Insurance coverage in Ecuador

1.  Home insurance.  We are monitoring what’s going on at the Ecuador coast to see how insurance claims are handled.  Almost six weeks after the earthquake, about 13,000 claims have been submitted for homes and businesses.  Only a tiny fraction have been paid so far, which is understandable.  It may be months before we get a really good reading on whether the insurance companies took decent care of their claimants.

2.  Health insurance.  In 2013-14, I had Salud S.A. coverage at $240 per month for medical and dental.  There were lots of exclusions -- during that time I was not eligible for pre-existing conditions or medication for such conditions.  The company paid for my periodic routine office-exams at a doctor’s office with only a small co-pay. 

As soon as it became known to Expats that there would now be wide coverage available to us through the EC government for comprehensive IESS health care, I dumped Salud and now pay about $70 a month for government coverage.  I have yet to use it and still visit the old Salud doctor -- paying 100 percent out of pocket.  But I know that in case of emergency or hospitalization, I qualify for IESS 100 percent care based on my payment history and my Ecuadorian residency ID.

Reasons I do not rely on IESS for routine care:  It’s a bulky bureaucracy with non-emergency service and appointments delivered painfully slowly according to multiple sources ... and the choice of doctor is typically determined by IESS with a doctor assigned for each visit -- not necessarily the same doctor.

cccmedia in Quito

Kenjee wrote:

What type of insurance expatriates need the most in Ecuador: health, house or liability insurance?....

Is it better to purchase insurance from an expat insurance specialist or from a local insurance provider?

Kenjee

I dropped my home insurance after one year, when the agent did not answer my emailed question as to whether my condo apartment was covered for flooding.

Part of my thinking was this...  If I ever had a claim and it was rejected, where did that leave me?  Could I contact an English-speaking state insurance commissioner?   No.  Could I successfully file a lawsuit to force the company to pay?  A dubious concept in Ecuador, IMO.

As for “liability” insurance, Ecuador is not a litigious society compared to the U.S.  So not many Expats are going the liability-protection route.  And the “expat insurance specialist” that Kenjee asked about:  the next one of these that I meet or even hear of ... will be the first.

When I travel I use the insurance offered by World Nomads, which can easily be arranged online.

cccmedia in Quito

When I first arrived, I asked about house insurance, and I was told that to be covered, I would have to have a receipt for every item in my house that I wanted covered. My house is adobe, and, with the exception of the ceiling, doors and windows, there would be little to burn ,and I am well above a flood zone. So, I opted not to get it.

As for health insurance, I signed up for IESS, a governmental insurance, because I had heard good things about it. However, recently, I have been told by both Ecuadorians and expats, that because of Ecuador's dire financial straits, many people are not being provided recommended surgery and tests performed outside of the IESS hospital. I recently needed a nuclear scan, and I was told by IESS that it would provide the scan for me at an outside hospital. However, once I had registered at the outside hospital and was waiting to be called for the scan, a hospital administrator came in and said that the paperwork that IESS had provided for the test had been incorrect, and I would not be able to have the test. That was three weeks ago, and I am still waiting for the paperwork. As well, I have a friend who needs back surgery, and she has been waiting over 5 months, and she still hasn't received it.

Because of the financial issues, I will likely go out of the system and pay for the surgeries and tests myself.

However, I have no plans of letting go of my IESS coverage. My premium of around $65-$70/mo is much less than what I was previously paying for many of my monthly medications. As well, of the services I have received at the IESS hospital, including Physical Therapy and a vast array of tests, I have been more than satisfied.

All of the medical care I have received thus far has been wonderful - and to have a doctor actually sit and listen to me as a patient, is something I have not received in many years. Hopefully, in time, Ecuador will find its way out of its present economic mess, and IESS will be better able to serve all of the needs its patients require.

