CCSS payment

I have a temp residence. I paid only to get a dimex. Now I don't pay.  I haven't paid for 4 months and paid for this period only to obtain my dimex. Now I don't. Technically they have no right to cancel your residence as CAJA is officially voluntary. With respect to dimex renewal, I guess it is better to consult with a legal professional or better with two of them, as they aren't reliable here. As well, I heard that retired people don't have to pay CAJA but again, this is "pura vida", so nothing is "for sure". Send me a private message if you'd like to be in touch.

@Henrych

Thanks so much. I will definitely do that since I don't even use this insurance. Imagine my meds cost 40mil a month and this Universal HC is making me pa 228mil 15 to 17% of my SSDI.  Thx again for your time to comment. ✌️

May I ask do you have private insurance and if so which one is best here in CR. Thank you Izzy:)

@Henrych correct me if I'm wrong but don't you need to present Caja receipt to renew your dimex as it's part of the requirement?

@Vild Yes I have renewed my ID. Now Im wondering can I get a Private Insurance.

I have a temp residence. I paid only to get a dimex. Now I don't pay. I haven't paid for 4 months and paid for this period only to obtain my dimex. Now I don't. Technically they have no right to cancel your residence as CAJA is officially voluntary. With respect to dimex renewal, I guess it is better to consult with a legal professional or better with two of them, as they aren't reliable here. As well, I heard that retired people don't have to pay CAJA but again, this is "pura vida", so nothing is "for sure". Send me a private message if you'd like to be in touch.
-@Henrych

Henry, did you purchase a provate insurance and will immigration accet this? Thx

@inivin57 ,By the way "Pura Vida"comes from a Mexican comedian we couldn't stand by the name of 'Clavillazo',1956......By the 1970's this disturbing fact was completely forgotten.By the 1980's it became part of the Tico vernacular......Everything is a smoke-screen here, even for that..

No, I have purchased nothing. Too expensive. I stay healthy despite all the crap i have experienced  here and huge financial impact(have received no C19 shot).

@edwinemora Funny, I've asked Ticos about meaning of "pura vida". Is it your right to be deceived, taken advantage of, robbed and submit to insane, suffocating bureaucracy? They were just laughing realizing the sarcasm. So, I guess, this the acceptance of all the above. My tica girlfriend is laughing when I happily scream "pura vida!" during regular electricity, internet and water outages. Pura vida!

@Vild This is a very good question. I don't know, as I've just obtained my dimex for 2 years. May be in 2 years I'll run away from here screaming...I don't know. You need a legal advice and perhaps assistance, as this sh....t is indicated as "voluntary".

Yeah I hear you. Just spoke with my lawyer says she will send me paperwork since I am now 1 yr in and married supposely now my husband can add me to his insurance. I just don't want to get a 4million bill from ccss which is sorry to say horrific for all CR. Anyways Thx for your time. ✌️

My 2 colones as a 13 year resident of CR both as a pensionado and permanent resident. I think there is some confusion here regarding the CAJA. First there are 2 parts to the CAJA (one is the health insurance side and the other is the retirement side). Historically expats as pensionado or permanent residents needed only to pay the health insurance portion. And participation in the CAJA (health insurance) was and is required of pensionados and permanent residents (I’m not sure about other categories of residency like Rentista) - it is not voluntary.

I think this may be what is causing some of the confusion. A few months ago there was some discussion in the government about requiring that newly applying pensionados pay the retirement portion also. This was not very well thought out as one must pay about 20 years into the retirement portion in order to get any retirement payments. Since most people applying for pensionado status are already 65 or so that meant they would probably never receive any retirement payments since they would have to be in their mid to late 80’s. This apparently has been dropped and is supposedly no longer a requirement of newly applying pensionados. This was not intended to apply to “current” pensionados or permanent residents - only newly applying pensionados.

