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Eligibility Conditions

In order to provide for the most cost-effective and extensive benefits possible without subjecting the Silver and Challenger participant to pre-existing condition exclusions, and without subjecting Affordable participants to high premiums, CINICO has designed very strict eligibility requirements. It is important to note that whilst premiums are guaranteed during the enrolment period, they may be subject to increases before or during a new enrolment period.

Please read the following carefully and the administrators would be happy to answer any questions that you may have:

General Requirements for ALL Participants

  1. With the exception of Affordable participants, only persons who, to the best of knowledge, have no health insurance coverage are eligible for participation.
  2. The Participant will initially only be able to choose benefits for Plan 1 (Silver, Challenger, Affordable).
  3. Once a Participant is enrolled in Plan 1 for 12 continuous months, the Participant can apply for consideration to participate in Plan 2 (Silver Plus, Challenger Plus, Affordable Plus), at the first available Enrolment Window. However, this election is only available one time only, irrevocable and no future changes will be allowed.
  4. Premiums are due on the first (1st) of each month; failure to pay premiums on a timely basis will result in termination of the policy. There is a one time ONLY reactivation of your policy subject to reactivation administrative fee of CI$200.00, plus the member's premium amount for the month in which the member wishes to reactivate the policy. Furthermore, it is mandatory upon reactivation that member must sign up for Direct Debit to pay their monthly premium (we use all banks except First Caribbean International Bank). If a member is in SHIC Plan 2, and is terminated for non-payment; the member has to revert to SHIC Plan 1 in order to be reactivated. If a member is terminated for a second time in either SHIC Plan, the member will NOT be eligible for re-activation, nor re-enrollment (during any open enrollment period) under any condition.

Please note that the Plan Numbers correspond to the Standard Health Insurance Contracts defined within the Health Insurance Law (2003 Revision).

Silver

  1. Participation is only available to individual residents of the Cayman Islands who are aged 60 or over.
  2. The Silver participant ("Participant") can enroll without penalty when they present a letter of denied coverage by an insurance company as classified as an approved provider within the Health Insurance Law (2003 Revision) or during the first 30 days after turning age 60.
  3. There will be no pre-existing conditions applied to participants who enroll during the Enrolment Window.
  4. Children may not enroll in the plan.
  5. You will need to complete an enrolment form and return it with photographic evidence of birth date e.g. Passport or Driver’s License.

Challenger

  1. Participation is only available to residents of the Cayman Islands who have been declined coverage by one insurance company classified as approved providers within the Health Insurance Law (2003 Revision).
  2. There will be no pre-existing conditions applied to participants who enroll during the Enrolment Window.
  3. Spouses may enroll in the plan if they are unemployed.
  4. Spouses who are employed may only enroll in the plan if they qualify as Silver ("Silver Plan"), Challenger ("Challenger Plan") or Affordable ("Affordable Plan").
  5. If the spouse is unemployed, children may enroll in the plan.
  6. If the spouse is employed, children may not enroll in the plan.
  7. If a person has a rider to an existing policy which limits coverage, they are NOT eligible for participation.
  8. Persons who are Challenger participants but also are aged 60 or over must enroll as a Silver participant.
  9. You will need to complete an enrolment form and present a rejection letter (from an insurance company as classified as an approved provider within the Health Insurance Law 2003 Revision) dated within 60 days from the date of your enrolment form application date.

Affordable

  1. Participation is only available to residents of the Cayman Islands who have evidenced a combined family income of CI$40,000 or less. This includes all forms of income such as rental, pension, dividend, etc.
  2. Pre-existing conditions of 24 months (as defined under the Health Insurance Law [2003 Revision]) will apply.
  3. Spouses and Children may enroll in the plan.
  4. Persons that qualify as Affordable participants who are also over 60 must enroll as a Silver participant.
  5. You will need to complete an enrolment form and return it with evidence from both your Employer AND your spouse's Employer, of your annual salaries. CINICO will then make a determination as to whether you have a combined family income of less than CI$40,000.

Last Updated: 2010-04-30