Like many things in Cayman, having a baby isn’t cheap and with little public healthcare, you’ll want to be on the best insurance plan you can afford, this time with a baby in mind too. Understanding costs, insurance and their relationship to each other is crucial for an affordable experience without surprises.
Some Insurance Issues to Consider
Birthing costs include:
1) Prenatal (antenatal) Care
2) Labour and Delivery (L&D) Care
3) Newborn Care
Prenatal Health Insurance
Health insurance is mandatory for all Cayman residents. For prenatal care and other birthing care, there are three main types of private plans:
Standard Health Insurance Contract (SHIC) (basic requirement by law): Allows max of CI$500 per pregnancy for prenatal care and up to CI$100,000 annual limit towards L&D and for the newborn. This CI$500 prenatal allowance could be used up on the very first visit if labs and/or ultrasound are done, thus making the balance of all prenatal care the mother’s responsibility. Typically on SHIC, overseas births are covered only when medically necessary.
Mid-Tier Plans: These will have fixed dollar amounts towards prenatal care (typically, CI$1,000-CI$2,500) and/or do not accrue the coinsurance (10%’s or 20%’s) of each prenatal visit, lab, etc. towards out-of-pocket coinsurance maximum per year. They allow at least CI$100,000 per year toward the L&D and possibly up to CI$500,000/year towards the birthing expenses. Elective overseas deliveries may be allowed but there could be dollar caps on the overseas delivery fees (including complications).
Comprehensive Worldwide Plans: These plans will not have a preset cap on the prenatal care and typically will count the coinsurance 20% toward the annual out-of-pocket coinsurance cap (so the mother may already be at her 100% of eligible coverage by the time she reaches the L&D day). These plans may allow SHIC allowance of CI$100,000, up to CI$500,000 per year and/or up to a CI$1m or CI$2m, lifetime to be used towards the L&D birthing event. With these plans, the mother may choose any country to have her baby.
If you need a procedure, such as an amniocentesis, or are hospitalised for pre-term medications and put on bedrest during your pregnancy, this will usually fall under your surgical and hospital benefits vs. the prenatal limits.
All insurance companies in Cayman are mandated by law to only pay up to the Standard Health Insurance Fee schedule (SHIF) within your policy cover and all plans have the requirements that care must be 'medically necessary' thus usually have limits on the number of routine ultrasounds covered and likely will not cover genetic or gender tests.
It is important to read the policy thoroughly and understand what benefits are and aren’t included. It is also vital to have your doctor’s office explain what will happen, how much it will cost and what proportion of it they expect will be covered by insurance.
Caymanian women may be able to access financial assistance via Public Health and/or the Department of Children and Family Services.
Pregnancy as a Pre-Existing Condition If you are pregnant upon arriving in Cayman, change plans or enrol on new coverage and are not 'portable' from a similar Cayman plan whilst already pregnant (even if you didn’t know at the time of filling in the form), your pregnancy may be considered a ‘pre-existing condition’. As such, you may be limited to the basic SHIC benefit limits mandated by law, even on some 'high plans'. The limits may or may not extend to the newborn too.
Birth Options & Their Cost Implications
Hospital Costs In Cayman, all babies are scheduled to be born in a hospital. Home and water births are not currently offered on-Island. Charges for the facilities and hospital stay are charged separately to those of the medical professionals supporting your birth. Births are permitted in the George Town Hospital and Doctors Hospital. When you discuss birth options with your obstetrician and paediatrician, they will advise which facility they prefer and may be able to help explain what each facility will charge, but we recommend registering and talking to the hospital finance department too. The HSA offers birthing packages for low insurance or self-pay situations.
Doula Services Private doula services are available to assist with the birthing process but are not covered by insurance.
Midwife Birth If you have your prenatal care and delivery at the Cayman Islands Health Service Authority (HSA), you will likely have your baby followed and delivered by an experienced midwife. Hospital obstetricians oversee the midwives and are called in as necessary during prenatal visits or delivery. HSA prenatal and delivery costs are lower than most private services, and considered by most to offer excellent care, thus mums-to-be with fewer prenatal benefits may choose to start with, or transfer care over to, the HSA.
