Ecuador Health Insurance: Private vs. Public IESS – EXPLAINED (2021)


– Welcome to Live Abroad Now. Today we have a very special guest. – Yes. Carlos Ramirez fromBlue Box Insurance stopped by to tell us all about thedifferent types of coverage and costs associated withprivate health insurance, as well as the publicIESS plan here in Ecuador. – Before we dive in, if you’re thinkingabout moving to Ecuador, punched the subscribe button. Ring the bell please, because we can show you how. – Holla Amelia and JP.Thank you so much better toinvite me to your situate. It’s my pleasure to be here. My name is Carlos Ramirez. I represent to Blue BoxInsurance advisor from Cuenca. We operate in insurancefor almost 10 years and we are now planning foropening a brand-new part in Manta. And it’s my pleasure supposed to be here with you. And let me know anyquestion about insurance policies. It’s my pleasure supposed to be here. I’m still working withdifferent fellowships, different insurance companies. We represent virtually 20 insurance companies. If we consider health insurance, automobile coverage, homeowners or different kinds of insurance. We represent virtually 20 insurancecompanies here in Ecuador and the company that werecommend you will depends, what kind of insuranceyou are looking for.If you are looking for healthinsurance, how aged are you? If you had pre-existing conditions, all that information is importantto prepare the best excerpts but we represent differentkinds of insurance companies and we are able to recommend you different ways to be completely should be included in Ecuador. Let me start explainingyou about health insurance. In Ecuador you have twooptions for health insurance. The first option is the IESS. The IESS is the government insurance and the other way to be covered for health insurance is theprivate insurance companies.We have seen in Ecuador 28 health insurance companies that proposal different kinds of coverage. With IESS, what’s importantto consider it with IESS. You will need first your Cedula. You can’t apply to IESS without a Cedula. And to get your Cedula, you are required to a certification from a private insurance company and then you can get your Cedula. Some people compound projects. That’s possible very, for example if you are a person that hasa pre-existing conditions you need consider thewaiting periods to be covered with the preexisting conditions. In the private insurancecompanies is commonly two years. But if you have preexisting conditions and like big coverage before two years, you can get the IESS. The IESS is only threemonths waiting period for pre-existing conditions. For these considerations, some people use IESS like a major medical plan for major things forsurgeries and a basic plan for example, from theprivate insurance companies to be able to use private health services in clinics or buy your medicinesin different pharmacies. Because if we consider how it runs, the IESS is a closed network. The IESS never will reimburse you money.See if you has only IESS you need try to use the public services, the public infirmaries. They will out authorizeyou to get medicines only from the public pharmacies. That’s the main difference between use IESS or usethe private guarantee. The private insurance is more flexible in where you can go to to be covered in. For example, you canchoose your own doctors your own clinics, your own pharmacies. You can compensate your medical expenses and apply to reimburse you. That’s the main difference between use IESS or use aprivate insurance company. Let me explain you a littlebit about the coverage. The coverage with the private insurance and the coverage with the IESS. The IESS is important consider that they will pay for all kinds of medical expenditures but only in his own networkin the public hospices. Then what kind of coverageyou will get from the IESS; remedies, surgeries, whether it is necessary to planifysurgeries, you can do it. And the waiting periodis only three months.With the private insurance companies the waiting periodsare a little different. You has a waiting period fordoctor appointments, one month. After one month, you will be covered in the private insurancewith doctor appointments. Three months to planify surgeries or the hospitality coverage. After three months if your doctor suggests to you any surgerythat’s not an emergency, you can do it after three months. Emergency in both programs, 24 hours. And the waiting period for pre-existing conditionsis the most important and probably is the maindifference between these two programs because in the private policy, you has two years waiting period for pre-existing conditions.And in the IESS who has onlythree months waiting period for pre-existing conditions. It’s important to knowhow manipulates both coverage because the IESS will pay for medical overheads onlyin his own hospitals. Sometimes when you goto the hospital in IESS and they can’t admityou in the IESS hospital they will send you to a private clinic. That can happen too. But all need to bepre-authorized for the IESS. With a private coverage is more flexible. You can choose your doctors. You can go to wherever you want to go to get your medical assistance. And then you can apply toreimbursement is more flexible. With the privateinsurance you has 90 days. That’s important. You have 90 daytimes to submit your contends. That’s a difference betweenthe coverage in the Regime extremely because I is a well-known fact that in theStates you can send the proposals for one year during the whole year.Here, you have three months. If you send the greenbacks after three months not will be paid for theprivate insurance companies. That’s important to consider too. Let me talk a little bitabout the deductibles because it’s a significant difference with IESS and the private assurance. With IESS you doesn’t have adeductible is zero deductible. With the private guarantee will depends what kind of plan you are looking for because we offer a higher quantities of coverage with higher deductibles. For example, a strategy announced, the Major Medical Plan that will cover you half a million dollars with 5,000 deductibles, andthe premiums will be cheaper.The other alternative is highercoverage with lower deductibles, for example $ 100,000 coverage per occurrence with $180 annual deductibleis another option. A smaller strategy with smallerdeductible is possible more, for example, a proposal that willcover you $6,000 per occurrence with $100 annual deductible. In the private insurance will depends what you are looking for. But in the IESS, youdoesn’t have a deductible. You doesn’t have a co-pay. The co-pay is important extremely