IMSS


IMSS is also a government healthcare program mostly for employees but some expats who are Temporary or Permanent Residents join. The annual fee are below. For those with pre-existing conditions you are normally declined. First year's coverage is almost non-existent but second year is much improved and subsequent years provides full coverage. Part of the decision to join IMSS vs Seguro Popular is availability of hospitals and clinics and annual fee. 


​Most young doctors dream of working for IMSS because of the benefits offered. They receive 2 months paid vacation a year, free housing in some areas, free "guarderia" for their kids, 0% financing and no downpayment housing mortgage, pensions, etc. So, competition is very strong and it's practically impossible to get in if you don't have a family member working for IMSS. This is how some IMSS doctors are able to live a very comfortable lifestyle with a mediocre public-sector salary.

2019 IMSS Annual Fees / Person in Pesos

0 to 19   years old        3,900   

20 to 29 years old        4,600 

30 to 39 years old        4,900

40 to 49 years old        6,800

50 to 59 years old        7,150

60 to 69 years old       10,350

70 to 79 years old       10,750

80 and older                10,800

Cedula - Professional Designation


A cedula is a professional license to practice. All attorneys, doctors, architects, accountants, engineers, notarios, dentists, nurses, chiropractors, etc must have one to legally practice. The law provides for penalties of up to six years in prison for foreigners that practice a profession without obtaining prior authorization / credentialing as per Article 250 of the penal code.

http://www.diputados.gob.mx/LeyesBiblio/pdf/9_051118.pdf?fbclid=IwAR2d1Mmb3URTHLEPY6mpSW0Hz7AFeoVsJcREA916OOLdk3u8pwMODz2vd2w

Mexico does have certifying boards for medical specialties. The cedula is a government issued document that certifies that the professional has completed proper studies for the licensure in the appropriate school. For doctors every one must have a cedula as a general practitioner and the doctors with specialties may have a second or even third cedula that certifies them legally for the practice of their specialty(s). However, that does not mean that a doctor is competent in what they do or claim to be specialized at.

Aside from the cedula there are certification Boards for every specialty in Mexico. This is a different kind of certification which requires not only that you have legal documents (cedula) but also requires a Board exam of knowledge and of technical skill when it applies. Board certification needs to be re-established every 3 or 4 years to ensure that specialty doctors are up to date. In order to get re-certification a specialist needs to obtain certain amount of points. Points are given for National and International congress meetings, conference attendance, publishing, teaching, and other educational or continuing education participations.

Last, board certification is mandatory to work in most private hospitals and to be part of other medical associations / staff. Hence, for a patient it is very important to know if their specialist is board certified and up to date. It is the only way to fight charlatans and fraud (doctors that say they are but they aren´t).  

Boards in Mexico are known as "Consejos", like: "Consejo Mexicano de Medicina Interna", "Consejo Mexicano de Otorrinolaringología", "Consejo Mexicano de Cardiología", "Consejo Mexicano de Ortopedia", etc..... and all databases can be accessed on line.

And, there are also expats including in San Miguel who will indicate they are professionals including Nurse Practitioner but have never proven their credentials in Mexico. And, they may not be certified in another country as anyone can print certificates. Once an expat is certified they apply at INM for permission to work. Some expats have bypassed this requirement as well.

So, the next time any one including an expat states they are a doctor, engineer, architect, lawyer, chiropractor, dentist or any other professional designation ask to see their cedula. Then check it on-line to ensure it is real.  http://www.cedulaprofesional.sep.gob.mx/cedula/indexAvanzada.action

And if you know the Cedula number enter it here: http://www.buholegal.com/consultasep/

 

Private Health Insurance

 

Much of the following is from a Mexican doctor. 

 

Mexico has a network of private hospitals that you can choose to go to, which provide excellent care. However, these hospitals are for-profit, and they are generally much more expensive than care at public hospitals. If you do find yourself at one of these hospitals, be prepared to provide a deposit or insurance information in order to cover the cost. 

On average, we find labor costs to be 1/10th what they would be in the US, but medication and equipment are still very expensive and these hospitals will at times raise the cost dramatically in emergency situations.

 

Many foreigners that plan on utilizing the private care system will pay out-of-pocket for all their minor bills. They carry private health insurance plans to cover them in case of an emergency.

There are two types of plans available: 

They are national plans and international plans. National plans are sold by Mexican insurance companies and they will cover you in Mexico, plus many have riders that will have partial coverage back in your home country. 

International plans are sold on the international marketplace, with many of them being US-operated insurance companies. These plans will provide coverage for you worldwide, including full coverage in your home country and Mexico. The cost of this insurance may range between $80 – $800 USD a month depending on your age and selected coverage. If you are under 65, the average cost of a basic plan is around $100 a month. If you are older, it will increase until you’re 75 and then plateau at around $250 a month.

