Health Insurance Commission - Department of Health Regulatory Services
Health Insurance Commission
The Health Insurance Commission (HIC) mission is to ensure that the provision of health insurance in the Cayman Islands is well regulated and that assistance is provided to the general public in resolving complaints relating to the provision of health insurance.
The role of the HIC is to monitor and regulate the health insurance industry in the Cayman Islands. The functions of the commission include the assessment and monitoring of premium rates, the administration of the Segregated Insurance Fund (SIF), monitoring the conduct of approved insurers, resolving complaints and advising the Minister generally on any matter relating to health insurance including advice on amendments to the Health Insurance Law and Regulations.
Background
The 1997 Health Insurance Law and Regulations came into force in 1998. Government had therefore established a framework for healthcare funding to be provided for all employees by way of health insurance, with employer and employees meeting the insurance premium costs fifty-fifty.
After a few years of experience, the newly installed health insurance system encountered a few hurdles which led to the revision and amendment of the original Health Insurance Law and Regulations, and the creation of the Health Insurance Commission (HIC) Law, 2003. The HIC Law, 2003 in conjunction with the Health Insurance Law (2005 Revision) and the Health Insurance Regulations (2005 Revision) were then validated to provide the regulatory framework to effectively monitor and regulate the health insurance industry in the Cayman Islands. Since 2005 the health insurance legislation has been amended on several occasions in a n effort to meet the changes in the health insurance and health practice fields.
HIC Board and Staff
The Health Insurance Commission has a 10-member Board consisting of the following: The Chief Officer of the Ministry responsible for health insurance; the Chief Medical Officer; the Superintendent of Health Insurance; six members appointed by the Governor from among persons experienced in the areas of health, health insurance, finance (including accounting) and regulation of insurance; and one member of the public who is not experienced in any of the areas specified previously. The first meeting of the HIC. was held on March 4, 2004.
Under the Department of Health Regulatory Services, there are currently nine staff members comprised of one Director/Superintendent of Health Insurance; four Health Insurance Inspectors; one Administrative Assistants, one Customer Service Associate, one Assistant Health Insurance Inspector and one Financial Accountant.
The staff are responsible for carrying out the following duties:
- resolution of complaints/ inquiries
- policy terminations
- approved insurer certification and renewal of certification
- approving high risk insurance persons applications.
- conducting site visits
- managing the collection of monies from the approved insurers for the Segregated Insurance Fund (SIF)
- maintaining the Standard Health Insurance Fees Schedule (SHIF)
- conducting investigations and enforcement activities
Health Insurance Commission Board
Chairperson - Mr. Justin Woods
Deputy Chairperson - Ms. Darlene Glidden
Members:
- Dr. Tricia Diane Hislop-Chestnut
- Mr. Mark Connolly
- Mr. Norman Wilson
- Mr. Paul Thompson
- Ms. Ricarda Harvey
- Chief Officer of Health
- Mr. Mervyn Conolly, Superintendent of Health Insurance (Ex-Officio)
- Dr. Nick Gent, Chief Medical Officer (Ex-Officio)
Resources
- Financial Performance Report
- Health Insurance Act (2021 Revision)
- Health Insurance Commission Act (2016 Revision)
- Health Insurance Regulations (2017 Revision)
- Individual Report to Request Changes to the Standard Health Insurance Fees
- Number of Insured Persons
- Standard Health Insurance Contract Application Form
- Standard Health Insurance Fees
List of Approved Insurers
- Aetna Life & Casualty | 345-623-8621
- BAF Insurance Company (Cayman) Ltd.| 345- 949-5811
- Cayman First Insurance Company Ltd. | 345-949-7028
- Cayman Islands National Insurance Company (CINICO) | 345-949-8101
- Coral Isle Medical Insurance | 345-949-8699
- Guardian Life of the Caribbean (GLOC) | 345- 949-5836
- Pan American Life Insurance Group (PALIG) | 345- 949-8304
- Cayman Integrated Healthcare | 345-745-5064
FAQs
The Health Insurance Law requires that every person resident in the Cayman Islands have, at a minimum the Standard Health Insurance Contract (SHIC). If an employee refuses health insurance provided by the employer, the employer should document the reasons why the employee refused the health insurance coverage and seek to verify if the employee has health insurance cover through another source. If the employer determines that the employee does not have other health insurance cover, the matter should be reported to the Health Insurance Commission.
Note: Under Section 10 (1) of the Health Insurance Law (2018 Revision) entitled “Employee to provide information to employer, every employee shall keep his employer informed of all facts related to the employer’s liability under section 5(2) of the law and any change of circumstances which would affect the employer’s liability under that section. An Employee who contravenes this section of the Law is liable to their employer for any expenses incurred by the employer for which he would otherwise not have been liable.
Health Insurance coverage should be taken out immediately. An employer, within fifteen days after the commencement of an employee’s employment with that employer, shall give a written statement to the employee consisting of:
a. the name and address of the approved insurer with whom the employee’s standard health insurance contract has been effected;
b. the effective date of cover under the contract; and
c. the insurance number of the health insurance contract.
The Health Insurance Commission recommends that the employer have the employee fill out the Health Insurance Enrollment Application (HIEA) form at the time of effecting the employment contract and submit the HIEA to the approved health insurance company on the first day that the employee commences employment.
The law makes it the responsibility of the health practitioner or the health care facility to verify benefits and submit claims to the approved health insurance company for payment. Patients are required to present their health insurance identification card at the time of seeking treatment and the patient will be responsible for paying any deductibles, coinsurance amounts and any charges exceeding the standard fees at the time of treatment.
A deductible is the initial dollar amount you must pay out-of-pocket each calendar year before an insurance company pays its share. This is usually a flat dollar amount.
Coinsurance is the share or percentage of covered expenses you must pay after you have paid the deductible. For example, your policy may pay 80% of expenses after you have paid the deductible. You would then pay the remaining 20% as coinsurance until a maximum out-of-pocket expense is reached.
If a person is employed by more than one employer, then insurance must be effected on his behalf by his principal employer. Where a person is employed by two or more employers, the principal employer of that person shall be deemed to the employer who employs that person for the most hours each week. Where each employer employs him for a similar amount of hours a week, the principal employer shall be that employer which first retained the services of the employee.
If a person is employed by more than one employer, then insurance must be effected on his behalf by his principal employer. Where a person is employed by two or more employers, the principal employer of that person shall be deemed to the employer who employs that person for the most hours each week. Where each employer employs him for a similar amount of hours a week, the principal employer shall be that employer which first retained the services of the employee.
The law stipulates that health care providers and health care facilities must submit claims to the approved insurer within 180 days of the date of treatment. If the claim is not submitted within this 180day time frame, the health care provider may be denied payment by the approved insurer and the provider cannot seek payment from the patient. The same time frame applies to individuals filing a claim on their own behalf.
