Thursday, October 28, 2021

Insurance for Maternity and Newborn Care

This is an INFORMATION page, verified by physician

Congratulations on being pregnant! Cayman is a wonderful place to have a baby but unfortunately, it is not cheap. Maternity and newborn care are not free.

Deciding whether you will have a baby through the government system or through the private system? In the government system, your care will be by midwives at the Health Services Authority. They will call an obstetrician and paediatrician only if needed. In the private system, you will choose your own OB/GYN. They will care for you throughout your pregnancy and delivery. You can also choose your own paediatrician to care for your baby from the moment of birth.

Understanding Maternity Insurance

By the time most women look at their pregnancy insurance, they are already pregnant. But, understanding how health insurance works can be very important. Especially when trying to understand how much it is going to cost you to have a baby in Cayman.

If you are unsure about your insurance coverage speak to your insurance company early. Some plans will provide almost 100% coverage others almost nothing at all.

By law, every person living in Cayman must have as a minimum, private sector insurance. This is to cover basic health expenses and is called A SHIC (Standard health Insurance Contract).

In Cayman there are 4 types of medical insurance plans:

  • CINICO (Cayman Islands National Insurance Company)
  • SHIC plan – the most basic plan
  • SHIC plus
  • Premium plan

If you have CINICO insurance, your care will be provided by the midwives at the Health Services Authority. If you have private insurance you can have your care under the Health Services Authority. Or through a private OB/GYN and a private paediatrician (for your baby at birth).

Unfortunately, a SHIC plan provides very little insurance coverage for maternity and newborn care. Whereas the premium plans are very much more generous.

Don’t have insurance coverage when you become pregnant? Or you arrive on island pregnant? You will be classed as having a pre-existing condition and you will not be covered for maternity or newborn care. The same rules apply if it is known you have had IVF treatment.

How does all insurance work?

The insurance company pays for each item of maternity and newborn care. This is at a rate known as a Cayman Standard Fee or Standard Health Insurance Fee (SHIF). These fees were developed in 2006 and have not changed since. Some private doctors will then charge you more than Cayman Standard Fees for some aspects of care.

On most policies there will be a maximum amount each year that your insurer will pay. This includes office sickness, wellness visits, antenatal visits, and inpatient care.

Have a deductible as part of your insurance plan? This is the amount you will need to pay before your insurance pays out. In some plans the deductible will apply at the beginning of each year. For example, on January 1st or after the insurance company has already paid out for some care. Deductibles are usually in the region of 500-600CI dollars per person per year.

Finally, depending on your insurer, they generally pay 80% of a doctor’s bill and you are responsible for 20%. This is called co-pay. Usually the co-pay element is charged to you on completion of the consultation. Generally, your doctor will claim the rest from the insurance company directly.

Insurance and costs specifically for antenatal care

All plans will have some antenatal pregnancy cover. And usually separate inpatient delivery cover.

Regardless of whether you use the Government system or the private system the minimum amount you will pay will depend on the terms of your insurance policy. Have basic insurance coverage? Your overall costs will be less if you book to see the midwives at GTH and plan for a normal delivery there.

In addition to the costs described above if you see a private OB/GYN then he or she may charge you an extra cost above your expected co-pay. This is to reflect the fact that Cayman standard fees have not changed for so long. One of the questions you may wish to ask when choosing your OB/GYN is how much will you pay out of pocket for each visit.

Sometimes you will pay more than 20% for blood tests and vaccines. This is because the standard insurance company rates don’t cover the costs. Or the insurance company will not cover the cost at all. For example, you may decide to have a prenatal test such as Panorama or Qnatal. This test is only covered under insurance for certain groups of women (usually >35 years). If you are not covered and want the test you will need to pay for it.

Another example, is the Tdap vaccine. This is advised to protect your new-born baby against whooping cough. This is not very expensive but again your insurance company will not cover the cost.

With antenatal care depending on your insurance there may be a maximum that your insurance company will pay out. You will then be responsible for 100% of your bill.

