Saturday, December 31, 2011

Cajas Beauty

Parque Nacional Cajas

Up we drove via rented car and driver to the beautiful lakes of Cucheros and Toreadora.  A reduced entrance fee of two dollars and twelve dollars an hour for the chauffer gained us entry into this jewel of the southern Andes.  Our sky alternated between ominous clouds and a nearly Carolina blue sky.

Both are beautiful high altitude lakes in the huge Cajas National Park. It is like Cuenca has Rocky Mountain National Park half an hour to the west. It has 240 lakes and lagoons, and many miles of trails, some of which require a guide. Be prepared, the altitude is 4000 meters or 12,000 feet. In minutes the weather can change from sunny and temperate to cold and windy with potential storms.

Cucheros is the first Cajas turn off only 30 minutes west of Cuenca. A gentle hour’s walk took us around the pristine lake, past the remaining buildings of a defunct German Brewery and over a covered bridge shading a rushing brook. Seven llamas and an equal number of alpacas placidly monitored our movements.

Another half hour west we found Toreadora Lake; it’s a bit higher and wilder. From the visitor center several trails offer a variety of views and terrain. We chose the 90 minute walk around the lake. Tiny alpine flowers were beginning to break out in yellows, reds, and violets. The results of spring rains remained everywhere, forcing detours into moist mossy meadows where the spongy turf met our feet like a relaxing sponge.

Ahh… we shall return.

Thursday, December 22, 2011

Trip to Azogules and Biblian

One of the couples in the Bible Study group took us to Azogules and Biblian one day recently.  We visited two old Catherdrals, both of which were high up in elevation.  Our dog, Stover was invited and then even allowed him inside the last Cathedral we visisted in Biblian.  There's a picture below of him at the altar repenting for his barking heard everywhere due to the acoustics!

We finished off our trip with a delicious lunch at Uzshupud.  Now there's a place you want to not only have lunch, but consider a night or two stay in their resort.  It's just lovely!  And we had a wonderful time!

A most enjoyable day trip !



We are Gringos!  No, that is not an insult. It may be in Mexico, but in Ecuador gringos are simply foreigners who are not Latin. Gringos include Americans, Canadians, Australians, and Europeans.
We are bigger, light skinned, and richer. It is fun being a “big Kid” at 5’-9”. Even Sue is mas alto than many, especially the native, Quichua, who are under five feet. Children enjoy looking at us and interacting. It’s fun to carry some candy for surprises. (I make eye contact with parents first for approval).

 Under the subtle class structure, we are immediately near the top. Curiously, we are unaware at first, because we tend to treat everyone equally. Men are most respected in the male dominated culture (see “Culture”).

You will soon discover “gringo pricing” especially with taxis, and small merchants. After a while I learned to give taxi drivers exact fare rather than ask. Short trips, under 6-7 minutes, are $1.50. Fares increase with traffic jams, sometimes in rain, and Sundays. Always start with buenas dias and depart with muchas gracias. Many drivers do not know how to read a map.

Please do not come to Ecuador expecting the create a American enclave. That created problems with locals in Panama and Costa Rica. If you move here, plan on learning some Spanish and adapting to the culture. Slow down, respect their relational priorities, remain flexible. Ecuadorans respond much better if you demonstrate a sincere desire to share their culture and language. Treat them as the equals they are.

Gringos initially tend to overpay for services. This disturbs the local pricing mechanism and creates unrealistic expectations. Many gringos moved here on a shoe string budget and do not want artificial inflation!  Besides, who wants to be viewed a rich and stupid?

My most memorable example is the routine purchase of a queen size bed frame. I sold our simple frame in NC, since wood work is inexpensive here. My quest morphed into a gringo custom job, at six times my expected price. Cuancano beds are a scant few inches off the ground, so our need was exceptional. Maybe there is a secret union here, since our first 5 bids were for $350.  What?... for an unfinished 2X4 bed frame! Finally, we asked our decorator, who had worked in NY for many years, “just a simple frame for $100 or less”. We settled for $140, over a week’s local pay.

