Health Insurance for Foreigners in Medellin: The Basics (Part One)

Foreigners in Medellin – whether they be visitors or permanent residents – have several choices (as well as restrictions) for several types of health insurance or alternatives.

For example: Medellin-based insurance giant Sura provided Medellin Herald with the following brief overview of health insurance for foreigners in Colombia:

“In Colombia, there are various ‘entidades prestadores de salud’” – that is, ‘EPS’ networks, similar to health maintenance organizations (HMOs) in the United States.

“The EPS affiliate member [that is, the patient] can be part of the ‘contributory’ regime, where workers in the formal sector put a percentage of their salaries into the EPS [as part of the national health-care] system, or the ‘subsidized’ regime, where persons in certain socioeconomic situations can’t afford to pay – for example, displaced persons, the indigenous communities and homeless people.

“These [subsidized regime] people can get health services in the same way that the ‘contributive’ persons get health care in Colombia.

“Foreigners also can be affiliated with an EPS network, but only if they join either as a formal employee of a company, or else as an independent person, or as a beneficiary [such as a spouse or other family member] of an EPS affiliate or another affinity as defined by Colombian law.

“In Colombia, there are private, public and mixed [public/private] EPS networks, and all of them are subject to supervision by Colombia’s Superindendencia de Salud [Health Superintendant].

“The big difference between one or another EPS is how each administers financial resources, upon which depends the level of service to their affiliates.

“On the other hand, there is private health insurance. This insurance is available to  persons that meet certain requirements demanded by the insurors.

“Some of these requirements include age limits. Almost all insurers in Colombia only will [write new policies for] persons up-to-59 years old. Other restrictions include no pre-existing health problems. Or, if such conditions exist, then these must be disclosed — and the insurance companies then will decide whether they want to insure that person.

“Another very important restriction is that women who seek a private health insurance policy in Colombia cannot be pregnant at the time of the application.

“Private health insurance carries a cost in addition  to the premiums you must pay to join an EPS. Such private insurance ensures very good health care in Colombia.

“Within the private sector, there are various other ways to ensure access to health care for emergency situations. People can pay for emergency services with credit cards, and almost all private insurers in Colombia also offer emergency health-care policies.

“For example, Assist Card offers medical assitantance for foreigners who visit our country. These policies are available at very low cost and cover emergencies that could occur. You only pay for the time you are in Colombia.”

Prepaid Medicine Advantages

While buying a prepaid medical policy is much more expensive than the cost of a temporary traveler policy or an EPS policy, the prepaid system offers big advantages, Sura pointed out to us.

“The advantage of prepaid insurance versus the health care policies that are provided through the EPS systems are basically the following:

“1. In prepaid, you can ask for appointments with specialists you prefer, provided that they have an agreement with the insuror responsible for supplying that particular procedure, whereas you will have to wait your turn to see an EPS specialist.

 “2. The time required to obtain an appointment with a specialist in the prepaid network may be one to three days on average, whereas in the EPS networks it will take approximately one to three months to obtain an appointment with a specialist. In addition, to obtain an appointment with a specialist in EPS networks, you first have to go to a general practitioner to get a referral to see a specialist.

“3. With prepaid medicine, you can choose the clinic you want — provided the clinic has an agreement with the prepaid insurer, which usually means several clinics are available – whereas with the EPS, you only have one choice: the IPS (Institute of Health) provider.

“4. The prepaid health system offers you the option to request reimbursement for fees paid to specialists outside the prepaid network agreements, whereas this isn’t posible with the  EPS networks.

“5. With prepaid medical coverage, you, have the option of getting a private room in case of hospitalization, whereas with the EPS system, if you are hospitalized, then you share rooms with other patients.

“6. With prepaid medicine, authorization for high-cost medical procedures is immediate, whereas obtaining such authorization in the EPS networks often requires a ‘tutela’ [lawasuit] where a Colombian court judge orders the EPS to authorize the medical procedure.

“7.  In prepaid, original-manufacturer drugs are the most recommended, whereas in the EPS system, drugs are generic.

“Note that in all cases involving emergency medical care, it doesn’t matter whether a person has prepaid insurance or EPS. Emergency care must be immediate,” as required by Colombian law.