Insurance and costs specifically for birth

You will have a number of different expenses around the time of birth.

Including:

  • The hospital,
  • Your OB/GYN
  • Your anaesthetist (if you have an epidural or spinal)
  • Your paediatrician.
  • If you have a boy and decide to decide to circumcise him there will be an extra cost (usually paid to an OB/GYN).

You are likely to pay an extra fee to both your OB/GYN and your paediatrician for care in hospital. These costs are likely to be in the region of 1000 to 1800 CI for your care and 400-750CI for each babies’ care.

These costs reflect having your personal doctor on standby. As well as the increases in malpractice insurance that both your OB/GYN and Paediatrican pay. Providing maternity care around the time of birth which is a high-risk time, so it’s important your doctor is insured.

Baby specific insurance cover

All babies are covered for the first 28 days under their mother’s health insurance plan. Except if the mother is on her parent’s plan, which usually happens if mum is still a student. If you are in this position it is essential to have insurance coverage in place from well before your baby is due. This ensures you do not become liable for the total cost of your baby’s care. Especially if they are born preterm. If the father of the baby has his own insurance i.e. he too is not on his parent’s insurance this is the easiest way forward.

Babies should be registered with an insurance company during the first 28 days of life. This ensures that there is no lapse in cover. Once there is a lapse any problems in the new-born period will be deemed pre-existing conditions and will not be covered. You will need to have your child/s birth certificate to be able to add them to either parent’s insurance policy.

When deciding whose insurance policy a child is put on, always try to get a policy with a high in-patient annual cover. We do not know what will happen to our children. The 100,000 CI maximum annual cover on the SHIC plan will not cover the cost of treatments for many severe illnesses.

If your baby needs to go to the neonatal unit and your paediatrician charges more than Cayman Standard Fees then fees can be large. But if they don’t, they should be manageable for most families. It is worth asking your paediatrician how they charge for neonatal care when you first meet them. Assuming your paediatrician only charges Cayman Standard Fees there will be a maximum co-pay for your baby’s care. This is usually 1000 or 1200 CI dollars per calendar year. Unless your baby’s care exceeds the annual limit for in-patient care.

Sometimes this co-pay will be paid to the hospital and sometimes to the Paediatrician. And sometimes it is split between the 2 but overall, you will only pay the amount once. If your baby is born preterm speak to your insurance company and your paediatrician early so you can understand the costs.

The neonatal unit at the Health Services Authority is excellent. But sometimes if your baby is very preterm or needs surgery soon after birth a decision will be made to try, to move your baby overseas. But, this will only happen if your insurance cover is adequate or the baby is Caymanian. If you have a SHIC policy or a SHIC plus policy, it is unlikely that your baby will be accepted into the USA for care. In this case particularly if your baby needed surgery they would be transferred to another Caribbean island. Usually Jamaica.

More Advice for Maternity and Newborn Care

It’s also worth checking out help, advice, and any maternity and newborn care posts in our Baby Facebook Group. It allows you to ask questions, gain access to basic advice and share experiences with others facing the same new experiences. You can join here: https://www.facebook.com/groups/babycayman/

about the author

Dr Lisa Joelshttps://obgyn.ky
OBSTETRICIAN & GYNAECOLOGIST - Dr Lisa Joels (MB ChB, MD, FRCOG, FHEA) has 34 years’ experience in obstetrics and gynaecology including 19 years as a Consultant working in Swansea (2001-11) and subsequently at the Royal Devon & Exeter NHS Foundations Trust in the UK (2011-20). These are both University teaching hospitals, each having more than 4,000 deliveries a year and providing tertiary obstetric and neonatal services as well as gynaecological services to their local population. Dr Joels has experience in management of complex obstetric and gynaecological problems including a multi-disciplinary approach and working closely with related specialties such as midwifery, neonatology, paediatrics and anaesthetics. She believes in a woman-centred holistic approach to clinical management and is an advocate for patient choice and shared decision making.

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