Upon arrival in Cuenca, visit the Gringo meeting places for English conversation and orientation.  In Centro, visit beautiful Calderon Park with the Nuevo Cathedral  (1870) and  Viejo Cathedral (1600's). Usually gringos are present here or in the adjacent RambiPamba restaurante.  Centro historic district restaurants, California Kitchen and Aussie Kookaburra CafĂ©, are initial gringo favorites.  And try the symphony, usually on Thursday or Friday nights. Government sponsored, translation – free, which are faithfully communicated on “Gringo Tree” email.

Finally, “expat” does not mean I lost my patriotism, but “expatriate”- someone living outside their native land.
                                   Come join us in Cuenca,

Sunday, December 18, 2011

The Gaithers - their first year in Cuenca!

Simply click on the video below and we'll take you through the highlights of our initial year here in Cuenca, Ecuador.  There are many memories, and also, there's a sense of awe to realize how much has truly been accomplished in this first year.

(Unfortunately, if you view it full screen it will be a little fuzzy though the original is clear)

But...hope you ENJOY!

Saturday, December 17, 2011



Here, as everywhere, relationships are the focal point of life, the source of joy and fulfillment.  They may also be a source of frustration.  So let’s share some principles with an Ecuadorian twist.
Latinos are mostly Catholic, family oriented and warm.  Sunday is definitely family day.  And by family we include parents, children, cousins, nephews, nieces, grandfathers, grandmothers and sometimes, their friends.  The day is usually dedicated to the familial group with lots of food, entertainment and children. 

If you are fortunate to be invited, expect it to be all day or much of it.  You will be an honored guest.  Frequently, this may involve a beautiful trip to the country to the family farm acquired by their abuelos (grandparents!).  Ask questions about the family history, children and activities. Enjoy their home style meals!

Working relationships may be entirely different.  Cuencanos have their own way of doing things and their own way of managing time, tools, and priorities.  Families trump work commitments.   Mother’s Day may involve taking several days off work unannounced.  Work may be done without a great deal of planning.  You know, of course, that everything changes, so flexibility is a way of life.  (Something I must continually learn.)
Remember this motto:  “Blessed are the flexible, for they shall not be broken when bent.”

While warm and friendly, Cuencanos dislike being told how to do their particular trade.  Americanos feel we are paying for the work and have the right, even the responsibility, to direct it in a personal way.  Be careful.  Your suggestions may save time, but they want to save face.

Beware also that projects, materials, and timing may be subject to constant renegotiation.  If you get a firm (turn-key) quote, some material costs may be added later. Gently restate your agreement. Get it in writing if significant sums are involved. Workers may arrive without the necessary materials.  They may expect you to go get them or pay them additional monies. My problems in the US with contactors while remodeling a dozen homes were even more numerous, but different.
Always be cautious to avoid negative words and attitudes.  They rarely have a positive result.  And, it seems that everyone in Cuenca is related to everyone else.  Reputations and honor are very important to all parties.

Gringos that come to Ecuador are a bit adventurous, eccentric, and fiercely independent.  Most of us are well-traveled, politically informed, and financially proactive.  Some are financial refugees, politically dissatisfied, or estranged from family. 
Gringos are highly motivated to establish a foreign “family” during their first year in Ecuador.  Newcomers are open, available and friendly, anxious to gather information about their new country and culture.  We love to “pay it forward” helping others as we have been helped in our transition.

Finally, people are mirrors. We will have our attitudes and actions reflected back to us. And we  will reap what we sow. Our transition is a wonderful season to improve our way of life with others and within ourselves!       
Rejoice and enjoy,   Gary

Monday, November 14, 2011

The Color Purple Event - Final Recap

The Color Purple Event - Final Recap

  Right after the Color Purple Event, October 4, 2011, we were scheduled to go back to the USA for one month.  During that time, I had the privilege of seeing my aging 89 year old mother who lives in Alabama and a busy time in North Carolina.  So needless to say, there was no time to update
 a final recap on the the Color Purple Event until now...

Below are pictures from the event that gives an idea of the day.  However, I want to start with a wonderful story with one of the staff members of SOLCA, after we delivered the proceeds to them several days past the event.

An appointment was made for us to see the Director of SOLCA on the Wednesday, following the Color Purple Event.  We enthusiatically carried with us, $1,360.00 as a gift to the pediatric's department of SOLCA for children with cancer.  We received a receipt for the donation.

