Last word on IMSS health insurance?
04-23-2010, 07:37 PM,
#1
Last word on IMSS health insurance?
about the only remaining question I have is: is it true that tourist visas qualify for application?
I wish I had known this website before applying for IMSS. --Doyle

http://www.medtogo.com/mexico-health-care-system.html
Obtaining Mexican Social Security (IMSS) Health InsuranceHere is information for both travelers staying longer than a month, and those considering relocation to Mexico.

Expatriates living in Mexico: Expats living in Mexico have other considerations and better economic choices not commonly shared with the short-term traveler.

First, there is no need for evacuation to a home country. Second, because many expats have developed a working understanding of Spanish and a comfort level with Mexican culture they can often find lower costs for just about everything including health care. With the right research, health care is extremely affordable in Mexico with or without health insurance. Many comprehensive private insurance policies are very affordable.

The Mexican government, through the Mexican Institute of Social Security (IMSS for its Mexican initials), provides affordable health insurance for all residents of Mexico regardless of nationality. (See Mexican Health-Care System in Plain English or "How to Apply for IMSS" see below.)

There are varying opinions on the quality and user friendliness of the IMSS system. But the following interesting health-care statistics might help you decide what is best for you:

Although less than 3 percent of the Mexican population possesses a private medical insurance policy, 52 percent of the country?s total medical expenditures are for private medical services. In fact, more than 25 percent of Mexicans with IMSS insurance pay for their medical expenditures out of pocket. As a general rule, Mexicans tend to prefer private health care to the state-run system.

With this information at hand, we recommend that individuals or families living in Mexico purchase an affordable, Mexican private health plan. We have listed various carriers, with comparative analysis, in the Mexico: Health and Safety Travel Guide.

How to Apply for I.M.S.S.
IMSS insurance is available to all foreigners residing in Mexico, with exclusions or limitations based on pre-existing illness as detailed below. For some reason, however, the insurance can only be applied for during certain times of the year: January, July, August, and most of February. You pay the inexpensive annual fee (approximately US$250 per year) in one lump sum at the time of application.

The application process may be daunting, so expect bureaucratic delays. If things go smoothly, you have lost nothing. To avoid any potential hassles, we recommend that you ask for an agent who will complete the legwork for you for about US$50?75.

Once approved, applicants are assigned a primary care physician who must certify the health of the individual via general examination. Your appointment also enters you into the IMSS database, which will enable you to receive care if you become ill in another part of the country. You will also be required to fill out a health questionnaire disclosing any pre-existing conditions. Your coverage will activate six to nine months after approval, but once accepted you will be covered for life, as long as you continue with your yearly premiums

To apply you will need:

Two photocopies of your current passport and immigration documentation
Copies of either your FM-T, FM-2 or FM-3 (tourist/expatriate visas)
Duplicate copies of your marriage license (if applicable)
Two copies of a most recent utility or telephone bill in your name or a renter?s lease agreement in your name
Three passport-type photographs
Exclusion Criteria and Insurance Limitations

As a foreigner applying for IMSS, you may not receive treatment for pre-existing illness for the term of your coverage. These exclusions do not include treatment for any other illness that is acquired during your stay in Mexico.

Pre-existing illness is defined as:

Malignant tumors (cancer)
Chronic degenerative disease such as that which is seen with long-standing diabetes, liver disease (cirrhosis, hepatitis, etc.), kidney disease (renal failure or renal insufficiency), heart disease (previous heart attack, arrhythmia, or valvular disease), lung disease (chronic bronchitis, emphysema, etc.), neurologic disease (multiple), cerebrovascular disease (stroke or TIA), peripheral vascular disease, and many others.
Drug or alcohol dependency
Psychiatric illness
HIV positive status or history of AIDS
History of traumatic or muscular injury that continues to require treatment
Further, you can not receive medical care benefits for the following conditions:

Benign breast tumors in the first six months after acceptance
Births in the first ten months after acceptance
In the first year after acceptance you also cannot receive the following surgical procedures:

Lithotripsy for kidney stones
Surgery for gynecologic conditions except for cancer
Surgery for vein disorders
Surgical procedures for the sinuses, nose, hemorrhoids, rectal fistulas, tonsils and adenoids, hernias (except for herniated spinal discs), and other operations that are also considered "elective," or voluntary, rather than required
In the first two years after acceptance you cannot receive surgery for orthopedic conditions.

In addition, your IMSS insurance will not cover the following:

Aesthetic or plastic surgery, eyeglasses, contact lenses, hearing aids, the surgical correction of astigmatism, lasik surgery or the equivalent, treatment of self-inflicted injury, preventive care, treatments for behavioral or psychiatric disturbances, dental care (except for extractions), or infertility treatments.