because normally in the private insurance you will be covered upto 90% in the network and 80% out of the network. In the IESS , no co-pays no deductibles like a JP say in theory because it’s reallyimportant to consider that the IESS offer that kind of service but many times doesn’t work correctly. For this reason. It’s a good alternative. Get IESS with a private guarantee just in case that doesn’t work correctly IESS you can use your private insurance.I has many costumers thatcombine these two schedules and they start a medicine for example in the private guarantee. And then they ask to move to IESS to continue with thetreatment, you can do that. That’s important to remember very. Okay. Let me talk alittle bit about rates. The tolls that determinehow much is the price for the insurance. Let’s just start with IESS. In IESS when you makea subscription to IESS the best way to enjoy theIESS is like voluntary.What that intends not willdepends of my incomes. For example, I am an Ecuadorian intermediary. If I has an income of $1,000, I will offer 17% of my incomes. But if you are an expat and you are going to subscribe to IESS you need choose theoption that say voluntary What say voluntary youwill pay considers the minimum income inEcuador that now is $400. Then your fee can be inaround 72, $74 per month, for IESS. With the private assurance can change because the private insurancewill ask you for your age for your pre-existing conditions. If you are a smoker, differentthings that can change the rate and the premiums. But to give you an ideahow you get a coverage, let’s see let’s say $100,000 per incident with a lower deductible ,$ 180 annual deductible for a 65 years old person can being around $220, $230. Now what you can do in the private service you can combine private assurance. For example, you can use a major medicalplan with higher deductible. Let’s see, let’s say a $500,000 coverage with 5,000 deductible. Then the premium will be less for 65 years old can beingaround $70 for that kind of plan. But if you like be coveredin a small procedures you can combine your major medical plan with another smallerplan, call it “Vida Buena” one of or four programmes thatwill extend you up to $ 6,000. Then what’s the reason tocombine these two plans.The payment for this smallerplan is only $ 39 with 20 cents. No thing your senility, $40, let’s say $40 plus $ 70 from the major medical with $110, $120 you will be covered upto half million dollars with the private insurance companies. And like I told you with the IESS you can choose the voluntary payment and you will pay around $72. Then IESS can be combinedit with the basic plan too and you can use IESSlike a major medical plan and be taken into consideration for the basiccoverage for the basic plan.And IESS more is possible blended designs. That’s a good way tobe completely embraced. You can save money because if you remember in my first example, themonthly fee is gonna be 220, 230. If you compound twoplans can be less money. You can save money andbe completely treated. Okay, let’s talk alittle bit about assertions. The amount claimed in the privateinsurance companies need to be sended amaximum in 3 month. Let’s see, let’s say Ihad an emergency today. I have three months to send the statutes to the insurance company and apply to reimbursement. It’s important try to send all the statutes before the three monthsor probably at the end of the second monthmaximum because sometimes the insurance company canask you for more substantiates. If the insurance companyasks you for more reports the time to present all thebills is the same three months. You find, it’s really important. Try to submit the billsas soon as possible. Please consider that if you hasa private insurance coverage emphatically you will needreimbursement forms.If you already are insured with any private insurance company, take care of the formsthat you will need present to get the reimbursementfrom the insurance company. And with the IESS is different because the IESS will giveyou directly relief. You need go to the IESS hospitalsor the public hospitals. And if you remember, you’re not will compensate co-paysdeductibles or monies. They will pay for all directly and you not will need reimbursement kinds. That’s the main difference. With the private policy, you will need reimbursement anatomies. You will need your proposals. You will need prescriptionsto get the reimbursement. But of course, if you are working with an assurance advisor, like with our department ispart of our profession help you to submit all these documents. It’s important to rememberthat if for any reason the private insurancecompany, disavowed your contend that not will be the last decision. You can get a second opinion. If you are working withan insurance broker the insurance broker can report to “Superintendencia de Compaas” about your assertion and the “Superintendencia de Compaas” will support all thedocuments and will strengthen if it’s a refuse of claim or in many times theyorder to pay the claims.We has countless repudiated demands but we apply to “Superintendencia” and finally they offer. They pay for the claims. That process when you hasan administrative claim with an insurance company, witha private insurance company and with not is likely to be, immediately. Can take three, four fivemonths to get the second opinion from the “Superintendencia de Compaas” but these are free process. You can do it by yourself. If you doesn’t have an insurance broker you can do it with “Defensora del Pueblo” is like the public servicefrom the government to help you to solve that kind of problem. So if you has a contractnow, a denied declaration you can talk with “Defensora del Pueblo” and they will help you to submit the claim to “Superintendencia de Compaas” and try to solve the problem.And if you are workingwith an insurance agent you can ask to your insurance agent for a second opinion from”Superintendencia de Compaas”. – We discussed our health insurance in our last cost of living video over on Amelia and JP, our other canal. I’ll put a link to thatvideo above Amelia’s head so you can go check it out. – We’re not insurance agents or experts. So if you do have specific questions we recommend that you contactan insurance agent directly. – Yes. And I will articulate alink to in the specific characteristics below if you would like to talkto Carlos and his squad. – That’s all we have for this video. If you met it helpful, leave us a thumbs up, satisfy. – And likewise be sure to checkout our other canal, Amelia and JP where we showyou what it’s really like to live in Ecuador ..

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