One hundred twenty five ladies (and a few men) attended the event.  Villa San Carlos, a beautiful event center here in Cuenca, graciously discounted a delicious lunch for us (as shown above).  The lunch included tomato bisque soup, mixed green salad with crumbled cheese and a yummy dressing layered on top of Branden's "famous" bread, cookies, a special ice cream treat, and tea - all for $5.00!

The ticket price was $10.  The 125 lunches were paid for that day, and with only a small printing cost for tickets, programs, paper, etc. we were able to give the gift as mentioned above.  We sold close to 200 tickets which again, afforded us the opportunity to have a greater gift to offer SOLCA.  This is also because of the "no shows," and there were some who bought tickets as a donation to SOLCA without attending the event.

Now for the story...

The Director of SOLCA, Dr. Raul Alvarado Corral, second from the left, shared with us that SOLCA depends on gifts and support of people so they can meet many of the needs children with cancer.  The families are not able to pay for the costs of treatment and the child's stay at SOLCA.  Also, some of the parents are not able to stay with the children due to travel costs of those not living here in Cuenca.

The lady on the far left shared with us (after we presented the check to the Director) that just that morning she had gone across the street to the Pharmacy to check on how much they owed on their bill for medicine.  It was about $500.

She said the thought came to her mind she did not know how they were going to pay the bill and she said a prayer.  Then she looked at me and said, "Now we can."  And then, with tearful eyes, she looked up to convey a thank you to the One Who provided.
This was a special moment for us, especially when we were leaving, as we saw her walking across the street with money her hand - to pay the bill!

Everyone who worked with this event donated their time, talents and resources.  We all bought our own tickets as well.  The door prizes were given from the community as well as chocolates, flowers,and a special table arrangement.  Interpreters from Abraham Lincoln School volunteered their time to support anyone who needed translation at their table.

A huge thank you to these and all who attended!
 The Color Purple Event Decor - October 4, 2011

Angie Barnes, (co-chairman) and Sue Gaither

Tania Sarmiento, (left) General Manager Hotel Inca Real, Patricia, and Connie McDonald (center - wife of Bill McDonald - CEO and President Unsion Television) and our lovely Emcee!

Sandra Flores on far right of Villa San Carlos -
On left, Eulaliadole Sinchi - volunteered to greet ladies at the door
Notice the beautiful table arrangement donated for the front table at entrance

Angie, enjoying giving out door prizes

Monica of Artelier, and a snapshot of other ladies with
their purple attire! Most attendees wore purple!

Dayana and Marcela Reyes (sisters) and Ecuadorian Beauties!
Dayana (left) gave her time to interpret for speakers and door prizes!

Friday, November 11, 2011



                Asheville, NC - Oct 2011. Waiting for the doors to open at the S S  office, I surmised that most of the middle aged scraggly looking crowd was seeking very early retirement via a disability claim. With jobs scarce in this government-induced great recession, who can blame them? My 9 am appointment was planned to avoid a long wait during my limited time in the US. It worked! After the multitude took their seats, I was invited to be the first one at the claim window.
My first words set my surprising objective, “my goal is to obtain an original signature on a government form or letter stating that I am eligible for retirement benefits.”  Silly me.  The clerk promptly informed me that no one signs anything. He generously offered to sign a printout (useless for obtaining an Ecuadoran visa). Printouts can come off anyone’s printer. And I needed to obtain a S S card. Mine disappeared 25 years ago. The required form was the one that the reception lady said was not necessary.
OK. Let’s determine the benefit amount first. He was very good at that. Again, I had done my homework: internet research on gov’t sites, blogs, years in financial product marketing. Earned income was going to be my issue. We are allowed about $1300 a month in 2012. Half of earnings over that had to be paid back to SS. My benefits would be recalculated at my “normal retirement” age of 66.   However, only the highest 35 years counted – I am way beyond those years. So any SS money paid back went to gov’t money heaven. No recalculation needed.
Yes, I had done everything legally allowed to reduce my future income stream from many years of long term insurance sales residuals. Silly me, I had yet to learn gov’t  math. Example 1.01 equals 2 when calculating equivalent months of excess earned income. No, Gary, you do not refund half of excess earnings for each month when filing the annual IRS 1040. SS uses the entire annual estimated excess earnings divided by monthly benefit to determine months of excess. So calculation is not refund half of excess for each month, but to determine months of zero retirement checks. Does your head hurt yet?
Result: Rounding alone cost me a month’s benefit next year. And since I had over two months equivalent excess, I may lose all of three months 2011 benefit. Yes, I can file for benefits starting October 26, but the checks will be for zero and a LIFETIME 22% reduction. Ok, I will wait until my 63 birthday on January 26 to claim benefits. We requested a letter from the District Director in St Louis. I may get it in two weeks. I knew SS pays in arrears, but they also take another month to process the check. So I will get 80% (early retirement at 63) of normal retirement starting in January. My first check may be in late April. I must refund in advance for a year’s excess earnings. Rounding and timing!
The SS letter: Prompt, confusing, self-contradictory, robo-signed form letter on letterhead. Cost for four Fed Ex mailings, Raleigh, NC Apostille stamp, and Washington DC Ecuador consulate was nearly $200. The first two paragraphs:
“We have approved your application for retirement benefits. Your entitlement date is January 2012.”
“We cannot pay you because or your work.”

