basis or through an employer’s group plan.

Health insurance plans are based around the Health Insurance Laws and Regulations. The Health Insurance Commission and Cayman Islands Monetary Authority license and regulate the health insurance companies.

Health insurance must be obtained through an approved health insurance company.

The Health Insurance Law (2013 Revision) mandates that every person needs to be covered by no less than the basic plan of coverage, which is called the Standard Health Insurance Contract (SHIC).

Employers are obligated, at minimum, to provide a basic insurance plan for all their employees – regardless of the type or length of their work permits. The employer is required to pay 50% of the premium for the SHIC plan, and the employee pays the other 50%.

The law also states that the employer is responsible for providing health insurance coverage for the employee’s dependents. However, the employer is not required to pay the premium for them, and usually deduct those amounts through the employee’s paycheque or as arranged with the employee.

A self-employed person is required to provide insurance cover for themselves and their dependents in the same way they would be required to provide cover for their employees.

If employment is ended, the employer is required to continue to provide the ex-employee access to cover (but not contribute to the premium) for 3 months after the end of their employment. An employer who fails to do this is in breach of the law.

Various plans

Many employers offer a higher level of coverage than the basic plan, and there are a range to choose from. Policies vary from the minimum legal requirements of SHIC to comprehensive international plans.

SHIC benefits cover at minimum up to CI$100,000 major medical per year with a CI$1 million lifetime maximum for each person. This is mostly towards hospitalisation, surgery, dialysis, chemotherapy, oncology radiation and emergency care.

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 (up to US$2 million or higher could be available in a calendar year), fuller prescription coverage, more outpatient services and options to have dental, routine optical and life insurance benefits.

According to AON Cayman, most health insurance plans fall within the following categories:
SHIC: Minimum plan required by law.

Enhanced SHIC: Minimum plan required by law, plus higher outpatient benefit limits; may include dental and/or vision coverage.

Mid-level: Higher annual maximum limits, adequate outpatient benefit, along with dental and vision coverage options.

Comprehensive major medical: Lifetime maximum limit of US$2 million, with wider access to overseas care and less out-of-pocket expenses.

Costs vary and comprehensive plans can be pricey. A basic SHIC plan without dental and vision costs around CI$167 per month per employee. A medical plan with enhanced outpatient benefits averages about 20 to 30% higher than SHIC.

More comprehensive benefits can cost up to CI$500 to $900 per month, per individual, and about CI$450 to $850 without dental and vision.

The premium rates are about double for a couple and triple for a family rate. 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.

As most employers in Cayman do not continue to offer health insurance benefits to people after retirement, many are unable to afford to retire here.

Cayman Islands National Insurance Company (CINICO) is a government-owned insurance company formed to provide health insurance coverage to civil servants (employees and pensioners), seafarers and veterans and their dependants.

CINICO also provides health insurance coverage for some statutory authorities, government companies and administers benefits for indigent residents.