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Compare prior SHIC Plans to the New SHIC (2013) Plan

The SHIC (2013) Plan became effective March 1st, 2013 with the Legislation of the Health Insurance Law revision 2013.
The "New SHIC (2013)" Plan is the minimuim "Prescribed Health Care Benefits" available under the Law.

Description SHIC 1 SHIC 2 New SHIC (2013)
MAXIMUM LIFETIME BENEFIT AMOUNT $1,000,000 Cayman Islands Dollars
MAXIMUM CALENDAR YEAR $100,000 Cayman Islands Dollars
MAXIMUM PER MEDICAL INCIDENT $25,000 Cayman Islands Dollars
(Inpatient Services)
$100,000 Cayman Islands Dollars
(Inpatient Services)
$100,000 Cayman Islands Dollars
(Inpatient Services)
COINSURANCE 80% up to a limit of $2,500 80% up to a limit of $2,000 80% up to the first $5,000
DEDUCTIBLE None $500 for Inpatient and Ambulatory benefits None
OUT-OF-POCKET (OOP) $500 Max. OOP after which CINICO will pay
all Inpatient and Ambulatory benefits up to
the maximum.
$900 Max. OOP after which CINICO will pay
all Inpatient and Ambulatory benefits up to
the maximum.
$1,000 Max. OOP after which CINICO will pay
all Inpatient and Ambulatory benefits up to
the maximum.

BENEFITS AND COVERED CONDITIONS

Description SHIC 1 SHIC 2 New SHIC (2013)
Benefit Limits and Per Incident Definition Note: The charges listed below are the total benefit amounts covered within the plan and based on a per diagnosis/per incident period of 60 days per Calendar Year. Example: If a SHIC 1 member is hospitalized, then readmitted more than 60 days later for the same diagnosis or condition, this re-admission is considered a new confinement and another $25,000 will be available. If re-admitted within 60 days for the same diagnosis or condition, all associated charges will be part of the initial incident with the initial benefit maximum of $25,000. If the amount is exhausted on the first admission, then no monies are payable on the second confinement. Per Incident Maximum is equal to the Policy Year Maximum.

COVERED CHARGES

Description SHIC 1 SHIC 2 New SHIC (2013)
All covered expenses are payable subject to a fee schedule or negotiated rate.
Emergency Medical Services
(inclusive of emergent
medication, drugs, and ambulance)
100% of the initial $4,000 per incident, then as per applicable benefit category. 100% up to $4,000 per policy year
Air Ambulance
Air Ambulance for “life or limb” threatening emergency Medical Airfare for “life or limb”
100% up to $15,000 per Calender Year 100% up to $15,000 per Policy Year
Prescription Drugs: Including
contraceptives and contraceptive devices available by prescription only
Not covered Not covered * 80% up to $400 (CIHSA, Local Providers and Overseas Providers with CMO approval)
Doctors Office Visits and other Physician fees including office procedures.
Diagnostics including Radiological / Labotory, Physio Therapy with physician (CMO) referral only.
$100 per calendar year (CIHSA only or Local Providers with CMO approval only) $500 per calendar year (CIHSA only or Local Providers with CMO approval only)
Wellness Benefits Routine Physicals, Annual Exams, Wellness Services, Well child care, Nutrition counselling with physician (Referral required),One Dental examination / check up and prophhylaxis annually. Not Applicable Not Applicable 80% within the $200 policy year maximum
for wellness services
In-patient Hospital Care (Including Physician, Specialist, Surgical services, Medications & Drugs, [Nursing care, Accomodation & meals in a semi-private room max of 30 days])
Out-Patient Surgery in an Ambulatory Surgical Center or Hospital
Chemotherapy or Radiation Therapy (in-patient or out-patient) Maternity-labour and delivery, major maternity procedure and hospitalization
Post-Natal (Newborn Care) 1st 30 Days
80% to coinsurance maximum, then 100% to Individual Annual Maximum ($25,000) 80% to coinsurance maximum, then 100% to Individual Annual Maximum ($100,000) 80% to coinsurance maximum, then 100% to Individual Annual Maximum ($100,000)
Haemodialysis 100% to $25,000 per year 100% to $100,000 per year  100% to $100,000 per year 
Mental Health-Inpatient Benefits 80% per medical incident 80% per medical incident ** 80% to coinsurance maximum, then 100% up to $25,000 per Lifetime maximum
Insulin for Diabetics 80% to $25,000 per year 80% to $25,000 per year 80% to $400*
Maternity Care

(A) Pre-Natal Care
(B) Post-Natal Care
(C) Delivery
A) $500 per calendar year
B) 80% (30 days maximum per calendar year
C) 80%
A) $500 per calendar year
B) 80% (30 days maximum per calendar year
C) 80%
(A) Pre-Natal Care – 80% within the $500 per pregnancy benefit
(B) &
(C) Delivery and Post-Natal Care Covered under Inpatient Benefits
Repatriation of Remains Not covered Not covered $2,000

IMPORTANT NOTES OF COVERAGE
*CINICO is responsible for 80% of approved services up to the $400 ($320) Member responsible for $80
** Mental Health (Illness) is a separate benefit and will reduce the annual benefit until $25,000 maximum is reached.

IMPORTANT CONDITIONS OF COVERAGE
  • Definition of 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.
  • All Non-CIHSA emergency admissions must be certified by contacting CINICO within 48 hours from the date of service.
  • OUT OF NETWORK: Any LOCAL and/or OVERSEAS Care, WITHOUT CMO approval will not be covered under any plan.
  • IN NETWORK: CAYMAN ISLANDS HEALTH SERVICES AUTHORITY (CIHSA) OR LOCAL & OVERSEAS PROVIDERS, WITH CMO approval, will be covered under any plan.
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