The next paragraph stated my future monthly benefit rate, etc. Now how is a native Spanish speaker in Quito going to interpret all that?
I signed directly below the Dist Director, had my original signature notarized and sent Fed Ex to NC Secretary of State. Whew, they apostillized it!
Now many of you are asking “WHY?” would I apply early, losing 20% of my benefits. Yes, I know the math says if I live over early 80’s my lifetime benefits are greater if I apply at 66. The obvious  Answer: Two governments and inflation. The resident visa requirements in beautiful Ecuador are constantly changing, and the US is becoming unpredictable as it moves to socialism. Oh, and what do you think a dollar is going to be worth in 10, 20 years?
Lessons:   1.apply 120 days in advance  2.Beware of rounding and timing  3. Do not earn much money in early retirement  4. beware the government.
                                Learning by doing,

Tuesday, September 27, 2011

The Color Purple Event Update

The Color Purple Event Update

We are so grateful for the wonderful response we have had to the Color Purple Event. 
Thanks to our sponsors who graciously purchased whole tables. 

Thanks to those businesses who donated the door prizes. 
So many have generously given their time, talents,
and resources to make this event possible.
Many hours have been given by volunteers who have helped
to organize and with ticket sales.
Everyone has donated their time.  With the exception of the discounted cost of the lunch and printing costs, SOLCA will be presented with the proceeds of $1200 to help these children with cancer.  We hope to have the presentation televised after the event.

125 ladies (and a few men) attended the event on Saturday, October 1.

Pictures will be posted soon.

We are grateful.  Thank you.

Thursday, September 22, 2011

The Color Purple Event

Evento El Color Purpura

The Color Purple Event

We never imagined that within 9 months of living in Cuenca, an event would come together what we have called “The Color Purple Event.”  Yes, complete with television interviews, newspaper coverage and many sponsors!
How did this happen?
Our transition began last November.  Imagine selling your home, wrestling everything into storage, Gary having surgery. Then gathering international papers for “Stover,” our mascota , to become “Ecuadog.”  And “900” seemingly other items.  By the time we arrived, it took a month just to catch our breath. 
Then holidays  – Thanksgiving, Christmas and New Years.  While Ecuador does not celebrate our Thanksgiving, we certainly had a celebration.  By January, we had established friendships. Our relationship with Unsion Television resulted in a room at the station to conduct our first weekly Bible Study.
In March of this year, we finally obtained our Cedula. 
We had already planned a trip home to the USA to pack a container.  We decided  we were called to make Cuenca our home.
Since January, I’ve been purchasing bread each week at the charming Villa San Carlos located on Remigio Tamariz.  Why there?  The chef and owner (along with his wife, Sandra) bakes what he calls “almost” sourdough bread each week.  We found out about the bread through our friends, Jim & Angie Barnes.
As the weeks turned into months of going to get bread each week, I found myself growing with an idea inside my heart about a ladies luncheon to be held at this beautiful Villa San Carlos.  In the States, I had often been part or even coordinated ladies events and retreats, so this was not a “foreign” idea.
After purchasing an apartment in May, I still held onto the possibility of doing something – but for a number of weeks we were held “hostage” to remodeling our apartment to live in and receiving our cargo.  Next, the unpacking and all that “jazz.”  Then, a young Gringa house guest from the USA for two months this summer.
So how, with all that going on, did an event finally come together?  Don’t know except it just seemed right – and with a lot of prayer and finally sharing it with Angie Barnes, I took the “plunge” and committed to doing it.
Where is it now?  It is happening next Saturday, October 1, 2011.  To date 120 tickets have been sold.  Generous donors have supplied a dozen door prizes – and the event has received two newspaper stories and a television interview.    The profits of the ticket sales will be going to SOLCA – the pediatrics department for children with cancer.
SOLCA will be presented with the proceeds gift.  They will be giving more information about SOLCA and the ongoing needs.
Also, we will have door prizes, a time for the ladies (both Ecuadorians and Americans) to get to know each other during lunch, recognition of sponsors and businesses.  We will enjoy Ecuadorian music and a scrumpuous lunch.  Sue will bring a short message on Esperanza/HOPE, closing with a beautiful, powerful song, "Will You Marry Me?"
This could not have come about without a “lotta” help from friends:  Angie Barnes, Sandra Flores (a sweet Ecuadorian  partner!), Jane Golden and Claudia Johansen.  Wow!  And then we’ve had table sponsors (10 people):  Joanna Cox, Charles & Kathleen Barrett, Jane Golden, and others.  How awesome!
Below is a flyer that was posted in businesses and elsewhere in Cuenca.  There are many stories of how it all “fell into place.”  Yes, it’s the first “The Color Purple Event” to be held in Cuenca, Ecuador. 
Second “Evento El Color Purpura” in 2012?

