Charges for services and supplies not covered under your plan.

Services, supplies or prescription drugs that are needed to diagnose or treat a medical condition. Your insurer will review the information provided and decide if it is accepted as standard practice, appropriate for the condition, age etc. and that it is not for convenience or cosmetic reasons. Sometimes additional information is required from you or the provider to make that determination.

An agreement and sharing of risk in which persons or companies make regular payments to an insurance Company (the insurer). The Company, in turn, promises to pay money towards specified wellness / preventative services and towards allowed medical services if the covered person becomes ill or injured.

A coding system that providers use on claims to describe the problems they are treating.

The division of the Cayman Government’s Department of Health Regulatory Services which monitors and assists with compliance of the Health Insurance and related Laws & Regulations. Their website is: dhrs.gov.ky.

A coding system using 5 number codes that providers put on requests or claims to describe the services they are proposing or have done.

Charges for services that your insurance plan will pay for. Not all services billed will be covered. Different plans and different insurance providers cover different services.

Any person covered under the plan.

When you pay some of the costs of your healthcare.

This is a 12 month period and will be detailed in your Policy. Usually the calendar year of 1st Jan to 31st Dec. If your benefit(s) stipulate e.g. 5 visits to a therapist in that period, you will have to pay for the additional visits. If you have the SHIC Plan you have Cl$400 for out-patient services in your benefit period.