Two considerations regarding private insurance:

Private insurance will not cover pre-existing conditions. If you do have one at the time of application, the insurer will review your medical history and provide a cost. Most often they will exclude your specific condition from coverage, while insuring the rest of your body. If not, they will have a higher deductible just for that condition.

Claims can be very difficult to file and get approved on your own. If you do choose to secure private insurance please ensure to use a broker that will represent you and file claims for you. I work closely with an excellent insurance provider. They are an agency that focuses on the expat market.

Please contact me for your private insurance needs. 

Public and Private Healthcare 

All of my services are available in Puerto Vallarta / Riviera Nayarit and San Miguel de Allende.


Please contact me for all your insurance needs including health, autos, property, etc. 

Farmacias Similares are found throughout Mexico and on Mondays there is a 25% discount. Prices are excellent. Often the medications they sell are made by the large pharmaceuticals and contrary to myths they are of high quality. 

Seguro Popular


Seguro Popular has approximately 60 million members providing services through many hospitals and hundreds of clinics throughout Mexico. Please ask how I may provide this healthcare coverage for you in San Miguel de Allende, Puerto Vallarta and Riviera Nayarit. 

If you have an emergency you go directly to a Hospital General for treatment.

At any time, if you have any problems at the hospital including billing, quality of care etc., you are advised to contact the Medico Gestor.

Coverage includes over 900 medical interventions including cancer of the ovaries, esophagus, liver; X-rays; fractures; appendicitis; hernias; malaria; vasectomy; heart and lung transplants; autism; heart disease; electro-cardiograms; HIV; hemophilia; AIDS, etc. That is over 90% of all medical issues. Dialysis is not covered.

​Most medicines are given by the hospital/clinic, although if insurance does not cover those medicines, they are usually sold to you by the hospital at a very reasonable price. 

There are no pre-existing condition restrictions; there is no age limit.

Your insurance starts immediately and is nation-wide. 

At times, fees for your policy and care may depend on how you answer questions such as: do you own or rent, do you have cement, dirt or tile floor in your house; do you have a refrigerator and stove; how many TV’s and bathrooms; number of bedrooms; do you work; do you own a car; what is your level of education; your age; number of people in a family; are you a Mexican national vs a Temporary or Permanent Resident, etc? If asked these questions, your answers determine a DECIL (level) 1 to 9 and this will also determine what you may be required to pay for example towards surgery.  

These questions when / if asked are in Spanish and are computer generated. It is important you answer these questions correctly. Otherwise, an error may result in over-charging. There is no chart showing all the variables, which establishes your annual fee and also what may be your costs when hospitalized etc.


Temporary and Permanent Residents in Guanajuato state all pay a fee for Seguro Popular. That fee depends on how you answer questions and you will be provided a 1 year policy. In the state of Jalisco questions are not asked and there is no fee and both Temporary and Permanent residents may apply for 3 years.


Over the next few months, major changes are coming with Seguro Popular. It will be rolled into IMSS which currently has a much higher fee of 6000 to 9000 pesos per year, denies coverage to those with pre-existing conditions and does not provide full coverage until year three. When this happens, we do not know IMSS limitations and costs, so we encourage those interested to enrol with Seguro Popular now.



 


​Seguro Popular Client's Knee Surgery, Sept. 2017
 

Having never needed surgery, I was more than a little chicken to go for a knee replacement

I went for the needed first step, which was my appointment at the Seguro Popular clinic in La Lejona, San Miguel de Allende. Following that, my kind and very capable Dr.Castro set up a variety of health checks at the local Hospital General: blood work, X-Rays, cardio, etc. All was without charge.

After results were in, the local trauma staff checked on my health status. This was followed up with seeing a doctor at HOSPITAL REGIONAL de ALTA ESPECIALIDADES in Leon, Guanajuato. I arrived with my Seguro Popular policy, the requested documents and previous test results. During this meeting the doctor reviewed my case while giving me all the possible information and advice.

Following that visit, I was given the fee amount for my surgery scheduled for 10 days later. I deposited the 33,000 pesos fee. The date was confirmed. The surgeon would be Dr. Reyes.

I checked in Sunday at 3 pm. My surgery was to be the following day. When I arrived staff were kind and patient. Others were checking in. The process was amazingly professional. Never did I feel like a number.

I was provided a place to change and then taken by wheel chair to my room. The room is for 6 patients. It was clean, has a washroom with shower, comfortable. 

