The Cayman Islands Healthcare System: Compulsory Insurance, Public Hospitals and Emergencies

The Ministry of Health, Environment and Sustainability sets health policy and oversees five entities: the Health Services Authority (HSA), the Department of Health Regulatory Services, the Department of Counselling Services, the Poinciana Rehabilitation Centre and the National Drug Council. Public health is delivered on behalf of the government by the HSA, which runs the public hospitals, general medicine, maternity, radiology, pharmacy and dialysis. Regulation of insurance falls to the Health Insurance Commission (HIC), which regulates premiums, keeps the list of approved insurers, handles complaints and advises the Minister.

The Health Insurance Act (2021 revision) recognises as health facilities the public hospitals, the George Town Hospital (now the Anthony S. Eden Hospital) and the Faith Hospital, as well as private hospitals and practices licensed under the health practice law. Professionals come under dedicated councils: doctors and dentists, nurses and midwives, pharmacists and paramedical professions. The sources consulted publish no health expenditure as a percentage of GDP for the territory: the World Bank API returns none.

Section 5 of the Act provides that every resident must take out, for themselves and their dependants, a standard contract, unless they are covered by their employer, by the government or declared uninsurable. The employer must take out and maintain this contract for itself, its employees and their dependants, that is children, the non-working spouse (including a retired one) and certain dependent adult children. The obligation also applies to self-employed workers and partners in a partnership.

• Premium: the employer pays the employee's standard premium and may recover at most 50% of it from the salary; it may withhold the dependants' premium in full (sections 7 and 8).
• Timing: cover starts on the first day of employment, with no waiting period, including during the probationary period; the employer provides a written certificate within 15 days, with the insurer's name, the effective date and the contract number.
• End of employment: cover ends on the first day of the following month; the employee may extend it for up to three months, or until a new job, by paying the full premium.
• Foreign cover: it may be kept, but a locally approved contract, at least equivalent to the standard contract, is required as long as you reside in the islands; a permit extension requires proof of active cover.
• Penalties: a fine of CI$30,000 on summary conviction and CI$40,000 on conviction on indictment for an employer or resident who does not comply with the obligation; the HIC may also impose administrative fines of up to CI$1,000.

Schedule 1 of the regulations (2017 revision, published by the HIC) sets the minimum benefits. The annual maximum is CI$100,000 per person and the lifetime maximum CI$1,000,000. For hospitalisation, surgery, chemotherapy and radiotherapy, the patient bears 20% of the first $5,000 of eligible costs, capped at CI$1,000 a year; beyond that, cover is 100% up to the annual maximum. Hospital care includes up to 30 days of semi-private room and nursing care, anaesthesia, tests, medicines and maternity. Inpatient mental health care is limited to CI$25,000 for life.

Outpatient care is reimbursed at 80% up to an annual benefit of CI$400 (consultations, tests, physiotherapy on prescription, prescription medicines including contraception). A wellness allowance of CI$200 a year covers routine tests, a dental check-up and an annual scale and polish, and prenatal follow-up benefits from CI$500 per pregnancy. Emergencies are covered at 100% on the first $4,000 of outpatient services; the air ambulance in a life-threatening case is covered up to CI$15,000 a year and the medical air ticket up to CI$2,000. The regulations also list possible exclusions: undeclared pre-existing condition, infertility, sterilisation, obesity treatment, glasses and hearing aids, unjustified cosmetic surgery, home nursing care, risky sports.

The HIC page cites a standard premium of about CI$167 a month, with no date or detail on the type of cover: the real amount should be confirmed with an insurer on the official list, which includes nine approved insurers. Insurers cannot refuse the standard contract; a high-risk person may be charged a higher premium: under the 2017 regulations, the insurer notifies the Commission when the loading does not exceed 200% of the standard premium and requests its approval beyond that. A person whom two insurers have judged uninsurable can be certified by the Commission and directed to a designated insurer. Conditions treated, medicated or symptomatic in the 12 months before the contract are considered pre-existing; non-disclosure may lead to refusal of a reimbursement or cancellation of the contract.