Tuesday, September 20, 2011

Homeowners Insurance - Ecuador

       Property, Casualty & Liability Insurance 

Now, let’s consider the largely ignored insurance coverage in Ecuador – homeowners and liability. Yes, our apartment has brick walls and concrete walls and floors. Try hanging a picture on these walls! Most of us have little fear of fire and pay cash for our homes. Mortgages are expensive (10-15%) and rarely cover over half the value of homes. So insurance is rarely required. Most homeowners “go naked.” Apartment associations usually have coverage for the building (elevators, structure, common areas) amounting to less than half the property value.
? However, who can sleep at night if our uninsured home is empty when we visit the states?

 Some of us have noticed the tremendous increase in “earthquakes, famines, wars and rumors of wars”, to use a Biblical phrase. And we live near the “ring of fire” volcano and earthquake zone of the Andes. Yesterday our hometown of Asheville NC experienced a tremor!
Now the usual problems arise. Who can you trust, especially when you do not speak the language or understand the subtleties of the culture? Will the insurance carrier pay the claim? How do we obtain coverage at reasonable cost?
You know I would not be writing this wonderful, informative article if I lacked an excellent answer (drum roll^^^).
Presenting… the group with the highest rating in Ecuador, conducting worldwide business in 53 countries.  The “ACE group” is AAA by Ecuador’s Bank Watch Rating and AA- by S & P (same as the good old USA, but that’s a long foolish political story). My agents are Daniel Gonzales who speaks excellent English and Pedro Valdivieso. Pedro’s assistant speaks English and his wife speaks German and French. And his brother is a plastic surgeon – need and little tuck or enhancement?

Quickly now, what coverage did we obtain?    OK… read fast:
Earthquake, volcanic eruption…fire,  lightning, smoke damage…windstorm, hail, rain, flooding…burglary, robbery…explosion…vandalism and malicious mischief…riot, etc.

Optional coverages:  Liability (our pipes rupture, damaging neighbor’s walls) , contents,etc…glass breakage..water damage.
Deductibles vary with the type of loss here, rather than one comprehensive deductible. You know, the greater of x% or y$ per incident. You understand by now that I am frugal. Our  $100,000 coverage has a premium = $ 39 per month.
Coming soon, another exciting topic - automobile coverage.  Hang on,      Gary

