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Cayman Parent | Articles | Expert Advice | Health Insurance Part I | Rules & Regulations

Health Insurance Part I | Rules & Regulations

Family having fun at home insurance

Health insurance for your children is absolutely essential, not only for the accidents and illnesses which come with childhood, but also because it’s the law. – Jeanette Verhoeven, Vice President of Health and Life at Aon Risk Solutions, explains the ins and outs of health insurance for children in Cayman.


Although decades ago medical care for children was free at the George Town Hospital, 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, 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.


Insuring Children

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.

Please note that information on insuring for pregnancy and birth, and on insuring newborns, can be found here.


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 other plan, or apply for both parents’ plans.

When deciding which plan to go with, you should consider:

What are the benefits of each persons 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 what monetary amount does each parents’ employer contribute towards each of 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?

Both Plans?

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. If both parents have the same insurer, however, 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 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.


Changing Plans

It is possible to change plans, and ‘portability protection’ means that if you or your child have been covered for 12 or more months with no more 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 however, 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 off 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 cover plans – allow yourself time to complete accurately. 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 a lesser 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 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.


Insurance can be tricky, need more information?

Check out our articles on Health Insurance Eligibility, Insurance for Kids Abroad, and Health Insurance for School and College Ages.

 
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