health insurance health insurance3Mexico has a plethora of insurance companies that, for a monthly premium, will give you private health coverage. In the event that you or a member of your immediate family are taken ill or suffer an accident, the insurance company will cover the medical fees.

How much is covered depends on what health care plan you choose to buy. The more cover you need, and the older you are, the more expensive the premiums will become. Other factors (such as whether you smoke or take regular exercise at a gym) may also influence the price of your premiums.

Most large companies offer a health care plan as part of their pay package. As with the USA, health insurance premiums have risen dramatically in Mexico over recent years. It is in part due to the higher cost of medical care, higher cost of medicines and an increase in hospital fees. Having a plan through a large company offers a distinct advantage because the company covers the lion-share of the premium cost, and this means that you, personally, pay less and get considerably more cover under a corporate insurance plan than you would otherwise get on a privately held plan.

If you don’t work for a company that offers health insurance, then a private plan is your only other option. You should shop around for the best deal and find a plan that matches your circumstances, potential needs, and budget.

Companies offering health insurance in Mexico include: ING MexicoGNP MexicoMonterreyRoyal & Sun AllianceMetLife and DVK.

In addition, Mexico’s Banks offer health insurance products as part of their service portfolios although you should check the small print for any limitations.

Obamacare’s Effects on American Expats Living Abroad

Oct. 24, 2013 Update:

This article is for all the Americans traveling or living abroad who have, so far, avoided learning about the Affordable Care Act (ACA). With the currentg Oct. 1, 2013 – March 31, 2014 enrollment period, for ACA – Obamacare, there are bundles of questions that arise affecting US citizens who are outside the USA.

Americans who are NOT residents of the USA, do NOT have to participate if you meet the requirements of being a resident of another country (or if you are outside the USA for 330 days or more per year).   You can find more details below on Exemptions to ACA and how to qualify as a Non-Resident US citizen at:

https://www.healthcare.gov/exemptions/

via ACA – Obamacare’s Effects on American Expats Living Abroad | Surviving Yucatan.

Cozumel Mexican Institute of Social Security IMSS

The IMSS Hospital and Clinic in Cozumel is located at  11th Avenue, crossing with 30th Avenue. The telephone number: (52-987) 872-0639. Most full time workers in Cozumel have medical  coverage either through IMSS or Issste paid for partially by their employer. You may buy into Medical Insurance on your own.  Medical Insurance is available to foreigners holding Immigration credentials. The cost is quite low, although it has risen annually.

There is a new procedure!

You now apply and renew online at:

https://serviciosdigitales.imss.gob.mx/portal-ciudadano-web-externo/home

You will need your CURP card and an email address. Once you are in, click on the box that reads:

“Incorporación al seguro de salud para la familia

Solicitud de incorporación al seguro de salud para la familia”

This will take you through the process including a health questionnaire. I use Google Chrome that automatically translates from Spanish to English. I will add the step by step instructions as soon as I apply for 2017 coverage. Somewhere along the line you will probably have to submit the following:

ORIGINAL Birth certificates & Copy
ORIGINAL Marriage license & Copy
CURP Card
Proof of residence (Utility bill etc.)
Copies of you Immigration documentation
Copies of your passports
Two infantile size pictures in color
They require the birth certificates and marriage license be translated by an approved translator.
Copy of your Social Security Number assigned to you at: www.imss.gob.mx

OTHER FACTS:

The first six months there is no coverage. The second six months only minor things such as colds are covered. The second year everything is covered except broken bones and orthopedic.

The third year covers everything including medication as long as you get them from IMSS. You will not be reimbursed for drugs purchased at other pharmacies. The drug benefit is the only negative I have heard, as they are many times short of medications.

IMSS Family Insurance this insurance entitles you to IMSS hospital, surgical, medical care, and pharmaceutical supplies for you and other members of your family.  Advance payment of annual fees is required and rates are determined by the age range of the person to be included in the insurance.

Annual costs Advance Fees:

Ongoing from 1 February 2016 to 31 January 2017

Age range     Annual quota

0 to 19 years            $ 2,250.00

20 to 29 years         $ 2,700.00

30 to 39  years       $ 2,850.00

40 to 49 years         $ 4,000.00

50 to 59 years         $ 4,250.00

60 to 69 years         $ 6150.00

70 to 79 years         $ 6,450.00

80 and more          $ 6,500.00

The amount of annual contributions is updated in February each year.

Insurance can now be purchased individually or at least two people, ie, the owner and immediate family such as: spouse, partner, daughters, mother, father or additional family such as: grandparents, grandchildren, nieces and nephews, etc.  If you reside abroad, you can also purchase this insurance for your family in Mexico as head of the family.

