Expat insurance and health insurance in the Cayman Islands

The Cayman Islands health system rests on compulsory basic health insurance and on public care provided by the Health Services Authority (HSA), under the supervision of the Ministry of Health, Environment and Sustainability. The Health Insurance Act (2021 revision) requires every resident to take out, for themselves and their dependants, a Standard Health Insurance Contract (SHIC) with an insurer approved by the Health Insurance Commission (HIC), unless they are covered by their employer, by the government or declared uninsurable. Nine insurers appear on the list published by the HIC. The Commission counts about 85,000 insured persons, for a population estimated at about 90,000 inhabitants by the Economics and Statistics Office.

The standard contract is a minimum base: in the 2017 version of the regulations published by the HIC, it provides for an annual maximum of CI$100,000, a co-payment of 20% on the first $5,000 of hospital costs (capped at CI$1,000 a year) and outpatient benefits subject to annual caps. Insurers cannot refuse this contract, and the HIC specifies that no waiting period applies, including during the probationary period; a high-risk person may be charged a higher premium, notified to the Commission up to 200% of the standard premium and subject to its approval beyond that.

Care is provided by the HSA: the Anthony S. Eden Hospital in George Town (Grand Cayman) and the Faith Hospital in Cayman Brac, to which are added five district health centres in Grand Cayman and the Little Cayman Health Centre. The emergency number is 911. Travel vaccines and the monitoring of communicable diseases come under the HSA's public health service; mosquito control is handled by the Mosquito Research and Control Unit.

• Tourist stay: visitors may receive permission to stay of up to six months, with the possibility of an extension on application to the Director of Customs and Border Control. The passport must be valid beyond the date of the return ticket, a return or onward ticket is required and the officer may ask for proof of sufficient funds. The Department publishes a list of countries whose nationals must obtain a visa (fee of CI$92 for a visitor visa); the situation of a French passport should be confirmed on this list before departure.
• Work: any non-Caymanian needs a work permit, applied for by the employer with Workforce Opportunities & Residency Cayman (WORC); the job must have been advertised for 21 days on the WORC job portal and in a local newspaper, and the holder of a first permit cannot change employer during the first two years without leaving the territory for a year, except by exemption.
• Employee health insurance: the employer must take out a standard contract for itself, its employees and their dependants. The standard premium is paid by the employer, which may recover at most 50% of it from the employee's salary; the cost of dependants may be withheld in full. Cover starts on the first day of employment and the employer provides a written certificate within 15 days.
• Self-employed person and resident without an employer: the obligation applies to every resident, including self-employed workers, who themselves take out a standard contract for themselves and their dependants. Foreign cover may be kept, but a locally approved contract, at least at the level of the standard contract, is required during residence; a permit extension requires proof of current cover.
• Student: a student visa may be required depending on the length of studies; the European Health Insurance Card does not exist for this territory, which is not in the European Union. A student insurance should be compared with the local contract depending on status.
• Seconded employee : stays on the French scheme, according to CLEISS, for three years renewable once, with reimbursement up to what the French scheme provides on paid invoices (form S 3125c). Membership of the Caisse des Français de l'Étranger (CFE) remains an optional top-up.
• Retiree: CLEISS points to local institutions, voluntary membership of the CFE or private insurance; no S1 form exists, as this territory is not in the European Union.
• Hurricanes: the hurricane season runs from 1 June to 30 November; Hazard Management Cayman Islands recommends providing at least seven days of water, food and medicines.

For the employer, failing to have a contract is an offence punishable by a fine of CI$30,000 on summary conviction, raised to CI$40,000 on conviction on indictment (Health Insurance Act, section 5). The sources consulted describe no penalty specific to the employee.

The Cayman Islands are not in the European Union, and CLEISS lists them neither among the States linked to France by a social security agreement nor among the territories covered by the European regulations: for a temporary stay, they fall under the category “other countries or situations not covered”. The CLEISS page on the United Kingdom scheme does not mention the Cayman Islands. Without an agreement, no cover is arranged between the funds.

• Temporary stay: CLEISS states that, on the spot, no cover is possible without an agreement, that reimbursement on return to France of unforeseen care is a possibility, that medical repatriation is not covered by health insurance and that travel insurance suited to the real cost of care is recommended.
• Secondment: the employee remains affiliated to the French scheme, three years renewable once; contributions are paid in France as if they worked there, but they may also have to pay those of the host country. Care is covered up to what they would have received in France (form S 3125c with paid invoices).
• Expatriation: the employee comes under the local scheme and leaves the French scheme; they can join the CFE voluntarily for sickness cover. Without an agreement, France does not take local periods into account when calculating the French pension.
• Retiree: CLEISS recommends checking local cover, choosing the CFE or private insurance, and points out that a retiree who is no longer tax resident in France pays neither CSG, nor CRDS, nor Casa.
• Taxation: the BOFiP list of tax treaties in force does not include the Cayman Islands. An agreement in the form of an exchange of letters on the exchange of tax information, signed in Paris on 16 September 2009 and in George Town on 30 September 2009, has been in force since 13 October 2010 (decree no. 2010-1550): it does not allocate taxing rights between the two States. The local government states that there is no direct tax in the Cayman Islands, while tax residence in France remains defined by article 4 B of the French General Tax Code (home or main place of stay, professional activity, centre of economic interests).

1. Before departure: notify French agencies of your departure (CPAM, CAF, France Travail, pension funds) and choose your cover according to your status.
2. Check on the Department of Customs and Border Control website the entry rules applying to a French passport (visa, length of stay, return ticket).
3. Employee: have the employer submit the work permit application to WORC and obtain the health insurance certificate within 15 days of the start of employment.
4. Seconded employee: request attachment to the French scheme from your employer and your fund; keep paid invoices for form S 3125c.
5. Self-employed person or spouse: take out a standard contract with an approved insurer on the Health Insurance Commission list.
6. Retiree: ask WORC about the residence certificate for persons of independent means, and prepare health cover before departure.
7. Family: arrange insurance for your spouse and children; an employer must insure dependants within the meaning of the law, and a permit for a spouse requires a minimum monthly income of the holder.
8. Register on the roll of French nationals living abroad, with the Consulate General of France in Miami.
9. Hurricanes: prepare a family plan and supplies before 1 June, and sign up for Hazard Management Cayman Islands alerts.