Last word on IMSS health insurance?

[Doyle Phillips]

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.

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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.