Some have said here that they do not pay the CAJA and it is voluntary. I think that is incorrect. Maybe the retirement portion is voluntary but not the health insurance portion. CAJA health portion is required to be a legal resident of Costa Rica. I’m pretty sure that Costa Rica will not track you down if you don’t pay your CAJA health portion but you will certainly not be able to renew your pensionado or permanent residency status without being current on CAJA payments. I just renewed my permanent residency last week and a statement from the CAJA that my payments were current was one of the required documents for renewal. It was easily obtained online at the CAJA website.

By the way, private health insurance is not accepted instead of CAJA payments. Private insurance is certainly a good idea but CAJA payments are still required for CR residency (pensionado or permanent).

Additionally, you may or not be able to leave the country without current CAJA health payments. I don’t know for sure if they check on departure. But I do know they check upon re-entry to CR. This was major issue during COVID as some residents were outside the country when CR locked down and they were not able to pay the CAJA health portion. When the country opened up again and they tried to return, they were denied entry as their CAJA payment had not been paid. They were held at the airport until somehow their CAJA payments were paid and up to date - typically by a friend or family menber. They did relax this after a period of time and did allow residents to re-enter without being current but they were required to become “up to date” on all CAJA payments and show proof within a short period of time.

To reply directly to the question about missing a CAJA payment. As I said, CR will not track you down for the payment or cancel your residency but you must be up to date at renewal or re-entry to CR. That would include the missed month payment. If you miss a month, my suggestion is to pay that missed month on your next payment. Obviously one would not be able to use the CAJA health portion if the CAJA payments are not current.

This is from my personal experience and chats with other resident friends on their experiences. One final point - as most of you know, things do change here in Costa Rica so if you are really concerned I’d discuss this with an immigration attorney (as other have suggested).

I hope this helps.

John

@jwboozeriii They still require you pay both health and pension portion, which amounts to a pretty large amount....especially when you don't use this health insurance, which is a joke.

Henrych,

You could be right - what is your source ?

According to my immigration attorney, payment into the retirement portion was only initially intended for new pensionado applicants - not those that already have pensionado or permanent residency (even for renewals). Apparently there is also a law in CR that most new laws can’t be made retroactive and that is the reason it only applied to new pensionado applicants.

But payment into the retirement portion has apparently been eliminated (according to my immigration attorney). That is also according to a close friend that is in the pensionado process (approved but awaiting his immigration appointment) and he is not required to pay into the retirement portion - only the health insurance portion.

You are correct that it can expensive depending on your income - even just the health portion.

Folks can argue all day about the quality of the CAJA health program - I’ve heard horror stories and I’ve heard great stories but the bottom line is that it is required for, at least, pensionado and permanent residency so it is kind of a moot point.

I’d be interested to know where you are getting your information. If I am wrong, I’m happy to admit it.

Looking forward to hearing your source of information.

Saludos,

John

@jwboozeriii

Thank you so much John for this info. Question how long do I have to be a Temp resident Dimex until I recieve permenant residence. My lawyer said 99% time theyll just give it to me on my 2 yr aniversary.Also, do you know if I can remove this CR pension now which is why I pay so much, unfortunately I was 2 days late when the president invoked this ness for foreignors to pay oension which I already recieve in my own country. I really hopw theyd remove it but last I asked a lawyer he wasn't cery pleasant. Thanks again Isabele

@Henrych

Oh and I applied as married now since 11/27/2020. I dont understand why he can't add me to his CAJA insurance. Do you know anything I can do about this? Much appreciate your time and advice.

Sincerely Izzy

@jwboozeriii

Oh and I applied as married now since 11/27/2020. I dont understand why he can't add me to his CAJA insurance. Do you know anything I can do about this? Much appreciate your time and advice.

Sincerely Izzy

@jwboozeriii I got my last information in July when I paid caja for 4 missing months in order to get my 2 year dimex. I paid both portions, as they charged me. I am not paying now but I do have a bad sensation that when i renew my residence (if i decide to do so) they'd make me pay for 2 years. BTW, ticos say that caja is a joke but i never used it.