Insurers pay only the official schedule (Standard Health Insurance Fees): a provider may charge more and the patient then pays the difference, as well as the deductible and the co-payment, at the time of care. Providers must submit their claims within 180 days and check the patient's entitlements themselves. A person who cannot pay may apply to the Department of Financial Assistance or the Needs Assessment Unit. To compare levels of cover, see the guide to expat health insurance.

General medicine is the first port of call for most needs; the HSA also offers a walk-in consultation (urgent care) for minor injuries and non-urgent illnesses. Appointments are made online and the MyHSA portal allows record follow-up and prescription renewal. Five district health centres, one per district of Grand Cayman, provide general medicine, vaccinations, maternal and child health and home visits.

• Anthony S. Eden Hospital (formerly George Town Hospital), 95 Hospital Road, George Town, Grand Cayman: emergency department, cardiology, dialysis, oncology, obstetrics and gynaecology, maternity, paediatrics, radiology, ENT, orthopaedics. Switchboard: +1 (345) 949-8600.
• Faith Hospital, 215 Dennis Foster Road, Stake Bay, Cayman Brac: +1 (345) 948-2243.
• Little Cayman Health Centre: the island's public health centre, with no address or telephone number on the HSA website.

The emergency department receives serious injuries, chest or abdominal pain, fractures, head injuries, strokes, severe burns and haemorrhages. The emergency number is 911 (police, fire, hospital) on all three islands; the official list also mentions local numbers in Cayman Brac and Little Cayman. The HSA page consulted publishes no rates; payment is a matter for the insurance contract.

Prescription medicines are covered at 80% within the standard contract's CI$400 outpatient benefit; the HSA has a pharmacy and an online renewal form. The regulations classify as experimental treatments, and therefore excluded, medicines absent from the British National Formulary or the Physician's Desk Reference, unless approved by the chief medical officer. Specialist care is offered at the Anthony S. Eden Hospital (cardiology, oncology, orthopaedics, ENT).

The regulations provide that the standard contract's hospitalisation benefits may be provided in a facility in the territory or abroad, whereas outpatient benefits are limited to facilities in the territory. The air ambulance in a life-threatening case is capped at CI$15,000 a year: for an evacuation that exceeds this cap, an assistance contract with medical evacuation remains to be considered, CLEISS (the French centre for European and international social security liaison) recalling that French health insurance does not cover medical repatriation.

The HSA's public health service offers advice and vaccines for travellers, childhood and adult vaccination programmes, screening for communicable diseases and their surveillance. Seasonal flu vaccination sessions are held every season, notably at the Bodden Town health centre. The Ministry of Health monitors the circulation of whooping cough and of H5N1 avian influenza, detected in some birds in Grand Cayman, the risk to the general public remaining low.

The Ministry may issue travellers' notices on arboviral infections (dengue, chikungunya, Zika, Oropouche) and leptospirosis, and the Mosquito Research and Control Unit carries out aerial mosquito control operations. The France Diplomatie (the French foreign ministry) travel advice page was not found for this territory: recommended vaccinations should be discussed with a doctor or an international vaccination centre before departure. The hurricane season (1 June to 30 November) also has a health dimension: Hazard Management Cayman Islands recommends keeping at least seven days of medicines.

No social security agreement links France and the Cayman Islands (CLEISS), and the Carte Vitale gives no right to any cover on the spot. The locally recruited employee is covered by their employer; the seconded employee keeps the French scheme for three years renewable once, with reimbursement on paid invoices (form S 3125c) up to French rates; the self-employed person, spouse and retiree choose between the local contract, the Caisse des Français de l'Étranger and international insurance. The page healthcare reimbursement in the Cayman Islands details each situation, and the country page brings together the obligations and procedures.