Health insurance for your children is absolutely essential, not only from a safety perspective, but also because it’s the law. Although decades ago medical care for children was free at the Cayman Islands Hospital in George Town, this is no longer the case. Cayman has adopted third-party American-style health insurance instead of socialised medicine. Cayman laws mandate that every citizen, including children, must have at least a Standard Health Insurance Contract (SHIC).
There are a few instances when Public Health may cover some, or all, medical costs. These include Cayman-required immunisations not covered by insurance (if obtained at the Cayman Islands Health Services Authority), financial assistance with pre-natal expenses for some Caymanian women if their insurance benefits have been exhausted (this does not include delivery costs), and treatment of tuberculosis and HIV/AIDS.
There are no insurers in Cayman that offer child-only individual policies for under 18s, so children must be added to a parent’s plan. Any parent working in Cayman should have health coverage offered by their employer, and the employer is required to extend coverage options to any legally resident dependants. This extension applies to spouses and their children, step-children or adopted children living in Cayman (even if they are attending school overseas). Employers do not have to pay towards the children’s premiums, although some do contribute. Health insurance for family members can be a large expense in the budget, so be sure to discuss as part of your employment package. Unemployed parents must insure their children via their own individual policy.
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Insurance for pregnancy & insuring newborns.
Mum’s Plan or Dad’s Plan?
If you and your spouse (or other parent) are on different health plans, you should choose to add your child to one or the other plan, or apply for both parents’ plans. When deciding which plan to go with, you should consider:
What are the benefits of each person’s plan?
Which parent is likely to stay in their job longer? Although it is possible to change plans, it can be time-consuming and things like deductible credits may be lost.
What are the monthly premiums and how much does each employer contribute towards the dependant’s coverage?
Ask your employer about renewal dates (the rates you are quoted today may change at renewal time, so the best deal right now may not be the best deal in a few months’ time).
When calculating the costs of insuring children, remember to take into account the variance in pay periods: if you are paid every two weeks, will you be looking at deductions on every pay check, including the months when you receive three?
Whilst the law requires a minimum coverage it does not block additional coverage, so in some cases it is possible to put a child on two plans. However, if both parents have the same insurer, double enrolment is not an option. In double coverage, the benefits should be coordinated between the two plans: the primary plan should pay first, and eligible differences can be submitted for coverage by the second. In Cayman, the father’s plan is usually considered the primary plan in cases of coordinating benefits (COB). It is important to consider, however, whether the potential benefits warrant paying the additional premiums. A possible instance when double-coverage could be beneficial is if a baby is ill or premature, and one plan’s benefits will not suffice.
Insurance for School & College Age Children
Whilst they are dependants, children are to be insured on their parents’ plan, but once they marry or begin regular work (not counting holiday jobs), they are usually no longer considered dependants eligible for the parents' plans and should go on their spouse's or own employer’s plan (even if under age 18). In the event that the child loses his or her job, returns to school or becomes financially dependent again, it is possible to apply to add them back on to their parents' plan.
Young adults between the ages of 18-19 years old (depending on the insurer) and age 30, who are in school or college and/ or otherwise financially dependent on their parent, may remain on their parents' plan as an ‘overage dependant’. However, in order to cover an overage dependent, proof that they are studying or financially dependent must be provided on a regular basis — often as frequently as every six months. It is therefore the parents' responsibility to maintain valid proof at all times.
Parents need to know and follow their insurer’s requirements in this important matter. Failure to provide such proof – even when premiums are paid – may result in claims not being paid, and the insurer being unable to verify coverage in emergency situations.
Children & Travel
Parents whose children travel either on school trips or to study overseas should make sure their insurance plan covers them wherever they may be. If studying overseas, it is not necessarily a good idea to drop their Cayman plan in favour of an overseas or college plan, especially if the college plan does not cover them during vacations or whilst in Cayman.
Similarly, children studying in Cayman may travel to other countries for sports or school trips. In such cases it is important to find out what coverage their plan provides abroad. Many of the basic plans have minimal or no emergency benefits, and require Cayman referrals signed by two doctors or the Chief Medical Officer in order to receive major care overseas. Parents may therefore need to purchase additional medical travel insurance for the periods when their children make trips overseas. Travel agents will often carry such policies.
Many overseas plans require pre-approval, so it is a good idea to provide the child or his/her caregiver with guidance on how to use the plan overseas. Your child will also need their ID card.
If a parent has children living overseas who come to visit them in Cayman, they too should ensure that the child(ren) have a home policy including overseas benefits, or a travel policy, to cover them in Cayman. The Major Medical Benefits (MMB) are the most important part of the coverage to review.
It is possible to change plans, and ‘portability protection’ means that if you or your child have been covered months or more with less than a three month break in coverage on a Cayman-based compliant plan, the next Cayman insurer cannot refuse your entry nor add new restrictions onto your enrolment for a similar level of plan. The insurers may rate the premiums higher for the risks presented, and can deny claims for conditions not disclosed on the application.
If you downgrade your family’s plan to save money, you will only be portable to the new level of plan if you change jobs or plans later. If you move your child from your local coverage and onto an overseas plan, your child will lose portability due to the break in coverage. Importantly, portability still requires, as always, the applicant to fully answer all questions accurately. Typically there will be more questions on forms for higher coverage plans — allow yourself time to complete these carefully. Pre-existing conditions not declared may have related claims denied in full, without even SHIC benefits available. This can be avoided by being thorough and truthful.
What Can You Afford?
The wisest course of action is to choose the highest coverage you can afford, as even the most mundane of procedures quickly climb in costs. If, however, you opt for less coverage in order to save on monthly costs, consider putting some of those savings aside for an ‘emergency fund’ which you can dip into if and when it is needed.
As per the Health Insurance Law, if you are Caymanian and cannot afford the premiums to cover your child, you may apply for medical coverage for your children through the Needs Assessment Unit (NAU), which is part of the Community Affairs Youth & Sports Ministry. Applications and relevant documentation should be submitted before a medical emergency arises. It is also worth noting that the Government allows Caymanians (but not expatriates) to sign IOUs or put their property up for collateral for urgent medical care not covered by their insurance. This lien will remain on the property until the medical debt is repaid.