?

Mexico?s Health Care System in Plain English
Mexico fosters three unequal, yet parallel systems of health care. There are six government-run social security institutions that provide care for approximately 50 million of Mexico?s gainfully employed. The uninsured poor, comprised of about 40 million Mexicans, receive limited health-care benefits administered by the Ministry of Health of Mexico. The private sector, which represents about 3 million Mexicans, is comprised of individuals whose health-care funding is met through private insurance carriers. We will limit our discussion to the two health organizations that are accessible to travelers and expatriates living in Mexico.

Social Security
The largest and most notable social security organization is the Mexican Social Security Institute or IMSS. The IMSS is available to foreigners residing in Mexico and is funded by contributions from employers, beneficiaries, and the Mexican Government. (Click here to learn how to apply for IMSS health insurance.)

Hospitals and clinics that provide medical care for Social Security recipients vary in quality. While major urban institutions may provide adequate to advanced tertiary care, rural hospitals often have outdated equipment, long waits, and inadequate staffing. MedToGo did not review Social Security doctors or hospitals for this guide, so if you choose to see an IMSS doctor, you will have to do your own research. Please note that in the IMSS system, you cannot choose your primary care provider. Therefore, your access to care (and hospitals) is regulated by your assigned physician.

Many of the doctors we have listed in this guide see patients in an IMSS clinic as well as a private practice setting. One way to circumvent the IMSS referral process is to see a doctor with IMSS privileges in private practice. Then, have that doctor refer you to the best IMSS facility for care (through the IMSS system). Social Security costs for medical care and prescription drugs are far lower than in the United States.

The Private Sector
In general, private medical care in Mexico is preferred; up to 25 percent of patients with Social Security benefits or no coverage at all prefer to pay out of pocket for private care. Since health care in Mexico is generally much less expensive than in North America, cash payment is still an affordable option. The cost for a general medical consultation may begin as low as US$20 (of course, costs rise in major cities and tourist destinations). Very few Mexicans have private health insurance, but this sector is growing.

Private hospitals in Guadalajara, Monterrey, and Mexico City offer some of the most advanced tertiary care centers in the world. Tertiary care is advanced care (i.e., cardiovascular evaluation and surgery, neurological evaluation and surgery, orthopedic surgery, hemodialysis, organ transplants, among others) that requires highly specialized skills, technology, and support services. Most of the doctors in these hospitals have had excellent Mexican medical education, and many have trained abroad in Europe or North America.

Be warned: most private hospitals do not accept any form of foreign health insurance, and require cash or credit payment prior to admission or treatment. However, if you are injured or in grave health, a private hospital will attempt to stabilize your condition and then transfer you to a government or Social Security hospital.

There are also very good medical centers in many smaller cities frequented by tourists. Private "hospitals" or clinics in rural destinations tend to be owned by groups of local physicians with varying levels of training. Their facilities and technology are typically outdated, but are adequate to manage minor illnesses.

Patients with advanced care requirements should always be transferred to one of the tertiary medical centers listed in the Mexico: Health and Safety Travel Guide. You should consider any hospital with a 4/5 or 5/5 MedToGo rating as advanced (see book for rating system criteria). Because of the great variability in physicians and hospitals, we highly recommend that you use a reference such as this guide prior to consulting with a private, rural physician.

Ministry of Health
Nearly half of Mexico?s 100 million inhabitants have no health insurance benefits at all. Their preventive care is limited to vaccinations and oral rehydration programs for children. Care in this sector is extremely limited. For example, infant mortality is ten times higher here than in the parallel private sector. Red Cross or Cruz Roja hospitals service the poor and are accessible to anyone in Mexico regardless of their ability to pay. We cannot recommend that travelers seek care in this sector unless there are no other options.
04-23-2010, 08:25 PM,
#2
RE: Last word on IMSS health insurance?
Doyle,

This is a great post with a lot of valuable info. Maybe a little out-of-date like Pvt Dr's office visits at $US20 when it is more the norm now of 400-600 pesos - still a steal.
The part about double tracking -getting private care until you need to go inside IMSS is right on and is local practice here in Guanajuato -. In our 1st year with IMSS coverage we had restrictada stamped in our booklets. This was removed in the 2nd year. The article you post states about $250US year for coverage and I've seen similar numbers elsewhere on the web. Meow's renewal this year [sin restrictiones] was around 1500 pesos. A friend here who is married to a Dr tells us that IMSS is good for the big stuff and that also where pregnancy is concerned IMSS pays your salary for lost time on the job - now how do we we work that out as we are self-employed? We do pay local taxes and have to ammend our 2009 return and pay 1 peso to get 2008 squared away. But for ejercico 2009 we are getting 290 pesos back!
04-24-2010, 01:23 AM,
#3
RE: Last word on IMSS health insurance?
Doyle, your post about your experience applying for the IMSS insurance gave me more than a few giggles. And the article you posted was very good and helpful, though some of what it says differs from my experience. Here's my experience.