Throughout my 4 day stay the attention from the entire staff was kind and totally professional. Medication checks were a minimum of every 3 hours

Monday morning I was wheeled down to the surgical waiting room. I was able to watch the hospital staff. All were very professional and attending to everyone in kindest manner giving me a good sense of comfort.

All staff who participated in my operation introduced themself. I was wheeled into the operating room where music was playing and next thing I knew, my surgery was a great success!

Thank you Dr. Reyes and staff!

I was somewhat comprehensive .... but I cannot say enough good things.

Comparing Seguro Popular and IMSS


In Nayarit, IMSS is only available to Permanent Residents. Your birth certificate must have an apostle, if American or legalized when Canadian. Then it must be translated by a certified translator in Mexico. In Puerto Vallarta both a Temporary and Permanent Resident may apply for IMSS and a birth certificate is not a must. In both PV and Riviera Nayarit you will pay the annual fee which is between 6000 and 9000 pesos per year with annual renewals. Once paid you will be scheduled for a medical. Should you not pass the medical as determined by an IMSS doctor you will be denied coverage and there is no refund. In San Miguel few obtain IMSS as there is only one very basic, overwhelmed clinic and no hospital.


In Puerto Vallarta and Nayarit, Seguro Popular requires no birth certificate, Your coverage is for 3 years and there is no cost. There is no denying you once you join. Neither age nor pre-existing conditions are a factor. Enrolment is available to both Temporary and Permanent Residents. In San Miguel, Seguro Popular is also open to Temporary and Permanent Residents and their is a nominal fee. 


I encourage anyone interested in either of these programs to enrol. Seguro Popular will be joining IMSS over the next 22 months, 8 states every 6 months. At this time, no one knows the requirements once SP joins IMSS but if they are as I have noted above, those who have Seguro Popular will have coverage for the term of their policy.


In San Miguel Puerto Vallarta and Riviera Nayarit, we can guide you in obtaining this medical coverage. ​​

Public Health Insurance


Emergency Hospital Treatment and Billing

In Mexico, the Federal General Health Law (La Ley General de Salud) governs the rights and responsibilities of hospitals and patients. The key provisions of the law requires: the nearest medical facility to treat patients with emergency medical conditions; that patients receive complete information about their diagnosis and care; patients authorize any treatment; inform patient where they will receive treatment. As well, hospitals may not retain or attempt to detain a patient, his/her passport or body to guarantee payment of medical services provided. However, the patient, family members or legal representative who authorized treatment is also responsible for arranging payment of the bill with the hospital administration and/or insurance company. 


Mexico's healthcare system is significantly changing over the next two years. IMSS will absorb Seguro Popular and ISSSTE. Effective immediately: Guerrero, Oaxaca, Veracruz, Tabasco, Chiapas, Campeche, Yucatán and Quintana Roo are under the new, federal health system. Every 6 months another 8 states will be added.​


1: Private sector (you must have foreign insurance that covers you in Mexico, or Mexican insurance, or pay out-of-pocket).

2: Currently, the public sector, is sub-divided into:


a) Seguro Popular which will join with IMSS in time
b) IMSS (for insured private sector workers)
c) ISSSTE (for federal government workers, such as federal police officers, etc.) and it too with join IMSS. 
d) other, local hospitals/clinics for government workers of that particular state.. for example, in Baja California, it would be: ISSSTECali... etc. (for local teachers, firefighters, etc.)

As a foreigner, you may enrol in either Seguro Popular or IMSS.

Seguro Popular, the General Hospitals, are usually better staffed and equipped than the IMSS counterparts. Most university hospitals belong to the Seguro Popular network and it's where most research and patient-centric care is performed.

It also depends on what type of care you're seeking and where. If it's in the Mexico City metropolitan area and you have access to the national institutes (Instituto Nacional) they provide world-class medical care. Some require a referral, but if it's an emergency they do not. They're located in the Tlalpan district and they all belong to the Seguro Popular network. For example, at the Gea Gonzalez Hospital, you can be seen in the E.R. for a co-pay of 100 pesos and if they determine that it's a true emergency, they waive the co-pay. All hospitals have a "Trabajo Social" area and they'll do a sliding-scale evaluation of your ability to pay in case you require further evaluations, hospitalizations, surgery, rehabilitation, etc.

In summary: outside of the private sector, most prestigious hospitals belong to Seguro Popular. The federal Ministry of Health in Mexico City distributes funding to each state's healthcare branch of government to pay staff and equip the healthcare facilities. IMSS, on the other hand, is more centrally governed, with most of the funds staying in the big IMSS hospitals in Mexico City while the states receive a smaller share of proceeds.

​​​​Sonia

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