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Fee Schedule
The following lists the benefits covered under:
| Effective January 2006 | In-Network Health Services Authority or Local Providers (with CMO approval) or Overseas Providers (with CMO approval) | Out of Network Local Providers (without CMO approval) or Overseas Providers (without CMO approval) |
|---|---|---|
| Maximum lifetime benefit amount | 1 Million Cayman Dollars | |
| Maximum Calendar Year | $100,000 Cayman Dollars | |
| Maximum per Medical Indicent | $25,000 Cayman Dollars (inpatient Services) | |
Coinsurance | 80% up to a limit of $2,500 | |
Out-of-pocket | $500 after which CINICO will pay all Inpatient and Ambulatory benefits up to the maximums. | |
| Note: A Referral/CMO approval is required for consideration of payment. If a person is hospitalized, then readmitted more than 60 days later, the new admission is considered a new confinement and another $25,000 will be payable. If admitted within 60 days for the same diagnosis or condition, all associated charges will be part of the initial confinement. If the $25,000 is exhausted on the first admission, then no monies are payable on the second confinement. | ||
| 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% to $15,000 per year | |
Routine Medical Primary Care Office Visits, Specialist Office Visits, Diagnostics, Routine Laboratory Tests, Radiological Studies, Physical Therapy | $100 per calendar year (At the Health Services Authority or Local Providers [with CMO approval] only) | Not covered |
| Haemodialysis | 100% to $25,000 per year | Not covered |
| Chemotherapy (including radiation therapy) | 80% to $25,000 per year | Not covered |
Inpatient Benefits/Ambulatory Surgery Benefits - up to 30 days per episode in 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 - up to 30 days per episode of full nursing services - standard surgical supplies - laboratory and pathological studies - Physiotherapy, inhalation and other facilities acilities - X-ray and ultrasound | 80% per medical incident | Not covered |
| - Insulin for Diabetics | 80% to $25,000 per year | |
Maternity Care
|
|
Not covered |
| Effective January 2006 | In-Network Health Services Authority or Local Providers (with CMO approval) or Overseas Providers (with CMO approval) | Out of Network Local Providers (without CMO approval) or Overseas Providers (without CMO approval) |
|---|---|---|
| Maximum lifetime benefit amount | 1 Million Cayman Dollars | |
| Maximum Calendar Year | $100,000 Cayman Dollars | |
| Maximum per Medical Indicent | $100,000 Cayman Dollars (inpatient Services) | |
Coinsurance | 80% up to a limit of $2,000 | |
Out-of-pocket | $900 after which CINICO will pay all Inpatient and Ambulatory benefits up to the maximums. | |
| Note: A Referral/CMO approval is required for consideration of payment. If a person is hospitalized, then readmitted more than 60 days later, the new admission is considered a new confinement and another $25,000 will be payable. If admitted within 60 days for the same diagnosis or condition, all associated charges will be part of the initial confinement. If the $25,000 is exhausted on the first admission, then no monies are payable on the second confinement. | ||
| 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% to $15,000 per year | |
Routine Medical Primary Care Office Visits, Specialist Office Visits, Diagnostics, Routine Laboratory Tests, Radiological Studies, Physical Therapy | $500 per calendar year | Not covered |
| Home Health Care | 80% (requires prior inpatient stay) | Not covered |
| Haemodialysis | 100% to $100,000 per year | Not covered |
| Chemotherapy (including radiation therapy) | 80% to $100,000 per year | Not covered |
Inpatient Benefits/Ambulatory Surgery Benefits - up to 30 days per episode in 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 - up to 30 days per episode of full nursing services - standard surgical supplies - laboratory and pathological studies - Physiotherapy, inhalation and other facilities acilities - X-ray and ultrasound | 80% per medical incident | Not covered |
| - Insulin for Diabetics | 80% to $100,000 per year | |
Maternity Care
|
|
Not covered |
IMPORTANT
- Definition of emergency: A medical emergency means a sudden onset of a condition with acute symptons requiring immediate medical care and includes such conditions as heart attacks, cardiovascular accidents, poisoning, loss of consciousness or respiration, conditions or other such acute medical conditions.
- Pre-certification is required for all emergencies and Chief Medical Officer (CMO) approval for all referred services abroad. Please refer to the reverse side of your CINICO health insurance card for contact information.
Last Updated: 2010-05-04