How to Get Health Insurance?

wlae84 wrote:

Are there any sites where permanent Visa holders can get health insurance? Is a cedula required?

www.iess.gob.ec : cedula required, $70 per month for an Expat, with no deductible after three-month waiting period.  Hospital emergency coverage with no waiting period.  Includes dental.

If you buy this government health insurance, consider doing it the way many Expats do:  Keep it for emergencies, and pay the relatively low fees for a family or personal doctor and dentist for routine care outside the IESS system.

If your espanol is weak, you may need a local or a translator to navigate the system.

Normally, sign-up is done online.

cccmedia in Quito

What can I do as far as insurance during the time between I  get my permanent residency and my cedula? I have to be present to get my cedula and my facilitator is 8 hours away. It'll probably be about a month wait between the time I get my VISA and the time I get my cedula.

So I need an emergency insurance during that gap period. I'm looking into expat insurance websites, but I was wondering if there was another solution? I think those sites want 1 year commitments and charge a lot.

My traveler's insurance rep told me that my policy becomes void if I become a permanent resident.

As you're discovering, insurance companies typically are not set up for a one-month subscription.

There is such a thing as travel insurance, which theoretically could be available to you, but posters on Expat.com don't know your health history and so you'd need to do your own research on that.

This is what I would do, based on the fact that the holder of a brand-new residency visa can technically obtain a cedula less than a week later:

1. Have the visa facilitator set you up for the cedula at the time you obtain the visa.  You'll know the building, the small cedula fee, the documents to bring and the date you legally can obtain the cedula.  Then do the cedula part yourself in the absence of the facilitator.

2. Rely on the public hospitals in Ecuador for up to one week between obtaining the visa and obtaining the cedula, for emergency care.  That's the lowest of the three rungs of the EC health system, below IESS and private care.

After obtaining the cedula, you'll be relying on IESS for emergency care provided you use the cedula to sign up.

At the top, I said "this is what I would do," and that was based on where I am and where I submit all bureaucratic paperwork, which is Quito.  Since you haven't told us what cities or towns you and your facilitator are in, nor in what city you are applying for the visa, what I would do may not work for you. 

If you post again looking for assistance, consider telling us where y'all are located and where your paperwork has been submitted.

cccmedia in Quito

wlae84 wrote:

I have to be present to get my cedula and my facilitator is 8 hours away. It'll probably be about a month wait between the time I get my VISA and the time I get my cedula.

If your visa facilitator is far away in the city where you have applied for the residency visa, and you have to go there on the day you obtain the visa, here are two alternatives:

1. Stay in that city for up to a week to obtain the cedula.

2. Make the long round-trip twice, for the visa and a week later for the cedula, to avoid the insurance conundrum and reduce the time before you can obtain IESS coverage.

cccmedia in Quito

1)I'm gonna probably go myself and get my cedula at this end of this week--using a translator. Do I get the cedula on the same day? Or will I have to wait a few days?

2) Are there any better insurance policies than the government one? How much more do they cost? For example, what about this service: http://www.ecuasanitas.info

wlae84 wrote:

I'm gonna probably go myself and get my cedula at this end of this week--using a translator. Do I get the cedula on the same day? Or will I have to wait a few days?

You must have meant "residency visa" instead of "cedula" in the first sentence above, for your questions to make sense.

Historically, there has been a wait of 3-5 business days.  That's how it was one year ago when I got my residency visa during one week, and had to wait till the next week to pick up the cedula.

Apparently, you ditched your facilitator, or you would be asking these questions of that party.  Dropping the facilitator probably became a no-brainer decision given that he or she was eight hours away.

cccmedia in Quito, cedula-holder since February 2014

wlae84 wrote:

Are there any better insurance policies than the government one?....For example, what about... ecuasanitas....

Better than IESS, you say.  Well, it's widely stated that private care (available through private insurance) IS better. 

There are, for instance, anecdotal reports of long waits to see a specialist participating in the IESS program.  We're talking months here.

With private care, you can choose your doctor(s) and make appointments at your convenience.  With IESS, you are assigned doctor(s) and the "medico" who examines you one month will likely be a different one from the one who examined you previously.