Izzy,

I'm alway happy to help. I try to only use my own personal experience rather than the "Coconut Wireless" (rumor mill).

Regarding how long one must wait before applying for permanent residency …. Everything I have read says one can apply for permanent residency after 3 years as a different type of resident (ie, pensionado). If you are a pensionado, I think most people wait, as I did, until their first renewal is about to expire to apply for permanent residency. That would typically be 4 years (2 years on first pensionado and 2 years on the first pensionado renewal). The reason is that about the only reason to be a permanent resident rather than a pensionado is that a permanent resident can work. If one is not going to work there is no real reason I can think of to “waste” that one year of pensionado status to get permanent residency. I hope that makes sense. Make sure to allow enough time when applying for permanent status because I think that process takes a little more time than simply renewing the pensionado status. Also I would use an attorney to assist in the paperwork.

Further, if you are married to a Tico then you should be able to apply for permanent residency immediately by being married (first degree relative).

Regarding the CAJA, I really have zero experience with that as I have a 3rd party company pay mine on my behalf and they bill me quarterly on my credit card. I have been doing that for over 11 years and I am single. It would seem to me however that if the law changed and pensionado are no longer required to have the “pension” portion of the CAJA that one could have that changed with the CAJA. Again that is a question for the CAJA directly or a knowledgeable immigration attorney.

Good luck to you especially with the CAJA pension things since, as you know, it is expensive and not really any benefit as far as I can tell.

John

@Henrych,

Regarding your comment, "ticos say that caja is a joke" is a bit misleading, in my opinion. I have lived here 13 years and every Tico that I can remember talking with says that the CAJA health system is excellent for emergency care. In fact, I just had lunch with my attorney (a Tico) yesterday and he said exactly that - emergency care is excellent. I know for a fact that many doctors (mine included) that work at private hospitals and clinics also work part time at the CAJA. So the medical care is not the issue.

Now having said that, I do agree that most Ticos think that routine services (non emergency) at the CAJA are very difficult and limited (maybe even a joke, as you say), to say the least. The main reason for this is the incredibly long wait time for routine medical care - it can be years. My eye doctor told me that there are over 20,000 people waiting for just cataract surgery - I'll take his word for it. The system hack of the CAJA medical system last year did not help with the long waits as many medical records and waiting lists were simply lost and people had to start over again.

One thing that I think is a great idea to help with more routine medical care, and it is available to pretty much anyone, is MediSmart from Hospital Metropolitano. It is a paid program that offers significant discounts (depending on the medical speciality) of up to 80%. The annual fee is less than $150 and can be paid monthly or annually. One can also add others to their plan and all receive the discounts. There are hundreds of doctors that accept MediSmart and one can make appointments on the website quickly and easily and often for the same day or week.

An example, I pay my internal medicine doctor about $20 per office visit using MediSmart and his normal office visits are over $100. I just had a colonoscopy a week ago for $307 (soup to nuts) using MediSmart.

I guess what I'm saying here is that a broad general statement that "that all Ticos think the CAJA is a joke" is not really totally correct or helpful to someone that is new to Costa Rica and searching for good useful information. That is why I have tried to explain both the good and bad of the CAJA health system plus offer an alternative solution to help with the more routine medical issues where the CAJA is significantly lacking.

I hope this helps !

John

I concur in John's sentiments immediately above. While there really are deficits in what the CAJA can provide, still it's the best option for many people, expats and Costa Ricans alike, and it far outshines what's available in most other less developed countries. The CAJA's shortcomings arise from a deficit of resources rather any lack of expertise.

A friend is currently being treated for a very complicated knee condition that almost resulted in amputation of her leg. The CAJA orthopedic surgeons put off that surgery, against her wishes, and now she's on the mend. That's hardly third-world care.

As to MediSmart, we're enrollees and believers, but there are two concerning factors. First, you are limited to using their medical staff and facilities which may be problematic if you don't live close to one of their hospitals or labs, or if you want a broader slate of choices among practitioners than MediSmart's offerings.