Obstetrician Birth Many parents-to-be, especially those with higher-coverage insurance plans, opt to have a private obstetrician (OB) throughout the pregnancy. If you do so, they can provide both the prenatal care at their clinic and the delivery at a hospital. In most cases, the physician’s (including midwives) L&D charges typically cover the in-hospital care for the birth, the mother’s hospital visits following birth and the first office visit post-delivery. It’s important to ask your doctor whether they will be on-Island for your due date and ask who handles their caseload if they are unavailable.
Private OBs do not have to charge within those SHIF levels and most private OBs do charge extra fees which are not payable by insurance. Since each doctor can set their own fees, you should ask your doctor early on exactly what they charge and how much of this is expected to be covered by insurance. Additional charges can also be incurred for an anesthetist, e.g. for an epidural (although that is usually eligible for insurance coverage), and for additional services such as a circumcision done at the time of birth (which is not covered by insurance).
Overseas Births High risk pregnancies may be referred overseas for care, which would be covered up to the allowed limits of your health plan benefits, as long as your insurance has approved the transfer of care. For elective births overseas, i.e. you made the choice, you must check with your insurer’s health claims office to verify if, and which, of your health plan benefits are eligible for births either in the USA or another country, such as your home country if you are an expat.
Coinsurance Most insurance policies require you to pay a proportion of the costs each calendar year (generally called coinsurance). Estimated cost-shares are usually collected by the provider’s office as the care is provided and claims are submitted. Labour and delivery charges will have a capped co-insurance (otherwise known as Out-of-Pocket or OOP maximum), usually CI$1,000 per person per year, but as mentioned earlier, if the doctor(s) charges above the Standard SHIF Fees, there will be an additional amount to budget for.
Adding a Newborn to Your Health Insurance It is your responsibility to ensure that your baby is enrolled on one or both parents' insurance schemes. Talk to your employer/insurance company in advance of your due date and familiarise yourself with the process you will need to go through after your baby is born. Although babies are automatically covered under their mother’s plan for the first 30 days of life, this does not count as enrolment onto an insurance scheme and this amount of coverage can be limited to the mother’s annual allowances minus her birthing charges. It is advisable to compare the benefits and costs of both the father’s and mother’s plans to decide which plan to enrol your newborn onto. Parents do not have to be married for the father to add their child to his health plan.
A Mother on Her Parents' Insurance If a mother is on her own parents' insurance policy, e.g. if she is still a student, the baby will likely not be covered after birth since grandchildren are not eligible as dependants unless there is a court order of guardianship. In this situation, you must arrange insurance onto the father’s plan or the mother should organise her own coverage to provide the newborn’s protection.
Neonatal Care Premature or sick newborns can be some of the largest claims insurance companies face. Infants can be faced with time in the neonatal unit or may even need care in the USA. Examine both parents' policies carefully to ensure that you enrol and obtain the best, most affordable coverage for your newborn baby, and be sure to check the fine print of the policy document to be aware of any potential limits of coverage.
In Cayman, it is mandatory to have a paediatrician present at all caesarean sections, however, it is optional for normal vaginal births. Some parents like the reassurance and safety of having a paediatrician present anyway, and others are content to have them attend shortly after birth. It is best to meet with potential paediatricians well ahead of your due date to discuss options and preferences.
Most good paediatricians do not charge for an antenatal meeting. Charges vary depending on whether you: opt for a paediatrician at birth, if they are called to the delivery (because of concerns), how many nights you stay in hospital and whether a doctor has to disrupt their existing clinic or needs to wait a prolonged period before your baby is born. In general, the maximum likely out-of-pocket expenses (over and above insurance coverage) are CI$500 to CI$750 for the paediatric component of care.
Maternity Leave in the Cayman Islands
When considering the costs of having a baby on-Island, make sure to factor in your maternity provision. You are entitled to a minimum leave of 14 weeks, provided you have worked for the company for 12 months or more (if you have not completed that time, any maternity leave is pro-rated).