Be prepared to pay double or triple the cost for private coverage, compared to IESS.  And unlike with IESS, you'll pay deductibles for most services.

I was with the well-known (in South America) insurer, Salud, paying $240 a month in premium, until I became eligible through a change in the law, for IESS.  Now I pay $70 in medical-dental premium per month.  That's a savings in premiums -- by my math -- of about two grand a year.

Based on your age and health history, your premium could vary, but as I said earlier on this thread, we don't know your history, so you yourself would have to ask for a bid from any insurer.

Unlike Salud and other private insurers, IESS does not have exclusionary rules for pre-existing conditions.

Salud did not cover any part of the cost of my various medications due to such rules.  If a chronic condition kicked up, I would not have been covered.

And you're not necessarily buying any language advantage with a private policy.  With Salud, everything from sign-up to doctor appointment(s) was conducted in espanol.

FYI, some hospitals offer an insurance-type plan, good only at their facility.  If you're going to be mostly in one place, that might be an affordable option. 

As for the company you mentioned, EcuaSanitas:  never heard of it before.

cccmedia in Quito

cccmedia wrote:

wlae84 wrote:

I'm gonna probably go myself and get my cedula at this end of this week--using a translator. Do I get the cedula on the same day? Or will I have to wait a few days?

You must have meant "residency visa" instead of "cedula" in the first sentence above, for your questions to make sense.

Historically, there has been a wait of 3-5 business days.  That's how it was one year ago when I got my residency visa during one week, and had to wait till the next week to pick up the cedula.

Apparently, you ditched your facilitator, or you would be asking these questions of that party.  Dropping the facilitator probably became a no-brainer decision given that he or she was eight hours away.

cccmedia in Quito, cedula-holder since February 2014

My facilitator is really good. I knew it would be harder because of his distance away from me, but I felt it was worth it. So far he seems to have made everything go smoothly. We'll see what happens. I had an option to meet with him last week, but I was really busy and I didn't know that my traveler's insurance would be voided, so I opted to delay it until later when my mom and I could both go.

No matter how good is your facilitator, there is the likelihood of an unavoidable hitch or hitches in the bureaucracy along the way.  That's when having to make an extra round-trip (or more) of 16 hours becomes a royal pain -- especially when it's just to visit an office or sign a paper.

cccmedia in Quito

cccmedia wrote:

wlae84 wrote:

Are there any better insurance policies than the government one?....For example, what about... ecuasanitas....

Better than IESS, you say.  Well, it's widely stated that private care (available through private insurance) IS better. 

There are, for instance, anecdotal reports of long waits to see a specialist participating in the IESS program.  We're talking months here.

With private care, you can choose your doctor(s) and make appointments at your convenience.  With IESS, you are assigned doctor(s) and the "medico" who examines you one month will likely be a different one from the one who examined you previously.

Be prepared to pay double or triple the cost for private coverage, compared to IESS.  And unlike with IESS, you'll pay deductibles for most services.

I was with the well-known (in South America) insurer, Salud, paying $240 a month in premium, until I became eligible through a change in the law, for IESS.  Now I pay $70 in medical-dental premium per month.  That's a savings in premiums -- by my math -- of about two grand a year.

Based on your age and health history, your premium could vary, but as I said earlier on this thread, we don't know your history, so you yourself would have to ask for a bid from any insurer.

Unlike Salud and other private insurers, IESS does not have exclusionary rules for pre-existing conditions.

Salud did not cover any part of the cost of my various medications due to such rules.  If a chronic condition kicked up, I would not have been covered.

And you're not necessarily buying any language advantage with a private policy.  With Salud, everything from sign-up to doctor appointment(s) was conducted in espanol.

FYI, some hospitals offer an insurance-type plan, good only at their facility.  If you're going to be mostly in one place, that might be an affordable option. 