Second, while they offer generous discounts on many services, since they don't publish "list" prices for those services, it's difficult to know just how much those discounts are worth. A fifty percent discount on a service is tempting, but what's the full price that you're only paying half of? That said, an office call to our local primary care physician is laughably cheap and he'll spend as much time as you and he need. Nothin' bad about that!

@jwboozeriii

John my issue is why do I have to pay if I already recieve pension from my home country! Why cant this be an option? I dont mind paying the CCSS but another100mil for pension I may never get back or want is outrageous. I rather use that to save for my kids college fund or a private extra doctor. Thx

@inivin57

Izzy, I totally agree with you and I’m sure that is one of the reasons the requirement for one to pay into the pension portion was apparently discontinued.

Have you contacted CAJA or an attorney to see if you can stop paying that portion? It might be worth an attorney’s fee to get it stopped. It is my understanding that it is no longer a requirement for residents to pay.

I just had a friend start the CAJA and he is only paying the health insurance portion (no pension portion).

Good luck !

John

@daveandmarcia

Dave and Marcia,

Glad your friend is on the mend! I had a friend that was at Blanco Cervantes (old folks part of San Juan de Dios hospital) for over 30 days and walked out with no bill or charges. I visited him several times and he was very happy with the care he received.

Regarding your MediSmart comments .... you are correct that one is limited to those practitioners that are in the MediSmart system. However, it is my understanding that they are always adding more doctors and staff to the program and also offering more locations around Costa Rica. Probably a work in progress but it is a wonderful option, where available, for the more routine issues.

Regarding the list prices, when I open the website and sign-in, there is a link at the very top of the page that says " Look for Prices and Services". When I go to that link and enter the type of procedure I get a list with Regular price, % of discount, MediSmart price with and without IVA. Also under "Benefits and Savings", there is a by percentage price for Regular and MediSmart prices. For example, click the discount percentage and there is a list of specialities offering that percentage of discount (with regular and discounted prices). I would send a link but I'm not sure that is allowed on this forum.

Is that what you are looking for or did I misunderstand what you said? If it is, I hope this helps.

Stay safe and healthy !

John

@jwboozeriii

Oh gosh I surely hope so I will call my lawyer and personally go to the Caja tomorrow. Thank you so so much.

Have a blessed day my friend.

Izzy

Izzy,

Good luck and please keep us posted. I'm sure there are others in the same situation.

Iqualmente !

John

John, thank you for your clarification (above) about MediSmart's published prices, discounts, etc. Honestly, I hadn't looked for that information in quite a while.

So, I stand corrected. And I continue to think that MediSmart can be a very good deal for many folks who find themselves paying for medical care.

Now, there is just one more question . . . If, like Marcia and me, you have a private medical insurance policy, how does MediSmart treat you in the billing process? That is, do they bill the private insurance company at the discounted rate, at a negotiated (reduced) rate, or at the full published rate?

    John, thank you for your clarification (above) about MediSmart's published prices, discounts, etc. Honestly, I hadn't looked for that information in quite a while.
So, I stand corrected. And I continue to think that MediSmart can be a very good deal for many folks who find themselves paying for medical care.

Now, there is just one more question . . . If, like Marcia and me, you have a private medical insurance policy, how does MediSmart treat you in the billing process? That is, do they bill the private insurance company at the discounted rate, at a negotiated (reduced) rate, or at the full published rate?
   

    -@daveandmarcia

Hola Dave,

Glad my reply about discounts was helpful !

Excellent questions regarding what rate is charged if one has private insurance. It is my personal experience that when one has private insurance and MediSmart that the "normal" rate is used rather than the MediSmart "discounted" rate.

I had INS private insurance and had procedures done at Hospital Metropolitano - Lindora. The procedures were pre-approved by INS. When I was settling the bill I gave them my MediSmart card and was told that they use the "normal" rate when INS is being used. This happened on several occasions with INS. I'm not sure about any other private insurance.

