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
Prenatal Health Insurance
Most policies have limits on prenatal care, e.g. only CI$500 per pregnancy on the basic Standard Health Insurance Contract (SHIC) plan, which might only cover the first visit and ultrasound. If you are covered by a company health insurance plan (or covered under your partner’s company plan), it is important to read the policy thoroughly and understand what benefits are and aren’t included.
Policy provisions can be different, even in two policies from the same insurance company. Even with premium plans, new parents can still expect to incur significant out-of-pocket costs. It is vital to have your doctor’s office explain what will happen, how much it will cost and what proportion of it will be covered by insurance. It is prudent to get this in writing from both provider and insurer, to ensure you understand.
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, or sign up to a health insurance plan whilst already pregnant (even if you don't know), your pregnancy will likely be considered a ‘pre-existing condition’. As such, you may not be covered by your new insurance policy, except up to the minimal benefit limits mandated by law. Some insurance plans require a 10 month waiting period before they will cover your pregnancy with full benefits. It's therefore important to discuss costs with your doctor's office before you begin your prenatal care.
Adding a Newborn to Your Health Insurance
It is your responsibility to ensure that your baby is enrolled on one or both parent’s insurance schemes from the moment of birth. 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 to ensure coverage is effective from birth. Although babies are automatically covered under their mother’s labour and delivery plan for the first 30 days of life, this does not count as enrolment onto an insurance scheme and the amount of coverage can be minimal. 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 either the father or mother to add their child to their health plan.
A Mother on Her Parent's Insurance
If a mother is on her own parent’s 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 dependents. In this situation, you must arrange insurance in advance of your baby’s birth to provide the newborn the best possible protection.
Premature or sick newborns can be some of the largest claims insurance companies face, so read the policy, (not just the benefit summary) very closely to understand the potential limits against complications, or for babies born with congenital problems. If your baby is in the neonatal unit, look at both parents' policies carefully to ensure that you get the best, most affordable coverage for your newborn baby. It may also be possible to enrol your baby on both policies.
An infant born very prematurely can have a protracted stay in the neonatal unit (10+ weeks under specialist care) and may even need care in the US. So if you are thinking about having a baby or if you are already pregnant, it may well be worth looking into whether upgrading your insurance plan would provide enhanced coverage for a preterm birth or any other complications, just in case.
Most insurance policies require you to pay a proportion of the costs (generally called co-pay), even for care at Cayman’s standard rates. Co-pay is usually taken by the provider when the first bills and insurance claims are submitted. Labour and delivery charges have a capped co-insurance (otherwise known as Out-of-Pocket or OOP) sum of CI$1,000 each, but if the doctor(s) charge above the Standard Health Insurance Fees (SHIF), there may be an additional amount to pay. Ask your insurance company what your co-insurance will be and always ensure your provider breaks down costs into standard charges, additional charges and what the co-insurance or co-pay part of that is.
Birth Options & Their Cost Implications
In the Cayman Islands, 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 generally charged separately to those of the medical professionals supporting your birth. Births are permitted in the Cayman Islands Hospital and Doctors Hospital. The service charges are different for each and vary depending on what’s provided. When you discuss birth options with your obstetrician and paediatrician, they should also be able to explain what each facility will charge you but we recommend talking to the hospital finance department too.
Private doula services are readily available and may be hired to assist with the birthing process.
If you have your pregnancy and delivery under the care of the Cayman Islands Health Service Authority (HSA), you will likely have your baby delivered by an experienced midwife at the Cayman Islands Hospital. Hospital obstetricians oversee the midwives and are called in as necessary during prenatal care or delivery. HSA pre-natal and delivery costs are lower than most private services, so those with fewer pre-natal benefits on their health plan may choose to start with, or transfer care over to, the HSA. Caymanian women are usually also eligible for prenatal assistance via the HSA.
If you have your pregnancy and delivery under the care of a private obstetrician (OB), they will provide both the antenatal (prenatal) care at their clinic and the delivery at a hospital. Most parents-to-be, especially those with higher-coverage insurance plans, will opt to have a private obstetrician throughout their pregnancy, labour and delivery of their baby. It’s important to ask your doctor whether they will be on-Island for your due date and who they ask to handle their caseload if they are not available. Insurance companies in Cayman are only mandated by law to pay up to the SHIF within your policy cover, but private doctors do not have to charge within those SHIF levels. Malpractice insurance for obstetricians worldwide has increased significantly over the years, without concurrent increases in the SHIF birth fees, and so most OBs will add surcharges above SHIF allowances to account for this. Additional charges can also be incurred for an anaesthetist, e.g. for an epidural or c-section, and for additional services such as a circumcision. Since each doctor can set their own fees, you should ask your doctor exactly what they charge and how much of this is covered by insurance.
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.
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).
Currently an employer is legally required to offer 20 working days leave on full pay, 20 working days leave on half pay and 30 working days on no pay. For practical purposes, this is treated by many businesses as the equivalent of 6 weeks at full pay, and 8 weeks at no pay.
At present there is no provision in the law for paternity leave. However, some companies will allow a new father anything from a few days off to two weeks off.