As for the company you mentioned, EcuaSanitas:  never heard of it before.

cccmedia in Quito

I'm kind of surprised. The prices are a lot higher than I thought they would be given what other posts have said about average salaries in Ecuador. I mean if it's gonna be double or triple $70/month then that's much more than I was paying pre-obamacare (before Obamacare I was at $106/month at 31 y.o, then after obamacare it skyrockted to about $300/month) in the US.  So based on the little info. I have so far it would seem that EC doctors make many more times the average salary here than US doctors do in the US.

The conclusion that EC doctors make a lot of money is not correct, so, you're right, you're working off little information.

Because of the law requiring two of my prescriptions to have "recetas especiales" in order to be filled legally at the farmacia, I have to go to a specialist for otherwise normal office visits.

That specialist, Dr. Ney Dolberg in Quito, charges the same fee now as when I saw him under Salud coverage.  (Of course, with Salud, I just had to pay a deductible.)  That's $50 per office visit.

Expats who go to non-specialist doctors can tell you they pay at least twenty bucks less than that. 

Back in Bethlehem, Pennsylvania, several years ago, I used to pay $99 to see my doctor at the clinic for a simple office visit.

cccmedia in Quito

cccmedia wrote:

The conclusion that EC doctors make a lot of money is not correct...

Back in Bethlehem, Pennsylvania, several years ago, I used to pay $99 to see my doctor at the clinic for a simple office visit.

A clarification is in order.

In my Gringo mind, EC doctors don't make that much.  But in terms of the national averages -- and you've seen some of the numbers -- they do much better than the working-class Ecuadorian.

I had two hard-working women cleaning at my condo today, giving it the once-monthly, clean-it-to-within-an-inch-of-its-life going-over.  They scrubbed and shined for about three hours, and collected a total of $25.

cccmedia in Quito

Would you happen to know if IESS allows  month-to-month coverage?

As mentioned, you'll need your cedula to start IESS coverage.

When you begin participating in IESS health coverage, you get immediate coverage for emergency care.

However, there is a 90-day waiting period for routine health care.

Cancel any time by stopping the payments being debited from your bank savings account.  Once you have your cedula, it is typically easy to open a savings account.

There have been anecdotal reports of delays in getting to see doctors -- probably due to shortages of doctors in the system -- especially specialists.  This could make "month-to-month" participation in IESS problematic.

cccmedia in Quito

Here's an informative thread:

http://cuenca-news.gringotree.com/ecuad … insurance/

It provides a lot of case studies  from EC expats on health insurance companies and prices.

A number of people report having monthly premiums far less than the $70/month IESS.

wlae84 wrote:

A number of people report having monthly premiums far less than the $70/month IESS.

As I have understood it, the super-cheap Coopera insurance is or has been available only in Cuenca.

If that's where you are, I say, go for it.

If any readers have participated in the super-cheap Coopera program, we welcome your commentary about it on this thread.  Results, geographical area served, quality of care, etc.

cccmedia in Quito.

wlae84 wrote:

Here's an informative thread:

(thread named removed by cccmedia)

It provides a lot of case studies from expats on health insurance companies and prices....monthly premiums far less than the $70/month IESS.

It seems those exciting "case studies" should be taken down from the Internet.

The survey at that link was from two years ago, February 2013, and a few months later Coopera -- which had offered those super-cheap insurance rates -- crashed and burned.

Here's how it was reported from Cuenca at the Ecuador Living website in June 2013:

"Coopera, which is a Cuenca-based food and financial cooperative, was shut down by (SEPS, an EC government agency) and its assets liquidated....

"Three of the company's officers were arrested and charged with laundering $31-million through the cooperative."

A later report on Cuenca High Life (2014) said that Coopera of Cuenca was not covered by EC's government banking insurance.  An Expat who had attended a city meeting on the possibility of reviving Coopera said investors were "whistling Dixie" if they thought there would be a bailout.

Apparently, there were many Expats in Cuenca who had invested over 10K each in the co-op...there had been a "bank run"...yet many lost large sums.

A cautionary tale.

cccmedia in Quito

There are a lot of reports of private policies having a maximum of $10K-$20K per incident.

Is this enough?