Exceptions

They cannot ensure people who have:

Pre-existing diseases, such as malignant tumors, chronic degenerative diseases, late complications of diabetes mellitus, diseases Hoarding (Gaucher disease), chronic liver disease, chronic renal failure, heart valve disease, heart failure, sequelae of ischemic heart disease (arrhythmia, angina or myocardial infarction), chronic obstructive pulmonary disease with respiratory failure, among others.

chronic systemic connective tissue diseases, addictions like alcoholism and other substance abuse, mental disorders such as psychosis and dementia; Congenital and Acquired Immune Deficiency Syndrome or Human Immunodeficiency Virus (HIV) disease.

The Mexican Social Security Institute will not make full or partial repayment of the payments made. It is very important that all information provided is accurate and complete, especially referring to pre-existing conditions.

When you have acquired the Family Health Insurance, you can renew it 30 days before the due date.

 

health insurance1

 

 

SEGURO POPULAR

Seguro Popular is a Medical Coverage Program for residents ran by the Mexican Federal Government. It is intended for all those that do not qualify for IMSS (Social Security) insurance, ISSTE or other working insurance coverage that is federally funded. . IMSS is intended for working people, and the premiums are paid by the employer and the employee. People may opt to pay 100% of the coverage out of pocket, but to buy the plan outright, you must be a family. (Example: Husband and wife, parent and child, etc.).

If you cannot afford IMSS insurance or do not qualify for it, Seguro Popular might be the way to go.

cozumel general hospitalThe office is located on Calle 13 South between Avenues 20 South and 15 Bis C South. It is directly across the street from the emergency entrance of Cozumel General Hospital. The office is the far glass door on the left. Bring with you original and copies of the following:

Permanent Resident Card
Birth Certificate, Passport (Main Page)
CURP
Utility Bill for proof of residence
They always get confused and ask for that Election document that none of us have since we are not citizens

The young woman who processes the application will ask some basic questions:  Name, Address, Own or Rent, phone number, Birth Date, Age, Marital Status, Working or Not. THEY NEVER QUESTIONED INCOME.

She will then scan all your finger prints one at a time into the computer for their records starting with the thumb on your right hand.

She will print out two copies of your insurance policy. You sign in three places. She stamps some official seal on everything, hands you one of the originals and wham, you have insurance for the next three years FREE OF CHARGE.

You must make many copies of your policy, as you are to give a copy to the service provider at each visit.

cozumel general hospital 2They will assign you to a Seguro Poplar Clinic closest to your home. The clinic opens at 7 a.m. Monday – Friday and appointments are made on a first come first serve basis. At this clinic, you may see a general Practitioner for all non emergency medical needs and preventive care. This includes Dental and Eye Care. If you need a specialist they will refer you to one. If there is none on the island, they will send you to an affiliate in the mainland.

All Seguro Popular Emergencies are handled by Cozumel General Hospital. The hospital and ambulance ride if necessary are free of charge.

There is a Seguro Popular Pharmacy on the same block a CGH on the 20th Avenue side of the block. There are also small pharmacies at the clinic. Their stock of medicine is very limited, but if they happen to have what you need, it is also free of charge.

They give you a handbook of rights and description of services that is in Spanish, but there is a website: http://www.seguro-popular.gob.mx/ that has all the same information. It is also in Spanish; remember to use the Google Chrome Translation feature.

seguro 004The clinic closest to my home is located at 40 Avenue between Calles 29 & 31, in Colonia San Miguel II. The building looks new, it is spotless and clean. The staff is friendly and professional. There is a long hallway that leads to a waiting area and a receptionist. There are two rooms for medical consultation, one for vaccination, and a dental office with equipment that looks new and modern. On the far left there is a pharmacy. The attending Physician spoke English.

A Cozumel Sun reader Karen Vissage wrote: “I’ve had Seguro Popular for a several years. I enjoy the fact that I don’t pay a premium and services are free. Free mammograms, Pap smears, HIV testing, contraceptives, vaccinations. For men, even PSA testing and even free “no scalpel vasectomy”. I like the staff at the Centro de Salud. They are very kind and caring.

When you get your policy, you are assigned a clinic in your area. For non-emergencies, you go to your clinic at 7am to get and line for your ficha. The ficha is a little slip of paper with your appointment time for later that day. You see the General Practitioner and whatever is needed, they write the orders for tests and medication prescriptions. If they don’t have the ability or equipment to do the tests in the system, you may have to see a private doctor. That is an out-of-pocket cost to you. I believe they will reimburse the cost, but I don’t know the process. Sometimes getting an appointment with a specialist who comes to the island can be a wait of weeks.

There is a learning curve with the system and sometimes a long wait. I learned about the referral to specialists on the mainland a couple of years ago. I had a questionable mammogram and they referred me to the breast clinic in Cancun. It’s a state of the art facility. If the service you need is not available in Playa or Cancun, they will refer you to Mérida.”

 

The Cozumel Sun.2

 

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