At my age (75), INS finally became too expensive and the coverage was limited to when I was actually a patient in a hospital (overnight). I discounted it last year so I am  MediSmart / CAJA kinda guy now.

Hope this helps. Feliz día de la independencia !

John

    @jwboozeriii I got my last information in July when I paid caja for 4 missing months in order to get my 2 year dimex. I paid both portions, as they charged me. I am not paying now but I do have a bad sensation that when i renew my residence (if i decide to do so) they'd make me pay for 2 years. BTW, ticos say that caja is a joke but i never used it.
   

    -@Henrych

Henry,

Thanks for the details on where you got your information that CAJA is still charging both health and pension portions - that is very interesting.

I'm still a bit confused here so help me out, please, if you don't mind.

First, let me give you what I understand to be the situation with the CAJA and the new program where expats were made to pay both CAJA portions (health and pension). The CR government started making "new" pensionados and rentistas (only these 2 categories) pay for both portions of the CAJA several months ago. This was only for those 2 categories PLUS only for those getting their residency for the first time (not renewals). It did not apply to those that already had a DIMEX and were paying the CAJA. (side note: the health portion is required for residency but the pension portion is /was optional.) This program remained for a few months but the government later decided to stop that program. I was told this by a well known legal office that specializes in residency. Additionally, I have a good friend that just got his pensionado residency approved (has his immigration appointment in October) and he was only quoted the health portion of the CAJA as what he would be required to pay.

Henry, here is what I don't understand about your situation .... if you were renewing your DIMEX then from what I said above you should not have been charged the pension portion since it did not apply to renewals. If this is the case, then maybe you were charged that because you were behind on your CAJA payments - I have no idea.

If this was your first DIMEX then I don't understand why you would have been charged for 4 missing months CAJA when you didn't have a DIMEX ?  The only thing I can think of is that when your residency is approved, one must join (pay) the CAJA in order to make an appointment at immigration to get a DIMEX. If you were in that window when both portions were necessary then maybe that is why you were charged both. Again, I have no idea.

Your situation is really confusing to me and it is well above my level of knowledge. Honesty, if I were you, I'd see a good residency attorney and find out about your actual situation and why you were charged for both portions. It might be worth the attorney fees if you could get some money back if it was indeed paid in error.

I'm pretty sure your "sensation" is correct .... if and when you try to renew your residency they will charge you for any unpaid CAJA months.

Henry, I'm not sure this helped at all but I hope so.

John

@Henrych Caja payments are required. If you don't pay you are in violation ofthe law. It might be a while for them to catch up with you but you will not get your cedula renewed. Other services may be denied.

Plus it is a good deal! Ny ex in USA pays 1500 $ a month for herseof I pay 250 $.They si far saved lives of 3 people I know. Not bad! Free COVID vaccination with the best USA had to offer (not mandatory). No pre-existing conditions and it keeps private care costs low.If you go to a nation; respec them. Otherwise you are not being a good visitor.

I pay all the time even when I travel.Even when my cedula was being renewed.

@jwboozeriii Medical Caja is NOT a joke. I got 3 living people to prove it. They are exceptional at emergencies.

But COVID-19 strained the system. Mostly du to required precautions. Thank GOD it neve got as bad as Peru. But still thetourism  industry took a big hit.

Vaccines mostly Pfizer were made freely available but it took a while to get them The government paid for them. Caja gave appointments for us; it worked perfectly.

@jwboozeriii I did after 3 years of Rentista. It took around on and a half years. I did not want to be illegal so I went to Nicaragua then they approved me but it took a few months to issue the permanent one. I returned and showed the immigration my letter of approval and he was ok with it. Now I got a permanent which needs renewal

But by the time they give you a premanent they have pretty much decide you are alright if you haven't been bad. I got married which does not hurt.

@jwboozeriii Never personally used CAJA but the friend of mine, who has lived here for 24 years had her breast amputated because of cancer. The subsequent test has revealed that it wasn't a malignant tumor. So, we never know. In the US, the second cause of death is medical errors, BTW.