There was a report about the "Michigan Family Faces 42K." There was another one about a tour bus crash.:http://www.dailymail.co.uk/travel/travel_news/article-2848530/Couple-left-16-000-medical-bill-private-hospital-treatment-bus-crashes-VOLCANO-dream-holiday-Ecuador.html

wlae84 wrote:

There are a lot of reports of private policies having a maximum of $10K-$20K per incident.

Is this enough?

Fair question.  The answer is...who knows....

It wasn't enough for the family from Michigan.  The grandfather, however, was 30 years older than you, and your likelihood of needing to make more than 20K in medical payments may be small for a long time.

At some point, you have to compare the premium costs versus the promised benefits, and make your own judgment call.

cccmedia in Quito

That survey was done in 2013. Three of the companies are now shut down and 2 others do not insure gringos any longer. Even the IESS at $62 is now $73. All in all IESS is the best. I have had it for 1 1/2 years now after having 2 of the others before (coopera and anos dorado (coopseguros)) and getting shut out due to govt shutting them down. I have a regular (primary) IESS Doctor at Mt Sinai hospital, my wife has the same Dr And specialist appointments are made by my primary and can be a soon as 2 weeks. Appointments with my primary can be 1 week or less. By the way, the waiting period is NOT 3 months! The period is based on 3 payments. That equates to 2 months and a few days! Figure it out.

Cuenca boy wrote:

I have a regular (primary) IESS Doctor at Mt Sinai hospital, my wife has the same Dr And specialist appointments are made by my primary and can be a soon as 2 weeks. Appointments with my primary can be 1 week or less. By the way, the waiting period is NOT 3 months! The period is based on 3 payments. That equates to 2 months and a few days! Figure it out.

Thank you, Cuenca Boy.  This is the most comprehensive report I've seen about an Expat family using IESS service.

Although this report shows success in Cuenca, we also know that IESS health care in Guayaquil is in need of a major overhaul, and El Supremo has his people working on legislation to change things there.

A new patient with IESS has a choice of multiple dates on which to start making the monthly payments, so the date on which he or she may obtain routine care for the first time may be up to 90 days.

If anyone has IESS experience in Quito that includes encounters with doctor(s), please report in.

cccmedia in Quito

CCC Thanks for the kudos! The dates for paying the premiums are from the 6th of the month to the 15th. Sign up is on line only, so if a person knows this and signs up around the 10th of the month the 3 payments will be done in 2 months plus a few days. 2 days after the 3rd payment is made a person can call the IESS appointment number and make an appointment with a primary doctor. They will ask where you live and  give you an appointment with a doctor at the nearest hospital with an IESS contracted doctor. Specialists are usually at the IESS hospital and those appointments are made for you by the primary doctor on the computer. Also all prescriptions (on computer also) are picked up at the farmacia in the IESS hospital (no copay or deductible). The primary doctor can write your meds for a 30 day supply. A specialist at the IESS can give you a 90 day supply. For refills you can go to window 7 at the IESS hospital and a staff doctor will write you 90 day refills. All information, appointments and prescriptions are done on computers. You only need to give your cedula number for any service, appointment or meds.

I read about our fearless leader doing a surprise visit to Guayaquil IESS and found things not up to par. It seems they had only used up $62 million of a $192 million budget. What?? Cuenca seems to be functioning well. This morning (for example) I had to go in for my tri monthly blood and urine test. As usual I showed up at 7;30 and there were about 70 people in line. BUT! as usual, I was in and out in about 20 minutes. Very efficient!! I am being given "preventative treatment"! how about that?? In the states that is unheard of! After receiving the level of care and total respect, I can say for sure that any expat can be assured that IESS is the only way to go as far as insurance and professional care is concerned!!

In case of any emergency  any place in Ecuador (waiting period also) you will be taken to the closest hospital and treated. If necessary you will be transferred to the IESS hospital when you are stable. This is a big plus especially for us older expats. Just knowing that if you have an emergency you will be taken to the closest medical facility and treated (life saved maybe?) Gives me big peace of mind!

I cant say enough good about the IESS system. It has proven to be the best system I have "ever" had for medical reasons!!

We have helped numerous gringo friends sign up to IESS (my wife is Colombian) all of the above is based on their experiences and comments also.