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. Norman Wilson
- Mr. Paul Thompson
- Ms. Ricarda Harvey
- Chief Officer of Health
- Mr. Mervyn Conolly, Superintendent of Health Insurance (Ex-Officio)
- Dr. Hilary Wolf, 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 2026 Q1-Q2
- Standard Health Insurance Contract Application Form
- Standard Health Insurance Fees
- Certificate of Compliance - Health Insurance (Form M)
- Health Insurance Commission Complaint Intake Form
- <li><a href="https://legislation.gov.ky/cms/images/LEGISLATION/PRINCIPAL/1997/1997-0015/1997-0015_2021%20Revision.pdf?zoom_highlight=health+insurance+act#search=%22health%20insurance%20act%22" rel="noopener noreferrer" target="_blank">Health Insurance Act (2021 Revision)</a></li>
- <li><a href="/documents/d/dhrs/health-insurance-commission-act-pdf?download=true" rel="noopener">Health Insurance Commission Act (2016 Revision)</a></li>
- <li><a href="https://legislation.gov.ky/cms/images/LEGISLATION/SUBORDINATE/1997/1997-0011/1997-0011_2017%20Revision_g.pdf" rel="noopener noreferrer" target="_blank">Health Insurance Regulations (2017 Revision)</a></li>
- <li><a href="/documents/d/dhrs/individual-report-standard-health-insurance-fees-pdf?download=true" rel="noopener noreferrer" target="_blank">Individual Report to Request Changes to the Standard Health Insurance Fees</a></li>
- <li><a href="/documents/d/dhrs/number-of-insured-persons-q1-q2-2026-pdf?download=true" rel="noopener noreferrer" target="_blank">Number of Insured Persons 2026 Q1-Q2</a></li>
- <li><a href="/documents/d/dhrs/standard-health-insurance-contract-application-form-pdf?download=true" rel="noopener">Standard Health Insurance Contract Application Form</a></li>
- <li><a href="/documents/d/dhrs/updated-shif-schedule-update_10jan2025-pdf?download=true" rel="noopener noreferrer" target="_blank">Standard Health Insurance Fees</a></li>
- <li><a href="/documents/d/dhrs/certficate-of-compliance-health-insurance?download=true" rel="noopener noreferrer">Certificate of Compliance - Health Insurance (Form M)</a></li>
- <li> <p data-lfr-editable-id="element-text" data-lfr-editable-type="text"><a href="https://gov.ky/w/hic-complaint-intake-form" rel="noopener noreferrer" target="_self">Health Insurance Commission Complaint Intake Form</a></p> </li> </ul>
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
-
Island Heritage Insurance | 345-949-7280
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.
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.
A policy termination investigation is initiated by the following:
- Failure to pay the monthly premium on the first of every month as legislated.
- 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 approved insurer reports to the Commission every month any policies that are lapsed due to non-payment of premiums. If your policy was included in the formal notice, it means your policy may not be active. As such, the employer, employee, and/or self-employed person should contact the approved insurer immediately to verify coverage or reinstate their health insurance policy.
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.
The Commission requires compliance with Section 5 (1) & (2) of the Health Insurance Act. Depending on the investigations, the Commission may recommend or impose
- Administrative fines (up to CI$1,000), or
- Refer the matter to the Office of the Director of Public Prosecutions (DPP) for a ruling where fines could be issued by the Summary Court.
Yes, for all modes of payment, the approved insurer should provide a receipt. The receipt confirms the transaction. Please inform the Commission if the approved insurer fails to provide you with a receipt for your premium payment.
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.
No, the employer is responsible for the payment of the premium. Employers can take the risk; however, the liability remains with the employer. Where the policy is not maintained, that employer would be responsible for any uninsured medical expenses that the employee would have been entitled to under the SHIC plan.
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.
Yes, the employer is liable:
- To reimburse the employee for all the health insurance deductions made while the policy was not active, and,
- If a policy is not active, the employer is responsible for the appropriate settlement of any uninsured medical expense in accordance with The Health Insurance Act (2021 revision) Section 9 titled “Unlawful Deductions”.
- The employer is subject to enforcement action under Sections 5, 9 & 12 of the Health Insurance Act (2021 Revision) for not effecting and/or maintaining a standard health insurance contract.