       Henry, here is what I don't understand about your situation .... if you were renewing your DIMEX then from what I said above you should not have been charged the pension portion since it did not apply to renewals. If this is the case, then maybe you were charged that because you were behind on your CAJA payments - I have no idea.If this was your first DIMEX then I don't understand why you would have been charged for 4 missing months CAJA when you didn't have a DIMEX ?  The only thing I can think of is that when your residency is approved, one must join (pay) the CAJA in order to make an appointment at immigration to get a DIMEX. If you were in that window when both portions were necessary then maybe that is why you were charged both. Again, I have no idea.Your situation is really confusing to me and it is well above my level of knowledge. Honesty, if I were you, I'd see a good residency attorney and find out about your actual situation and why you were charged for both portions. It might be worth the attorney fees if you could get some money back if it was indeed paid in error.I'm pretty sure your "sensation" is correct .... if and when you try to renew your residency they will charge you for any unpaid CAJA months.Henry, I'm not sure this helped at all but I hope so.John         -

@jwboozeriii Hi John, I was approved for 2 year residency in May 2022, then I had my Dimex appointment in January 2023 and was assured that Dimex would arrive in 2 months. So, I've been waiting for more than 4 months with no avail. Eventually, I visited an immigration office in Paso Canoas and obtained the digital Dimex. There, they advised me to pay all CAJA fees compiled after January otherwise the Dimex won't arrive, so I did in July and CAJA charged me around $120 monthly which included both CAJA portions (one person) and I am a pensionado. The penalty for missing months was negligible. Since then, I haven't paid. Now, with respect to lawyers. The pura vida problem is this country is that you never know when they screw you. The good chance is that they definitely will. The majority of them. Which means you have to doubt the  integrity of the information they provide. Sometimes it works, sometimes doesn't. Maybe I'll visit CAJA again to confirm using my limited Spanish (or pachito which they speak here) but again, what they say in a particular CAJA office isn't necessarily true. For example, once I've arrived to CR,  I couldn't open my BCR account from the first attempt (they told me I had to be a resident), then I successfully did at a different branch. So, this is how pura vida works.

    @Henrych Caja payments are required. If you don't pay you are in violation ofthe law. It might be a while for them to catch up with you but you will not get your cedula renewed. Other services may be denied.Plus it is a good deal! Ny ex in USA pays 1500 $ a month for herseof I pay 250 $.They si far saved lives of 3 people I know. Not bad! Free COVID vaccination with the best USA had to offer (not mandatory). No pre-existing conditions and it keeps private care costs low.If you go to a nation; respec them. Otherwise you are not being a good visitor.I pay all the time even when I travel.Even when my cedula was being renewed.        -

@Faramarz Rabii Thank you! Free covid vax boosters???!!! Wow! I can't miss this opportunity!

I dont have an issue with paying Caja insurance my issue is why shoukd I pay pension when I onky requested temp residency voluntary thats all. Of course I respect the laws here my children and husband are Costarican. Anyways Im now in the process of naturalizatin since weve been married 3 yrs now and will be less costly for us. Thanks folks have a good one.

Good morning , does anyone know how much you pay la caja once you have your residency?  i hear a high number, can  you get the payments down by negotiating??

thanks

I got my residence in March. They charge me 63000 colones for one person. Do the math...If you skip, they'll charge you for all missing months plus penalty. You can't come back to CR if you travel and have missed payments...pura vida

    Good morning , does anyone know how much you pay la caja once you have your residency?  i hear a high number, can  you get the payments down by negotiating??thanks         -

@miriamsoriano -  the amount depends on the amount of your income that was used to get your residency. I think a rentistsa is based on a $2,500 amount. My internet research shows that for health insurance only, the percentage varies between about 3% and 11% of your income. I suggest you contact a good attorney specializing in residency for the most accurate information and if negotiating is possible.