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Health Insurance Commission Addresses Cayman First Insurance Concerns

Local News 16 Jan, 2023 Follow News

Health Insurance Commission Addresses Cayman First Insurance Concerns

The Health Insurance Commission (HIC) is aware of questions and concerns raised in the community about Cayman First Insurance.

In late September/ early October 2022 the Health Insurance Commission (HIC) received an informal verbal complaint from a registered health care provider about Cayman First Insurance (CFI).  This was the catalyst for a fact-finding mission that, based on its outcome, triggered an investigation by the HIC, working in consultation with the Cayman Islands Monetary Authority (CIMA).

The HIC identified the following issues with CFI:

1- Shortage of personnel

2- Problems with a newly introduced claims filing system which impacted:

a. Clients being able to access the insurer

b. Registered health care providers being able to file claims directly, thus impacting their ability to receive payment for their “clean claims” in a timely manner.

The HIC has since been in regular contact with CFI senior leadership- President and Vice President- via weekly phone calls, regular exchange of emails, and frequent updates.  The HIC also conducted a site visit of the CFI’s office.

CFI senior leadership has assured the HIC that these issues are being addressed, but that they will require some time for complete resolution of the challenges.  CFI issued a release to a local media house to update stakeholders on the situation in November 2022.

Even though the HIC recognises the efforts which CFI has made in working to rectify the situation, the HIC has, nonetheless, imposed a series of conditions on CFI with which the insurer must comply to maintain its Approved Insurer Certificate.  These conditions include, but are not limited, to the following submissions:

 1- Quarterly financial reports for the year 2022;

2- A written mitigation plan for the system integration and restoring appropriate staffing levels;

3- Monthly reports for:

a. Outstanding historical claims (ie: claims over 30 days)

b. Current outstanding claims

4- A timeline for the resolution and clearance of identified backlog (claims payments and enrollment);

5- Providing the HIC with a complaints-handling policy.

 CFI is expected to provide an update to the HIC on the staffing and systems issue by 15 January 2023.  However, the HIC will also be pursuing the insurer to provide stakeholders with more regular updates on adherence to the conditions and ongoing steps to resolve the above stated issues as a matter of public interest. 

It is important to note that to date the HIC has only received the one initial informal verbal complaint from a registered health care provider.  However, the Commission is aware that statements have been made in the public domain that there potentially is a number of other providers who have been impacted by the issues relating to the non-payment of claims.

The Health Insurance Regulations (2017 Revision) states in section 9 (6) and (7) that:

(6) Where an approved insurer fails to pay a claim in accordance with the time limit set out in subregulation (1) and there is no dispute as to that claim, the approved insurer shall be liable to pay interest on the money owed from the thirty-first day after the claim has been submitted to the date on which payment is made to the health care facility or registered medical practitioner.

(7) The rate at which interest is payable under subregulation (6) is at the rate of two percent above US prime interest rate in force from time to time.

Registered health care providers, as well as clients who have been impacted by the non-payment of claims or any other concerns  are encouraged to file a formal complaint or contact the Health Insurance Commission by email on hic@gov.ky  or by phone on 946- 2084. The HIC office is located at the Government Administration Building.


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