Yes, maintaining a health insurance policy while you remain in the Cayman Islands as a resident is required. Note that proof of active health insurance coverage is a requirement on the application for an extension.
Where an employer failed to effect and continue, at a minimum, the standard health insurance contract for an employee, that employer would be responsible for any appropriate uninsured medical expenses that the employee would have been entitled to under the SHIC plan. The employee is also encouraged to submit a complaint to the Commission.
Contact your approved health insurer to confirm the payment status of your insurance policy, or if you are an employee, please contact your employer/office administrator or appropriate officer.
The Standard Health Insurance Contract (SHIC) is the minimum contract of prescribed health care benefits established in the Health Insurance Regulations (2017 Revision) and sold by all approved insurers.
Employers are responsible for providing health insurance for all of their employees, the employee’s unemployed spouse, themselves, and any of the employee’s dependent children who reside in the Cayman Islands. The health insurance coverage must be obtained through an approved insurer. A self-employed person must provide their own health insurance coverage with an approved insurer. Their unemployed spouse and dependent children should also be covered.
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.
You could apply to the Department of Financial Assistance (DFA) to determine if you would qualify for assistance from the Department of Children and Family Services.
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.
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.
Health Insurance coverage commences on the first day of employment or as soon as the employee commences duties. The Health Insurance Act (2021 Revision) section 11 (1) titled “Duty of employer to provide information to employee” states:
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 Application (HIA) form at the time of signing the employment contract and submit the HIA to the approved health insurance company to ensure that the coverage starts on the first day that the employee commences employment.
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 Act states that every employer shall effect and continue health insurance on behalf of an employee. If an employee chooses to keep their own health insurance cover, they can do so with the approval of their employer. The Health Insurance Act states that the employee must contribute towards a plan that the employer has established for that employee. However, the employer is obligated to contribute to a plan if a group plan is not established.
For a group plan, the individual would not be able to maintain coverage with their previous employer if they are gainfully employed. Under the Health Insurance Act (2021 Revision) section 15(2) titled “Termination of a Contract” states:
(2) A standard health insurance contract terminates on the first day of the month next following the date of termination of employment of an employee; but if that employee does not become compulsorily insured with any other employer, cover under the contract shall continue for a period of three months from the date of termination of employment or until that person becomes employed, whichever is earlier.
Yes. The premium payment is due on the first day of the month for which it is payable. As long as you are employed on the first day of the month, you must be covered by a health insurance contract for the entire month by that employer.
Once your employment ends, the liability of your employer ends on the first day of the month following. 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 up to three (3) months or until you become employed, whichever is earlier. 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. If you choose not to extend your health insurance cover for the three months, your (former) employer will not be liable for any uninsured medical expenses.
If an employee’s premium contribution is deducted from their salary and not paid over to the approved insurer, the employer has made an unlawful deduction. The employee should file a formal complaint against the employer with the Health Insurance Commission (HIC) to investigate the matter.
The Health Insurance Commission is accessible via email at HIC@GOV.KY. Alternatively, you can submit one of two forms, the “Notification of no insurance form” or the “Complaint intake form.” Both forms can be downloaded from our website.
No, as per the health insurance legislation, it is the responsibility of the registered healthcare practitioner or the registered healthcare facility to verify the benefits and submit claims to the approved insurer for payment. Patients are required to present their health insurance identification card at the time of seeking treatment to their healthcare provider, and the patient will be responsible for paying any deductibles, coinsurance, or any charges exceeding the Standard Health Insurance 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 health insurance benefit may pay 80% of the costs 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 health insurance must be effected on his behalf by his principal employer. The Act states that where a person is employed by two or more employers, the principal employer of that person shall be deemed to be the employer who employs that person for the most hours each week. Where each employer employs him for a similar number of hours per week, the principal employer shall be that employer which first retained the services of the employee.
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 law stipulates that registered health care practitioners and registered health care facilities must submit the claim(s) to the approved insurer within 180 calendar days from the date of service. If the claim is not submitted within the 180-day time frame, the health care provider may be denied payment by the approved insurer, and the provider cannot seek payment from the patient.
Approved Insurers are obligated to reimburse Registered Medical Practitioners and Registered Healthcare Facilities the fee(s)published in the Standard Health Insurance Fees (SHIF) Schedule that can be found on the following link or under the resource section of the link below: https://gov.ky/dhrs/hic.