Before I started traveling, I researched health insurance. Since I was taking only 3 suitcases with me, I did not worry about insuring my personal property. I decided on travel insurance, since I live in Panama, Ecuador, Canada, and wherever else, most of the year and in the US for about 1.5 mos. I currently am 72 yrs., pay about $2000/year, and am covered for virtually everything, everywhere in the world. My insurance is from Seven Corners, a US company (to qualify for this coverage I must be out of the US for 6 mos. or more--no problem for me!), and is called Reside Worldwide. Check it out!! I've had one large claim, for cataract surgery in Panama. It took 45 MINUTES to get the company to approve the procedure and they had a check ready for the doctor before the doctor's facility even got their banking info to the insurance company!

bobettejane wrote:

I decided on travel insurance, since I live in Panama, Ecuador, Canada, and wherever else, most of the year and in the US for about 1.5 mos. I currently am 72 yrs., pay about $2000/year, and am covered for virtually everything, everywhere in the world. My insurance is from Seven Corners, a US company (to qualify for this coverage I must be out of the US for 6 mos. or more--no problem for me!), and is called Reside Worldwide. Check it out!! I've had one large claim, for cataract surgery in Panama. It took 45 MINUTES to get the company to approve the procedure and they had a check ready for the doctor before the doctor's facility even got their banking info to the insurance company!

Wow, that’s quite a travelin’ lifestyle, whether you’re 27 or 72 !

I was unfamiliar with Seven Corners / Reside Worldwide, so I consider this to be a great recommendation.  Especially since they have treated you right.  And because it’s so relevant to our peripatetic members.

Good job and welcome to the Ecuador forum, Bobette Jane.

cccmedia in Quito

I would like to update my post.

I went and discussed the funding situation with my doctor today. While she never directly answered my question regarding funding, I DID get the okay to get my nuclear scan today.

So, I am hoping that the rumors are just that - only rumors. The treatment and kindness I have received from my IESS doctors are far and away the best I have ever had in my life!!!

To Ms. Bobette Jane,
I accessed the website for the Seven Corners insurance you recommended. It states that coverage is offered to U.S. residents up to age 75 and does not cover any pre-existing conditions. There are certain other limitations on annual costs incurred for lab tests, etc. Does the age limit mean one's coverage ends at age 75 or that one must enroll prior to age 75? You must be in excellent health - esp. to be so peripatetic! Best wishes.

http://www.travelinsurancereview.net/co … rs/reside/
Thank you.
PS

Isn't refusing coverage for pre-existing conditions now illegal in the US?

To Susan F:
The Reside Worldwide plan is for medical coverage OUTSIDE of the U.S.  With such an exclusion, it seems to be an attractive option for very healthy individuals. If one intends to return to the U.S. for any medical care, it's wise to continue making those Medicare payments since RW doesn't cover stateside services.
PS

I had no pre-existing conditions, take no medications and am in excellent health, so getting the Seven Corners coverage was no problem. I'm not certain about the age limit; I assumed my coverage would only be renewed up to age 75 but I'll check with the company.

bobettejane wrote:

I live in Panama, Ecuador, Canada, and wherever else, most of the year and in the US for about 1.5 mos. I currently am 72 yrs., pay about $2000/year, and am covered for virtually everything, everywhere in the world.

Given the U.S.-coverage exclusion, what do you use for insurance during your 1.5 months per year when you are in the U.S. ?  Medicare Parts A, B and other ?  Do you re-start and re-cancel Medicare Part B ?  What are your Medicare premiums for Parts B-Z ?  Part A is usually ‘no additional cost.'

cccmedia in Quito

I'm curious also, cccmedia and is there a penalty for canceling and restarting Medicare Part B? This past year subscribers got locked into certain life-time premium rates meaning they had applied to SS benefits. Some were at the $104.90 (don't quote me on the dollar) but because some hadn't taken SS until this year, their premiums were locked in at $123.. per month (even though they were paying $104 per month previously BUT NOT COLLECTING SS). In other words, your Medicare premium correlates with the year you begin collecting SS.  I don't think one can enroll and unenroll without penalty. Any advice out there?

peripatetic_soul wrote:

I'm curious also, cccmedia and is there a penalty for canceling and restarting Medicare Part B? This past year subscribers got locked into certain life-time premium rates meaning they had applied to SS benefits. Some were at the $104.90 (don't quote me on the dollar) but because some hadn't taken SS until this year, their premiums were locked in at $123.. per month (even though they were paying $104 per month previously BUT NOT COLLECTING SS). In other words, your Medicare premium correlates with the year you begin collecting SS.  I don't think one can enroll and unenroll without penalty. Any advice out there?