Tuesday, September 13, 2011

Medical Tourism

            Medical Tourism
   Or… how to enjoy a free trip to Ecuador 
Our first trip to the Andes included Quito and Cuenca in June 2010. We fell in love with Cuenca’s charming people, old world architecture and gentle climate. We had learned to reimburse our travel costs during previous trips to Montevideo, Uruguay. Bloggers were also a prolific source of information.
Like many self employed folks we saved premiums by having a $5,000 deductible on our U S Blue Cross coverage and using a HSA for tax deductible reimbursements. So we were out-of-pocket on most medical, dental and vision expenses. Now let’s see how many interesting experiments we can complete in a few days.
                                              Ecuador Cost          USA approx.        
 1 .Vision exams-both of us           $20 x 2 = $40                          $  150 
2. Bi-focal lenses –Gary only                          54                               150
3. Specialist office visit                  $ 25 x 2 = 50                               400
4. Bone density Scan-GE                   40 x 2 = 80  Just like at home  240
5. Ultra Sound – neck                                      36                              150
6. Lab CBC, calcium, parathyroid, Vit D         52     All is well          200+
7. Meds                                              11 x 2 = 22                                80
8. Massage – ahhh                            15 X 2 = 30   Discount for 2     130
9. Manicure (why not?)                      5 x 2 = 10                                 30
10.Haircut – Gary (a risk?)                               5    Looks great!         15
                Totals                $ 329  Saving covers airfare  $1,545  

We met some very interesting and friendly locals.  And delighted in many delicioso meals. 
 And we learned of their culture. Yes, you could enjoy similar savings in many countries in Latin America or Asia.
       Don’t just be a tourist… Be medical (and cultural) tourist!     
                                                                            Rejoicing,   Gary

Monday, September 12, 2011

Health Insurance - Coopera

                  Health Insurance – Part III
Medical care in Cuenca is excellent.  Sue and I have enjoyed friendly professional care from specialists, dentists, opticians, labs, and pharmacies. A trip to the doctor also no longer requires a degree in medical billing and coding to understand insurance coverage. And all at a fraction of costs in the US.    But, we are always looking for new ideas and further savings.
Our Coopera membership gave us excellent fresh organic fruits and veggies as described in our December blog. They also function as a credit union and now offer a health plan. So, in June we signed up for the health plan for $2.62 monthly drawn from our account. No handouts or colorful brochures were available, so we’ll figure it out later. We have three month waiting periods for many services, so when the student is ready…an English speaking guide will appear.
Gringo grape vine tells us about Cuenca Referral Network (dot com), so we sign up as associate members. Thanks, Brian. Their site provides a link to Coopera’s. Can this be true?
Office visits for routine medical are two bucks.    Ditto dental. Reimbursement of medical costs (up to $400), lab and drugs is at 80%. Yes, even hospital care…after four  monthly payments of the grand sum of $2.62. There is only one way to know if this is true and functional...
 So, off we go to the tiny town of San Joaquin, located half a mile east of the largest Coopera market. The road is under total reconstruction, so a short walk from the highway is required.    TA DA!      Hidden away off the dirt path is a modern beautifully landscaped traditional white building with tile roof. Financial offices are in front; medical offices are behind the rear courtyard. Juan speaks excellent English and  helped me with a 10.5% CD.  Dr Pena provided my exam also in English. And Veronica cleaned my teeth. Total cost was four dollars for pleasant and efficient care!  We really enjoyed these friendly Cuencanos.
Oh yes, my cuerpo Jubliado  required lab tests and a medication for about $25 each. I chose Monte Sinai three blocks from our apartment off Avenida Solano. Did you know a 10% discount appears if you display a SuperMaxi or Monte Sinai discount card (Chamber of Commerce members)?  And our 80% reimbursement will be posted to our Coopera account next month.
     Life is tough… then you move to Cuenca!         Rejoicing,  Gary

Tuesday, August 23, 2011

Health Insurance Part II

         Medical Insurance in Ecuador – Part Two
                     Policy We Purchased & Why
We may be typical of healthy North American Expadorians nearing retirement, so here is our thinking. I am 62 and Sue has fewer laps around the sun (late 50's). We take no serious medications nor have pre-existing conditions. Economy, some US coverage, quality of carrier (and agent), and continuation past 70 are priorities.
Policies with several agents were considered. Now for the boring, but important details by insurer.
Pan American offered a high end international policy with full US coverage at US medical cost reimbursement within their US network. Unlimited maximum coverage. However, cost was over $600+/month. Since our annual time in NC will be well under the 90 days allowed by our Cedula, we will skip the nuances.
Best Doctors offered a similar plan.
Humana offered a tempting variety of plans which changed by the time of our purchase decision. Policies and prices change here like in the fast moving US marketplace. However, you had to buy the expensive underlying "first dollar" coverage to be eligible for the catastropic coverage.
Salud won us over with a combination of features and policies. Their separate cancer plan has no deductible, continues in force throughout our lifetime, with unlimited maximum coverage. Cost $17.50 monthly apiece. So we can live to 100 and get inflation proof coverage (unless they change the policy).  You know, nothing is guaranteed forever!   A six month waiting period applies before coverage kicks in.
We skipped the first dollar, small co-pay plan that would cover the first $11,000 of claims due to the cost and our risk tolerance.
Our final choice was a $10,000 deductible with $128,500 in coverage with $55,000 accidental death insurance. Total premium for us both is $98/month. Coverage is reduced to 30% at age 70. Who knows what Medicare or private care will look like in even a few years?
Yes, a waiting period of 3 months for hospitalization; immediate coverage for accident or emergencies. And you may use any hospital. US coverage is paid at Ecuadoran medical costs (20% to 40%  US costs) - a common provision in Ecuador.

