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