The idea is to make you pay for the months you did pay for the part B.  Suppose you canceled for 10 months, then the $1049.00 you did not pay would be calculated into the increase, but I have never seen the formula, could be based on life expectancy.  The older you are, the greater the increase.

I checked with the online information for Medicare, and I think it said that if my husband withdrew from it and then wanted it again, that is would cost 10% more. therefore your figures look right.

Dear Ms. Brohrich,
Does that mean 10% increase in premiums, effective the date of restartup, or 10% penalty for each month of all months withdrawn? I read somewhere about a hefty penalty for not maintaining enrollment. I won't comment on that ludicrous rule. Thanks.
PS

Thought I'd "resurrect" this thread to ask a simple (or perhaps not so) question.

Does anyone know of any insurer/broker who can/will price risk on the coast? We'd like to purchase homeowner's insurance against natural disasters (earthquakes and the like), but have been unable to find anyone who will provide this, following the April 'quake. Are we wasting our time even looking? Do we just accept the risk? (Our house is in Salinas, BTW, and was un-damaged in the April 'quake).

In Ecuador it is one thing to buy insurance, it is another to collect....

Insurance is the same globally. I'm just after information as to whether any insurers do insurance for dwellings on the coast. If I can find one (or preferably several), I can do my own research on what their claims settlement history is like...

I want to explore obtaining insurance for the building we live in Salinas. Does enyone know of an insurance company that would do business with us? There are about 13 owners an administrator, etc

expat_sooner wrote:

Insurance is the same globally. I'm just after information as to whether any insurers do insurance for dwellings on the coast. If I can find one (or preferably several), I can do my own research on what their claims settlement history is like...

The above citation is from five years ago.  Still, it was new to me and maybe is to you.  I think it's worth commenting on since the subject is evergreen.

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Unless you're professionally trained in such research and have Spanish language skills, I would delegate this to an attorney or the Ecuadorian equivalent of a paralegal.

Sure, you can talk to people and get anecdotal stories .. or you could ask an insurance agent/agency.  But the agent/agency has a proprietary interest in convincing you that insurance is valuable.  So would I trust him or her's word?  I doubt it.

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"Insurance is the same globally," you wrote.  With about 200 countries worldwide from developing countries to first-world countries, this quote is, how should I put it, 'just like your opinion, man'.

cccmedia

occulus7 wrote:

I want to explore obtaining insurance for the building we live in (in) Salinas. Does anyone know of an insurance company that would do business with us? There are about 13 owners...

Dear Occulus,

Welcome to the Ecuador forums of Expat.com ...

If your building is smacked by an earthquake or some other "act of God," that's potentially a major expense to an insurance company that is insuring a dozen owners. 

Even if the policy would cover y'all in case of such a catastrophe, you will want to vet the policy issuer's record of paying claims.

Ideally, I would find out which company honored the most claims in the wake of the Big One -- magnitude 7.8 five years ago -- and, if it's still solvent, consider going with that company, probably on an individual basis.

cccmedia

I had insurance for a year on my condo, which was then new, circa 2014.

I found communicating with the agent to clarify what was covered .. to be
difficult and unsatisfying.  I figured if I couldn't get a simple answer to clarify, it might be nightmarish sorting out a potential claim.

What are you going to do if your claim is denied?  Write letters to the company?  Hire an attorney to pressure them?  Take them to court?  Complain to the state insurance commission if you can find one?

I did not renew the policy after one year.

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However, I recognize that property on the coast can be severely damaged by earthquake, flooding or whatever.  This is why one must rent and not buy in Coastal Ecuador.

cccmedia in Quito