Benefits Fee Schedule

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Benefits Fee Schedule

The following lists the benefits covered under:

Civil Servants Medical Benefits
Effective January 2006	In-Network Health Services Authority or Local Providers (with CMO approval) or Overseas Providers (with CMO approval)
Maximum lifetime benefit amount	* Unlimited
Maximum Calendar Year	n/a
Maximum per Medical Indicent	* Unlimited
Coinsurance	Covered by Cayman Islands Government
Out-of-pocket	Covered by Cayman Islands Government
COVERED CHARGES
All covered expenses are payable subject to a fee schedule or negotiated rate.
Emergency Medical Services (inclusive of emergent medication, drugs, and ambulance)	100%
Routine Medical Primary Care Office Visits, Specialist Office Visits, Diagnostics, Routine Laboratory Tests, Radiological Studies, Physical Therapy, Diabetic Insulin & Supplies	100%
Home Health Care (as approved by C.M.O.)	100% (requires prior inpatient stay)
Prescription Drug and Medication	100%
Haemodialysis	100%
Chemotherapy (including radiation therapy)	100%
Inpatient Benefits/Ambulatory Surgery Benefits — a hospital semi–private room or intensive care unit — physician, specialist and surgeon services including Ambulatory surgery performed in a licensed medical facility — anethesia, use of operating room and recovery room — full nursing services — standard surgical supplies — laboratory and pathological studies — Physiotherapy, inhalation and other facilities acilities — X–ray and ultrasound	100%
Maternity Care Pre-Natal Care (A), Delivery (B), Post-Natal care (C)	A) 100% B) 100% C) 100%
Mental Health	100%
Substance Abuse	100%
Chiropractor Visits	100%
Hospice Care (as approved by C.M.O)	100%

* All medical services that are provided by either a local or overseas provider without Chief Medical Officer (CMO) approval will not be covered.

* It is important to note that whilst Cayman Islands Government lifetime medical benefits are unlimited, CINICO's share of this liability is limited to the terms & conditions of its reinsurance policy.

Civil Servants Dental Benefits
Effective July 2005	In-Network Health Services Authority or Local Providers (with CDO approval) or Overseas Providers (with CDO approval)
Preventative, basic restorative services are covered. Major dental services are covered subject to preauthorization by the Chief Dental Officer.
Cleaning & General Hygiene	100%
Bridges	Not Covered
Dentures	50% (with C.D.O. approval)
Cosmetic Dentistry	Not Covered
Orthodontia Services	50% (maximum to age 18 years with C.D.O approval)
Periodontal Services	50%
Porcelain Crowns	100% (with C.D.O. approval)

* All dental services that are provided by either a local or overseas provider without Chief Dental Officer (CDO) approval will not be covered.

Civil Servants Vision Benefits
Charges for vision care services and supplies are covered as follows:
Eye Exam	One exam in a 24-month period to a maximum of CI$60 (exceptions for pilots and certain Scenes of Crime staff)
Frames	Not covered
Lenses or Contact Lenses Single vision, bi-focal, tri-focal, progressive & lenticular	One pair in a 24-month period (exceptions for pilots and certain Scenes of Crime staff)

Last Updated: 2010-04-28