You are here: Homepage > CINICO Plans > SHIC > FAQs

FAQs

What is the definition of a child?

A child, as defined under the Health Insurance Law (2003 Revision), means a person who is: Under 18 years of age; or

Over 18 and under 23 years of age and a full-time student at a University or other educational institution.

My child is full time student in the United States. Is my child covered?

The only services covered would be for a life-threatening emergency/sudden and serious onset of illness. All other services must be provided by the Health Services Authority in order to be covered under the plan. You will want to schedule routine check-ups with HSA while your child is home during school breaks and holidays.

If your child sees a provider in the United States, for a non-life threatening condition, the cost will be your responsibility.

Is SHIC coverage only available to Caymanians?

No, all legal residents of the Cayman Islands who can provide evidence that they satisfy the eligibility criteria may obtain coverage from CINICO.

What is a SHIC Open Enrolment Window?

The Open enrolment Window is a period which a person can enroll into the CINICO SHIC Health Insurance Plan. There will be public announcements when these windows are available.

Why is there an Enrolment Window?

Basically, it is an underwriting control put in place in order for CINICO 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.

What SHIC benefits will I receive?

Benefits are defined under the Health Insurance Law (2003 Revision) as SHIC Plan 1 and SHIC Plan 2. CINICO benefits are exactly the same as those defined within the Health Insurance Law (2003 Revision). See Benefits Covered page for SHIC Benefit Fee Schedules.

• The Participant will initially only be able to choose benefits for SHIC Plan 1 (a.k.a. Standard Health Insurance Contract #1.)

Will I be able to switch to better Health Coverage later on?

CINICO recognizes that the benefits provided under SHIC 1 may not be adequate for everyone. Therefore, once a Participant is enrolled in SHIC 1 for 12 continuous months, the Participant can apply at the next Enrolment Window for consideration to participate in SHIC 2. However, this election is available one time only, irrevocable and no future changes will be allowed.

Will I be subject to pre-existing condition limitations?

With the exception of Affordable participants, the CINICO program provides coverage for all conditions, subject to plan limitations. If you currently have a medical condition, services for that condition will not be excluded from the plan. For Affordable participants, pre-existing conditions of 24 months (as defined under the Health Insurance Law [2003 Revision]) will be excluded.

When is my SHIC premium due?

Premiums are due on the first day of that month’s coverage.

What happens if I don’t pay my premium on time?

If you fail to pay premiums within 45 days of the due date, your policy will be terminated. Go to SHIC Eligibility Conditions page, General Requirements for ALL Participants # 4 for more details.

What evidence do I need to provide in order to prove I am eligible as an SHIC Silver Participant?

You will need to complete an enrolment form and return it with photographic evidence of birth (e.g. Passport or Drivers License).

What evidence do I need to provide in order to prove I am eligible as a SHIC Challenger Participant?

You will need to complete an enrollment form and return it within 60 days of being rejected by one insurance company classified as "Approved Providers" under the Health Insurance Law (2003 Revision). You must also provide a copy of a letter of rejection with the enrollment form.

What evidence do I need to provide in order to prove I am eligible as a SHIC Affordable Participant?

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.

Are vaccinations a CINICO covered benefit?

The benefit is limited to children over the age of 6 and adults. Vaccinations are provided free for resident children of the Cayman Islands up until their sixth birthday at the H.S.A Hospital Public Health Department.

Who is CINICO?

Cayman Islands National Insurance Company Ltd. (“CINICO”).

Can I visit any Doctor or Hospital?

No. Without a Chief Medical Officer (CMO) referral from Health Services Authority (HSA), you would only be able to use services provided by the HSA. This would include the George Town Hospital, the District Clinics, and Faith Hospital on Cayman Brac.

How are my services covered if I use an HSA provider?

All medically necessary services, up to policy limitations, are covered in full as long as HSA providers perform care.

If my HSA provider wants to refer me to a private practice provider within the Cayman Islands, will I be covered?

Yes, if the Cayman Island’s Chief Medical Officer (CMO) determines it necessary.

What happens if I go directly to a non-HSA provider without CMO approval?

If you elect to see a non-HSA provider, the services will be at your own expense.

What is a Case Management Co-ordinator?

CINICO has contracted with overseas Third Party Administrators (TPA) who provide Case Management Co-ordinators that work in conjunction with the HSA to determine the most appropriate treatment for you and your family.

Why does CINICO have a Case Management Co-ordinator?

The Case Management Co-ordinators have access to hundreds of hospitals and thousands of physicians in the United States. Not only does the Case Management Co-ordinator assist a patient in coping with the financial burden of being overseas, but they also negotiate preferred rates at overseas facilities. In some instances, the Case Management Co-ordinator works with the Chief Medical Officer (CMO) of the HSA to determine if a referral is appropriate.

How does a Case Management Co-ordinator work?

After reviewing the information submitted by your physician, the Case Management Co-ordinator determines the need to access non-HSA care. For example, if the medically necessary specialty services are not available through the HSA, the Case Management Co-ordinator will approve off island care at an appropriate medical facility. The telephone number for the Case Management Co-ordinator will be on the back of your CINICO I.D. Card.

How are benefits paid if I require emergency treatment and I cannot be treated at a HSA hospital or HSA physician?

Life threatening emergencies/sudden and serious onset of illness will be covered to the plan benefit maximum. Please call the CINICO Case Management Co-ordinator before, during or within 48 hours of the emergency visit to acquire a Case Management Co-ordinator approved referral. Non life threatening emergencies without CINICO Case Management Co-ordinator referral will NOT be covered.

What do I do in an emergency?

A medical emergency means a sudden onset of a condition with acute symptoms requiring immediate medical care and includes such conditions as heart attacks, cardiovascular accidents, poisonings, loss of consciousness or respiration, convulsions or other such acute medical conditions. Use appropriate judgment and go to the hospital emergency room! Emergencies both on island and off island will be treated the same way.

What happens if I am traveling outside the Cayman Islands?

If you travel to the United States, you will be covered subject to the CINICO Case Management Co-ordinator approval.

In the United States, you can take advantage of CINICO's US based network of preferred providers. You can call the TOLL FREE NETWORK HOTLINE listed on the front of your CINICO health insurance benefit card. Remember, off island care must be approved by the CINICO Case Management Co-ordinator.

Outside the Cayman Islands or United States, medical care is also covered. However, you will be required to pay the charge in full and then submit a claim to CINICO for reimbursement.

Note: non-emergency services not approved by CINICO Case Management Co-ordinator will not be covered.