Healthcare Reimbursement in the Cayman Islands: Who Pays for What Depending on Your Situation

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”. CLEISS indicates that there is, on the spot, no possibility of cover except under the provisions of an agreement; that reimbursement on return to France of unforeseen care is a possibility; that sickness daily allowances are not paid abroad and that medical repatriation is not covered by health insurance.

On the spot, local law decides: every resident must hold a standard contract with an insurer approved by the Health Insurance Commission (HIC), which reimburses only within the limits of its schedule. The page healthcare system in the Cayman Islands describes this contract; this page indicates, for each French situation, who reimburses.

The locally recruited employee comes under the scheme of the host country and is no longer insured in France: CLEISS specifies that they must notify their fund and return their Carte Vitale, which can be used only by someone who resides and is insured in France. Their employer must take out a standard contract for them, their non-working spouse and their children from the first day, pays the standard premium and may recover at most 50% of it from the salary, the dependants' premium being withholdable in full. The employee may join the CFE voluntarily for sickness, maternity, disability, work accidents and the basic pension. Without an agreement, France does not count local periods when calculating the rate of the French pension.

The seconded employee remains affiliated to the French scheme for three years renewable once, their contributions being paid in France as if they worked there. Care is reimbursed up to the benefits they would have received in France for the same care: they send their paid invoices with form S 3125c to their fund. CLEISS recommends private top-up cover when care is expensive. Family members who accompany them follow the same procedure; those who stay in France continue to come under their fund. In case of sick leave, the notice is sent to the fund within 48 hours; in case of a work accident, the employer is notified within 24 hours. Children who leave with them no longer give entitlement to French family benefits.

The self-employed person must take out a standard contract themselves for themselves and their dependants (Health Insurance Act, section 5); the CFE offers voluntary sickness and maternity cover. The student comes under no European form: the sources consulted indicate that a student visa may be required depending on the length of the course, and local law targets “every resident”; they compare the local contract and a student insurance with the HIC and their institution.

The spouse and children of a local employee are dependants within the meaning of the law: the employer must insure them, a child born after the contract is taken out being covered, with postnatal care of at least one month if they are Caymanian or authorised to reside (section 5). The spouse includes the retired non-working spouse. For the non-employed spouse of an expatriate, the CFE allows voluntary old-age insurance membership under certain conditions (six months of prior compulsory insurance and application within six months).

The retiree does not come under form S1, which is valid in Europe. CLEISS indicates that they check to what extent the local scheme covers their care, and that they can join the CFE voluntarily or take out private insurance. The CFE retiree offer has a contribution that depends on age and the plan chosen according to the fund's home page, the final price depending on the country, age and family composition. A retiree who is no longer tax resident in France pays neither CSG, nor CRDS, nor Casa; a health insurance contribution is levied if they remain attached to a French scheme (about 3.2% on the basic pension and 4.2% on the supplementary pension according to CLEISS). See the guide on retiree health insurance abroad and the page on retirement in the Cayman Islands.

During a temporary stay in France, French cover concerns holders of a French pension showing at least 15 years of insurance in France and with no professional activity; an accompanying spouse is not covered and a hospital stay of more than a month requires prior recognition by the CPAM (the French local health insurance fund). CFE members send their claims to the Seine-et-Marne CPAM.

The CFE is presented on its website as the social security of expatriates. Its health offers are distinguished by age: a youth offer for those under 30 (with a contribution that depends on age and the plan chosen), a main offer beyond age 30 (with a contribution that depends on age and the plan chosen) and a retiree offer (with a contribution that depends on age and the plan chosen), according to the fund's home page. The level of reimbursement of care abroad depends on the CFE scale for the country of care; this scale was not read for the Cayman Islands and should be consulted before seeking treatment. See the guide on CFE reimbursements.

On returning to France, service-public states that a CFE member may, subject to conditions, keep their benefits for three months. Someone who resumes a job returns to the Assurance Maladie (the French national health insurance) from the first hour worked (copy of the contract or a payslip with form S1106). Without the CFE or a job, you must show three consecutive months of residence in France and then submit the S1106 to the CPAM; French unemployment benefits open rights; failing any cover, you apply for universal health protection. CLEISS specifies that a three-month waiting period is in principle provided in case of return. See reducing the waiting period and the page on returning to France.

International health insurance with first-euro cover reimburses actual costs within the limits of its contract, after any deductible, waiting periods and exclusions. It answers the main limit of the local standard contract: an annual maximum of CI$100,000, outpatient care capped at CI$400 a year and a schedule that the provider may exceed, the difference remaining the patient's responsibility. The local contract's outpatient benefits are limited to facilities in the territory, whereas hospitalisation benefits may be provided abroad.

The tourist has no right to any cover on the spot: CLEISS recommends travel insurance suited to the real cost of care, whose assistance covers repatriation, which French health insurance does not reimburse. Unforeseen care may then be reimbursed in France, as a possibility and not an obligation, at French rates.

• Consultation: the standard contract reimburses 80% of consultations, tests and physiotherapy on prescription up to an annual outpatient benefit of CI$400. The insurer pays only the official schedule (Standard Health Insurance Fees) and the patient pays on the spot the deductible, the co-payment and any fee excess.
• Hospitalisation: the patient bears 20% of the first CI$5,000 of eligible costs, capped at CI$1,000 a year, then the contract pays up to the annual maximum of CI$100,000. Benefits cover up to 30 days of semi-private room and nursing care, surgery, anaesthesia and tests.
• Medicines: prescription medicines, contraception included, are covered at 80% within the same annual limit of CI$400. The seconded employee obtains French reimbursement on invoices up to French rates.
• Dental care: the standard contract covers one check-up and one scale and polish a year, as well as surgery for impacted teeth, tumours or cysts and treatment of injured sound teeth, within the limits of the plan. Additional dental benefits are optional.
• Optical care: the supply and fitting of glasses, contact lenses and hearing aids are excluded from the standard contract; vision benefits are supplementary cover that the law leaves to insurers.
• Maternity: prenatal follow-up is covered at 80% up to CI$500 per pregnancy; delivery, major maternity procedures and newborn care for 30 days come under hospitalisation benefits. Prior conditions not declared when the contract was taken out may be excluded.