Frequently Asked Questions (FAQs)

The health insurance company reports to the Commission on monthly basis on policies lapsed due to non-payment of premium.  If your policy was listed in the formal notice means your policy may not be active. 

As such the employer, employee and/or self-employed should contact the health insurance company immediately.  

The Health Insurance Act (2021 Revision) states that an employer shall be liable to pay the total cost of the premium of the Standard Health Insurance Contract (SHIC), but shall be entitled to recover directly from the salary, wage, or other remuneration of each employee, 50% of the cost of the standard premium. The employer is not required to contribute to the premiums for the employee’s dependents.

Premiums are due on the first of every month.
Regulation 6, sub-regulation 7 of the Health Insurance Regulations (2017 Revision) titled ‘Premiums’, provides that:

(7) A standard premium shall become due on the first day of the month for which it is payable.

Where an employer failed to effect and continue, at a minimum, the Standard Health Insurance contract (SHIC) coverage for an employee, that employer would be responsible for any uninsured medical expenses that the employee would have been entitled to under the SHIC plan.

A policy termination investigation is initiated by the following:

1.    Failure to pay the monthly premium on the first of every month as legislated.   

2.    The approved insurer reports the terminated policy to the Health Insurance Commission due to non-payment of premiums.
Once the termination notice is received, the investigation process is initiated for compliance with Section 5(1&2) of the Health Insurance Act (2021 Revision).
 

The employer is responsible for the premium payment to maintain the health insurance coverage. The Commission does not recommend that the employer place this responsibility on the employee. However, in this instance, the employer should contact the approved insurer immediately to verify what payments are outstanding and take the appropriate action to maintain the health insurance coverage for the employee. 

Your health insurance coverage terminates on the first day of the month following the date of termination of employment. If you remain resident in the Cayman Islands and if you do not become insured under any other employer, upon your request to your former employer, your coverage can continue for a period of three (3) months. In these circumstances, the employee will be responsible for the full amount of the premium. It is recommended that arrangements be made with your employer for payment of the premiums at the time of the termination of employment. 
Where the insured has an individual plan, the policy can continue for up to three months once premiums are paid monthly.

The Health Insurance Act (2021 Revision) requires that every person resident in the Cayman Islands must have, at a minimum, the Standard Health Insurance Contract (SHIC). If an employee refuses health insurance coverage 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 coverage through another source. If the employer determines that the employee does not have other health insurance coverage, the matter should be reported to the Health Insurance Commission.
Note: Under Section 10 (1) of the Health Insurance Act (2021 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.

Under the Health Insurance Regulations (2017 Revision), it is unlawful for the approved insurer to refuse coverage for the SHIC. 
Where the person's health insurance risk is so excessive, the approved insurer may apply to the Commission to deem a person unacceptable for cover under the SHIC contract. Upon review by the Commission, the person would then be certified by the Commission to be uninsurable and eligible for coverage with an approved insurer designated by the Commission, or they may be eligible for assistance with their medical care via the Children and Family Services Department.

The Commission prefers compliance to Section 5 (1)(2) of the Health Insurance Act (2021 Revision).   Depending on the findings, the Commission may recommend or impose 
•    Administrative fines (up to CI$1,000) under HIA sec 24 or 
•    Ruling from the Department of the Public Prosecution (DPP).