Private Health Insurance Seminar

• CAFTA has opened up the market however no other players have entered the market.

• Several different plans – International, Regional,

• London Life Insurance

• Limit up to $200,000 per year

• Deductible - doctors within the group (90%), outside the group (80%)

• He files the claim which take 21 days to be reimbursed; can be direct deposited in to national banks.

• Surgery requires pre-authorizatioin (7 days); pay deductible only; for emergencies this is not necessary. 

• Doctors – none in San Ramon in their group; this is a problem!  Hector says he is going to push to have doctors in the area added to the group; pharmacies do not have to be part of the group

• International – 20% for pre-approved, 30% outside the group; need to call

• Visit a doctor pay $10 for the visit, everything else you pay only 10%

• Difference between CAJA and INS (Cesar) – long lines/waits for care; the private care is better than the public care; CAJA is good for emergency or catastrophic care

• Optical

• Dental

• Pre-exisiting conditions – not covered; will cover all other illneses but not anything pre-existing, never!

• Have to have an exam in order to qualify for their coverage; INS pays for exams

• Age limit – up to 65, can accept between 65 and 70 but will require many tests; after 70 is difficult to get coverage; once you’re in you’re in, your premium goes up

• Premiums – the quotes on the sheet are annual costs; they are paid quarterly, every 6 months or annually; they have not risen in the last 5 years.

• Need a declaracion from your doctor indicating that you live here; residency is not required; he has a form that can be emailed; identify one lawyer and negotiate a fee to handle the declaracion (how much – €15,000 to €20,000).

• May not need an exam if you are under 65;

• Must also be part of CAJA under the new laws IF you are a legal resident; generally around €40,000/month; you don’t not need CAJA for getting INS

• Drugs – must have a prescription; can be renewed at the pharmacy for whatever the length of the prescription; Doug’s doctor issues one for January, one for February, etc.

• Prostate – not covered for the first year.

• Chiropractic – 10 sessions per incident and then can request another 10 sessions (max – 20); per year.

• Hector knows the people that handles pre-authorizations and authorizations and can call and work with them.

INS MEDICAL BROCHURE