I applied for the IMSS insurance on October 27 last year, and the coverage was effective on November 1. Because I came with all the needed photocopies, documentation, and photos, the entire application process took under two hours, including a run to my bank for cash and a run to HSBC to pay the fee. I was amazed. I live in the Centro and was assigned to the IMSS clinic across from Teatro Principal, and IMSS hospital at Cantador Park. Perhaps my experience will be of benefit to others in the GTOlist.

So, here is what you need to sign up -- bring copies the same as you do for an FM-3 or FM-2.

1) Acts de nacimiento original y copia de todos los integrantes (de devuelve el original). (I gave my FM-3 and passport and INAPAM card for this; I had an apostille copy of my birth certificate, but they weren't interested in it)

2)dos fotografias de cada integrante (infantil) (You can get 6 color photos for practically nothing at any of the photo shops in the Centro)

3)acta de matrimonio (esposa o esposo) (This is if you and a spouse are applying as a family. This could be tricky because you may need an apostille of your marriage certificate, and a certified translation into Spanish. Might be less hassle to apply as two individuals, though I suppose it would cost you more.)

4) llenar y firmar cuestionarios medicos de cada integrante (This is the questionnaire you get from the lady at the desk)

5) comprobante de domicilio (utility bill or some such. They selected my CFE bill from the array I offered)

If you apply as a sole person, you will need a letter saying that your application is for you alone. Here is the wording (change the date, and add your full legal name below the signature):

INSTITUTO MEXICANO DEL SEGURO SOCIAL

GUANAJUATO., GTO. 27/10/2009

Por medio del presente, solicito se me autorize la compra del seguro de salud para la familia, solo para mi persona, asi mismo manifiesto -- que no cuento con ningun familiar que incluir.

A T E N T A M E N T E.

-------------------------------------
You go to the Social Security office in the Casa de Moneda on Sope?a. Hours are 8 AM to 2 PM. The office is straight back from the security guard, and on the right. The person you get the application from is at a desk at the back of the area behind the two windows to the left of the door into the Social Security office. The application has to be made in triplicate. It is very simple, and asks some basic medical information. One page. Then, you present your application and supporting documents to a person at one of the two windows -- I had the woman at window #2 who was so nice I felt like hugging her when it was all finished! She types and verifies and stamps, and sends you upstairs, through the arched doorway, for more paperwork, this in quadruplicate! The nice man there then told me to take the forms to the bank (HSBC or Banamex) and pay (for me, at my age, it was 3211 pesos). I went to the bank, where they accepted my cash, stamped everything, and gave me three copies back. I took those copies to the nice man through the arched doorway upstairs, and he gave me some papers to take back downstairs to the lady at window #2. She gave me copies of the documents for my files, and also a medical form and an appointment/explanation page to be placed in my very own booklet at my first visit to the clinic.

It was so simple! BUT, you are not finished yet! Next, you have to get your booklet. For this, you go to the clinic. (Take a rest, and do this another day.) At the clinic across from Teatro Principal, you go up the big staircase, then straight back toward the front of the building. There is a young lady who sits at a desk behind what appear to be cupboard doors -- you would never know she was there -- I think the cupboard opens at 9:00 A.M. She will issue you a booklet, color coded as to your age. You take your book with you to all visits and appointments. Your booklet says which consulting room (thus, doctor) is yours, and the time of your clinic visits.

The next step is an examination to establish your baseline health. My assigned clinic time is 8:00 A.M., so for my first visit I got there (another day) about 7:30. Somehow, everyone waiting seems to know who is just ahead of them and when the desk opens, the people line up in exact order to present their booklets. On my initial visit, I was referred to a consulting room where two delightful female med techs (or nurses) gave me a pretty complete medical exam, took vitals, gave me a flu shot, and made note of my vaccinations. (I carry an International Vaccination Certificate in my passport, and they copied the relevant information from that.) Then, I was told to come back at noon to see a doctor on the first floor (not my regular doctor). This doctor asked me the usual questions about illnesses, diseases, and medications. My only issue was arthritis, and the doctor decided to order X-rays of my gnarly fingers. I was sent upstairs where the X-ray guy operated out of a tiny space behind another office. He completed the X-rays right then and there. I took them back to the doctor, and he told me to bring them back to my regular doctor on the first visit. Then, he gave me an order for complete blood work which was to be conducted at the IMSS hospital at Cantador Park.

