Frequently Asked Questions
With so many health insurance options to consider, the more you know, the better decisions you'll make. We've made it easy by providing you with answers to the most frequently asked questions.
- Who will handle the enrolment process?
- 100% by Caribbean Insurers (Health) Limited (CIHL);
- What is the procedure for the settlement of claims from the time they are received?
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- Settlement of claims will be made directly with the Preferred Providers
- In non‑Preferred Provider networks, payment can be made directly to the Provider after satisfaction of the appropriate deductible and co‑insurance by the insured person
- For BVI Providers, claims will be paid directly CIHL
- Claims Checklist
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Secure your receipts
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Notify your Agency – numbers on the rear of the card
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Complete a claims Form and submit to your Agency within 60 days
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Claims – Administration
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Claims will be administered and settled by CIHL experienced Claims Executives
- What are the requirements for cancelling the policy?
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- The Underwriters may cancel this certificate at any time by giving thirty (30) days written notice to the Certificate holder
- The Underwriters may cancel this certificate at any time by giving thirty (30) days written notice to the Certificate holder
- The Certificate holder may cancel this certificate at any time by written notice to the Underwriter
- What is Pre-certification?
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- These plans require pre-certification, not less than 7 days in advance, of all in patient confinements for surgical or medical treatment, surgeries in an out-patient facility or special procedures at the doctor’s office, home health and rehabilitative services, second opinions and out-patient studies such as magnetic resonance imaging (MRI), computerized tomography scans (CT Scans), endoscopies, laser procedures and lithotripsy (Extracorporal Shock Wave), and all other special testing procedures
- If the pre certification requirements are NOT met, you will be subject to an additional penalty of 35% in the ‘Preferred Provider’ Network and 50% in the ‘Non Preferred Provider’
- Emergencies. Pre-certification is not required in emergency hospitalisation. Notification to the Agency is required within 72 hours of admittance into the hospital.
- What is the Residency Requirement?
- Coverage under this certificate is applicable only to those persons physically resident in the British Virgin Islands where the applicable certificate is delivered, and such persons must be physically resident in the British Virgin Islands during at least 9 months of each calendar year while the certificate remains in force
- What is a Deductible?
- The deductible is the amount of eligible expense each Covered Person must incur each calendar year before the Plan pays medical benefits
- Who does coverage extend to?
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- An employee’s spouse who is resident in the British Virgin Islands not less than 9 months of the calendar year or who has written authority from Underwriters to extend the coverage from the British Virgin Islands to the normal place of domicile
- An employee's child who meets the conditions:
- With written authority from the Underwriters, a child who is at least 15 days old and less than 19 years of age, is not married, or is at least 19 years but less than 25 years of age is not married and is a full time student at an accredited educational institution of higher learning, including trade schools
- At age 25, coverage for full time students will cease. Coverage will be available on an individual certificate basis, subject to usual Underwriting requirements
- Are Ambulance Services covered?
- 100% coverage for Ground and Air Ambulance to the nearest available facility
- Are family members allowed to travel with the Insured?
- One family member can travel with the insured; however onus of expense return will be on the member traveling
- What is Co-payment?
- A specified amount of expenses applied to a covered service for which the insured is responsible
- What is Co-insurance?
- The percentage of the covered expenses which must be paid by the covered person and the Company. The actual percentages are shown in the Schedule of Benefits
- What do the initials PPO mean?
- They mean ‘Preferred Provider Organisation’ which is an organization consisting of doctors, hospitals and other health care facilities providing services to you at a reduced rate
- What is out of pocket expense?
- The amount of expenses incurred by the insured after the application of the deductible/co-insurance/co-payments
- Are Maternity Benefits Covered?
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- The policy will cover Maternity Benefits for the pregnancy of the Insured or the Insured’s spouse up to a maximum of $6,000.00 per pregnancy, per 24 months, for the medically necessary treatment, care and services, including Physicians’ fees. The Underwriters may cancel this certificate at any time by giving thirty (30) days written notice to the Certificate holder
- Hospitalisation relating to prenatal, postnatal care, delivery, complications of pregnancy and charges relating to Well Baby Care.
The pregnancy of any Covered Person other than the Insured or the Insured’s Spouse is not covered