Registered Healthcare Practitioners/Facilities can charge their own fees. However, the approved insurers are only obligated to utilize the SHIF Schedule for the payment of claims. The insured person may be required to pay the difference between the SHIF Schedule fees and those fees charged by the registered healthcare practitioner or registered healthcare facility.
Your health care practitioner does not have to charge you the SHIF; however, your approved insurer is only obligated to pay the fees listed in the SHIF Schedule and published on our website. The SHIF can be accessed via this link or under the resource section of the link below: https://gov.ky/dhrs/hic.
Where a high-risk person (person with pre-existing conditions) applies to an approved insurer to obtain health insurance coverage under the SHIC, the approved insurer is allowed to apply to the Commission for approval to increase the premium above the standard premium to consider the increased risk being assumed by the approved insurer.
You can maintain your overseas health insurance cover, but while you are residing in the Cayman Islands, you must effect health insurance cover with a locally approved insurer at least to the level of the SHIC.
Based on the Health Insurance Regulations, applicants for health insurance coverage would only need to disclose any conditions that occurred within the last 12 months, including any treatment given or recommended, or medications taken or prescribed.
If you are applying for a supplemental benefit plan (Voluntary Health Insurance), your approved insurer can review your previous medical history and decide on the risk(s) to determine the appropriate premium.
Definition of “pre-existing condition” for the SHIC means a medical condition known to the compulsorily insured person before the date of a health insurance contract or a medical condition for which treatment was given or recommended or drugs taken or prescribed or of which symptoms were or had been manifest during the period of twelve months before the date of the health insurance contract and of which the compulsorily insured person should have been aware;
Failure to disclose if you are diabetic or failure to disclose any other pre-existing condition could result in the denial of a claim and the cancellation of your health insurance coverage. Please note that any sickness or the signs of a medical condition or injury that occurred within twelve months before the date of your application may not be covered unless fully disclosed on the application. Also, failure to disclose pre-existing condition(s) could result in the insured having to compensate the approved insurer for any claims that were paid on behalf of the insured.
The Health Insurance Regulations (2017 Revision) provide that: –
(4) Where a person shows his identification card to a health care facility or a registered medical practitioner in relation to a medical benefit that is covered by a contract of health insurance and provided to him by the health care facility or the registered medical practitioner, the health care facility or the registered medical practitioner shall -
A.) accept the identification card; and
B.) verify that there is in existence a contract and benefits therein issued by an approved insurer to provide cover in relation to that person,
and, where such a contract exists, any claim under the contract in respect of the covered medical benefit so provided shall be deemed to be assigned to the health care facility or the registered medical practitioner, as the case may be.
The Health Insurance Regulations (2017 Revision) 15 (1,2,3) titled “Identification card” states:
i. An approved insurer shall, within two weeks of the making of a standard health insurance contract, issue an identification card to each person insured by the approved insurer under that standard health insurance contract.
ii. An identification card shall contain such minimum information as is specified in Schedule 3.
iii. An approved insurer who fails to provide an identification card in accordance with subregulation (1) commits an offence and is liable on summary conviction to a fine of two thousand dollars.
No, there is no waiting period required for the provision of health insurance coverage by your employer, even if you are required to complete a probationary period. If your employer communicated otherwise, you could file a complaint with the Health Insurance Commission regarding the matter.
If the employee incurred uninsured medical expenses during the probationary period, the employer could be responsible for the benefits that are covered under the Standard Health Insurance Contract (SHIC) and the applicable fees as per the Standard Health Insurance Fees (SHIF).
You must disclose to the two approved insurers that you have a health insurance contract outside of the one established with them. This will allow them to be able to determine who the primary approved insurer is and coordinate your benefits. Coordination of Benefits (COB) is part of the health insurance payment process, and it is how insurance companies decide who covers the cost of your care in a given situation
No, the employer is responsible for maintaining employment and earning records detailing the amount deducted monthly from your wages/salary. Employers who fail to maintain records or produce payslips, in accordance with section 18 of the Health Insurance Regulations (2017 Revision), commit an offense and are liable on summary conviction to a fine of five hundred dollars ($500.00).
