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Standard Health Insurance Contract (SHIC)

  • Plan Description
  • Eligibility Criteria
  • Benefit Schedule

General Information and Requirements for all Applicants & Participants

The Policy, which includes the “SHIC Application & Change of Circumstance Form” and “Policy Rules & Conditions” document, and any amendment agreed to in writing, may not be changed or any provisions waived unless agreed to in writing by the CEO or CFO of CINICO.

All New Applicants, and Participants with changes to their existing coverage, must complete the CINICO “SHIC Application & Change of Circumstance Form”.

Premiums are subject to increase with a minimum of 30 Days’ notice.

Premiums are payable monthly in advance, and are due on the 1st day of every month.

If a Participant fails to pay premiums within 30 days of the due date or the policy lapses for any reason not authorized, the Participant’s policy will automatically be terminated.

The Participant will ONLY be able to re-activate a terminated policy under both of the following conditions:

  • For each and every reactivation, a New  “SHIC Application & Change of Circumstance Form” must be completed along with any required information, and a reinstatement fee must be paid in the amount of KYD $200.00 for the first reactivation and KYD $300.00 for every subsequent occurrence.

The currency of the Policy and any quoted Premiums is in Cayman Islands Dollars.

This policy is only available to Legal Residents of the Cayman Islands.

All Applicants are subject to individual risk rating.

Failure to disclose relevant details or giving misleading information on any formal communication to CINICO may cause your application as well as your Insurance coverage to be deemed null and void.

A Self-Termination letter or notice from the member must be received by CINICO at a minimum of 10 days prior to the 1st day of the next month. (Post-marked envelopes with 10 days prior are also acceptable as valid notice).

 

Affordable Plan Participation

Participation is available to residents of the Cayman Islands who are under 60 years of age.
Legal Resident Spouses, Children & Dependent Offspring may enroll in this plan.

Silver Plan Participation

Participation is only available to individual residents of the Cayman Islands who are aged 60 or older.
Children & Dependent Offspring may not enroll in this plan.

The Standard Health Insurance Contract (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 minimum "Prescribed Health Care Benefits" available under the law. 

                              SHIC (2013) Medical Benefits

Description  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

$100,000 Cayman Islands Dollars (Inpatient Services)
 

COINSURANCE

20% up to the first $5,000

DEDUCTIBLE

None

OUT-OF-POCKET (OOP)

$1,000 Max. OOP after which CINICO will pay all Inpatient and Ambulatory benefits up to the maximum.

BENEFITS AND COVERED CONDITIONS

Description

New SHIC (2013)

Benefit Limits and Per Incident Definition

Per Incident Maximum is equal to the Policy Year Maximum.

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% 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 Policy Year

Prescription Drugs: Including contraceptives and contraceptive devices & Insulin available by prescription only

* 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.

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.

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 ($100,000)

Haemodialysis

100% to $100,000 per year

Mental Health-Inpatient Benefits

** 80% to coinsurance maximum, then 100% up to $25,000 per Lifetime maximum

 Insulin for Diabetics

  80% to $400*

Maternity Care

(A) Pre-Natal Care
(B) Post-Natal Care
(C) Delivery

(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

$2,000

 

* CINICO is responsible for 80% of approved services up to the KYD $400 ($320). Member responsible for KYD $80

 

**Mental Health is a covered In-patient benefit with a 80% Coinsurance maximum, then 100% up to KYD $25,000 per lifetime.

 

  1. Emergency means a sudden or unexpected occurrence or event causing a threat to life or limb.
  2. All Non-CIHSA emergency admissions must be certified by contacting CINICO within 48 hours from the date of service.
  3. IN NETWORK: Cayman Islands Health Services Authority (CIHSA) OR LOCAL & OVERSEAS PROVIDERS, WITH Chief Medical Officer (CMO) approval, will be covered where medically necessary in accordance with the benefit plan.
  4. OUT OF NETWORK: Any LOCAL and/or OVERSEAS Care, WITHOUT CMO approval will NOT be covered under any plan.
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