Some days later, I went to the IMSS hospital to get an appointment for the blood work. I arranged it so that the appointment would be in January when I returned to GTO from Christmas vacation. In January, I showed up at the hospital for the early morning fasting blood draw, and as instructed, I also brought a jar of the first urine of the day. If course, there were waiting lines and masses of people waiting in the hallways. The M?xicans do excel at handling huge numbers of people efficiently! I was in and out of there in about 20 minutes.

The results of the bloodwork are sent to the clinic in about five days, after which you make your first office visit with your assigned doctor.

Well, that's all I know. Like so many things in M?xico it seems daunting until you actually do it. Since then, I have visited the clinic a couple of times for minor issues, receiving both doctor consultations and medications without further cost. Even without an appointment, I have never had to wait as long as I routinely cool my heels in a U.S. doctor's office. I like the M?xican IMSS system; it seems to me that it is public health care as it should be practiced.

Constance
04-24-2010, 06:06 PM,
#4
RE: Last word on IMSS health insurance?
An addendum to the excellent information provided by Doyle, Bill, and Constance:

Be very careful about your annual IMSS renewal date. After having IMSS insurance for a few years, last year I failed to realize that my date was coming up. I learned the hard way that there is NO GRACE PERIOD. I arrived at the IMSS office only a couple of days after the expiration date, but I had to start all over again as if enrolling for the first time. There are some limitations on IMSS services for the first year or two, and now Gela and I are on limited status again.

A corollary to the lesson I learned is that, if you're signing up for IMSS for the first time, take care to choose a time of year when, year in and year out, you're likely to be in town.

Don
04-24-2010, 06:57 PM,
#5
RE: Last word on IMSS health insurance?
Don, Thanks for adding that about renewals - I was going to add the same caution about not renewing on time and then having your status lowered.

However on your corollary [chosing a join/renew time when you most always expect to be here] there is a simple way around it. Meow and I are never here at renewal time. So for our 1st renewal I went a month ahead of time and was told a renewal could only take place in the renewal window [whatever month the policy expires in]. I asked if someone could act in our behalf in our absense and there was no problem. Just make sure you leave your surrogate the three new photos and whatever else is required. We have done this for several years without problem.
04-24-2010, 11:28 PM,
#6
RE: Last word on IMSS health insurance?
Oh, when we renew do we have to submit NEW photos? My renewal doesn't come up until October, but I want to be ready! Thanks.
04-25-2010, 08:43 AM,
#7
RE: Last word on IMSS health insurance?
Yes, you must give them a new set of photos
04-25-2010, 12:36 PM,
#8
RE: Last word on IMSS health insurance?
Thanks Constance. Our experience has been very similar. We have had no problems signing up even though our Spanish is still very ordinary. We are up to the fun stage of going for our blood tests tomorrow (and me a mammagram today - Sunday!) We are very pleased to be allowed to enter this system as we have left a no cost system in Oz, just how it should be everywhere!

Cheers,

Heather & David
05-10-2010, 12:38 PM,
#9
RE: Last word on IMSS health insurance?
So, is July the next "Open Enrollment" period for IMSS ?
05-10-2010, 01:14 PM,
#10
RE: Last word on IMSS health insurance?
i suppose the restriction on applications time-wise has changed. i applied in April and got it completed with the doc's very simple interview the first week in May. ???


Possibly Related Threads...
Thread Author Replies Views Last Post
  Looking for private health insurance... Blackpool 2 130 06-21-2017, 09:45 PM
Last Post: Blackpool
  Auto Insurance Mike 4 162 06-17-2017, 05:27 AM
Last Post: pianoheat
  A mobile app for women's health Barbara 0 143 03-08-2017, 10:16 PM
Last Post: Barbara
  Travel insurance Sewhappy 2 359 12-15-2016, 12:10 PM
Last Post: roberb7
  seeking used MX vehicle and insurance advice Doyle Phillips 3 432 12-07-2016, 11:47 AM
Last Post: DonJuane
  What is the LOST WORD of the Mason? cam00 5 1,152 01-03-2016, 05:02 PM
Last Post: roberb7
  Car insurance PatB01 1 508 10-29-2015, 04:30 PM
Last Post: pianoheat
  Short term insurance in USA Doyle Phillips 1 711 08-31-2015, 12:32 PM
Last Post: The Duck
  Medical Insurance vs IMSS M Webber 3 1,535 03-07-2015, 10:44 AM
Last Post: raquelita
  Car Insurance Lisa Andrews 2 1,141 01-05-2015, 09:33 AM
Last Post: Lisa Andrews

Forum Jump:


Contact Us | gtolist.com | Return to Top | | Lite (Archive) Mode | RSS Syndication