We may later add a small first dollar plan to assist in the first $10,000 in claims exposure. Meanwhile, office visits average $25 in Cuenca.
Future postings:
* A new plan offered by Banco Pichincha and Santa Ines Hospital
* Coopera's new small claim, first dollar coverage for $2.62 in monthly premium
* Homeowners coverage; earthquake, theft, etc.
           Salud,    Gary

Friday, July 29, 2011

Health Insurance

            Medical Insurance in Ecuador – Part One
                          Basics and Background
My twenty years in North Carolina medical insurance sales passed very quickly amid constant government interference, regulations, and politics. I remember the basic considerations well: Deductible, co-insurance, co-pays, networks, exclusions, pre-existing conditions, underwriting at issue or at claim processing, preferred rates, maximum coverage per year/lifetime, company ratings, age pricing, history of premium increases, and most importantly agent integrity. And then there is taxation/deductibility, health savings accounts. Group coverage has several additional considerations.
Ecuador has interesting twists on many of these issues. They use waiting periods and broadly defined pre-existing conditions due to the difficulty of obtaining physician records of medical history. The US Medical Information Bureau (MIB) for sharing claims history does not exist here, so underwriting (medical history review) may occur after the claim is submitted. Surprise!
Baby boomers are uncertain of Medicare’s cost cutting in the future. A quick return to the US may be impractical for many medical conditions. Quality is excellent here, but some procedures and drugs may not be available.  Policies often end at age 70 or become dramatically reduced. And what about “long term care”?   Then there is medical inflation.  Oh well, we cannot eliminate all risks!
Policy design is quite different in Ecuador, due to different considerations of family economy, culture, social security, and entitlements. Medical records have lesser importance in a low litigation society. And a cash-based society expedites care and eliminates much bookkeeping. Care delivery looks like the “good old days” in North America. Rarely do we encounter long waits with clip boards/laptops, medical transcriptionist, holdup or billing/medical records staff.
Bi-lingual multi-line agents with understanding of US customs and expectations are rare in Ecuador. Maybe this blog will help!
                        How to Shop Health Insurance
Since my experience is limited to the Andes city of four rivers, I’ll start here. Pleeease, folks, give me your feedback on any errors or omissions. As usual, check more than one source!
Shop a variety of agents, policies and companies. Get referrals. Tell your prospective agent exactly what you are looking for and your premium range. Ask several times and be patient. Will the agent help with claims? Do they maintain office hours? Expect clear and definitive answers – do not be rushed by the language barrier.
Questions to ask your prospective agent:
            How long in health insurance business?  Companies represented?
            Will agent help with claims process?  Office staff and hours?
            What is Company size, rating, etc?  How long in health insurance in Ecuador?
            Waiting period for office visits; hospital admission?

Hospital network required. Out of network % covered.
             Underwriting (medical review) requirements?
Guaranteed renewable? (can policy be cancelled
Does policy end or reduce at age 70 or 75?
Residency required?
             Is a separate cancer needed (lifetime coverage, unlimited claims)?
Coverage in US, other countries. At Ecuadorian costs or US
Definition of "reasonable and customary" costs for reimbursement?
Definition of  pre-existing?
Additional International Policy questions:
Maximum limits for major illnesses vs costs in EC and US
Policy issued in US or EC (under EC or US law)
How long is business- in what countries?
Next week:   What coverage did we purchase and why?
                          Salud,     Gary