The short answer is no. Health Insurance applications must be first submitted though underwriting where you will provide information regarding your medical history. Generally, preexisting conditions will have some sort of restriction on the policy. The coverage proposal is determined on a case-by-case scenario and it will depend on the severity of the risk presented by the condition. Once you are signed up, however, any condition that may arise during the life of the policy will be covered lifetime according to the terms and conditions of your policy.
Novamar Insurance Mexico has specialized in providing insurance solutions for the expat community since 2009. We offer communication in English, as well as a courtesy translation of important documentation –including your insurance policy.
Novamar will help you understand the claim documentation needed for the insurance company but as your broker we are not authorized to intervene in the process. The insurance company executive will facilitate and manage your claims directly.
IMSS is also a government healthcare program mostly for employees, however some expats also join. The annual fee is approximately $400 and is renewed annually. People with pre-existing conditions are normally not accepted in the IMSS Program. The downside of depending on IMSS for all your healthcare is that you have no control over the doctors or specialists that you see for your problems. Sometimes the wait to see a doctor or to receive medication can be uncomfortably long in very crowded hospitals.
Seguro Popular is a Mexican government healthcare program. Seguro Popular has many hospitals and hundreds of clinics throughout Mexico. Expats must have a Temporary or Permanent Resident visa to qualify. There are no pre-existing conditions restrictions and there is no age limit. Your insurance starts immediately and is nationwide. You should always present the enrollment approval form and number when needing care.?Coverage is for 3 months to 3 years. This insurance was designed to serve the poorest of the poor.
Some Insurance companies have a network of hospitals and doctors, and if you prefer to be treated at a hospital or with a doctor out of their network, they would cover you through reimbursement up to a certain limit. You can consult with your insurance agent who can tell you what is the amount of coverage included in your policy for out of network treatments. At Novamar Insurance Mexico we have plans that allow you to choose any hospital in Mexico.
An RFC is a personal identification code Mexican citizens have for life. When Americans and Canadians (or any other foreigner) don’t have a Mexican residence card, they don’t have an RFC. A general RFC code is used for this group of people recognized by any institution in Mexico. When you need a Factura but you don’t have your own RFC, you can have your Factura issued under this general RFC code.
A Factura is a receipt. The only difference is that a Factura has an official number that Mexican Insurance companies need in order to pay reimbursements. When you ask for a Factura, you need to provide your RFC.
You would have to submit an official invoice (Factura) to the insurance company for reimbursement. If any laboratory studies are prescribed you also need to submit a medical report, prescription, and laboratory official invoice. The insurance company will apply coinsurance and reimburse the rest.
An insurance policy can only be cancelled by the insurance company for non-payment or by omitting and stating false information on the insurance application. It is very important NOT to let your health insurance policy lapse for any reason.
Premiums are calculated in increments of 5 years of age (from 50 to 55, from 56 to 60, etc.). Insurance Companies review their premiums yearly. Rates depend on the insurer’s loss experience historical, current, and predicted future medical costs. While rates increased about 8% annually industrywide in 2016, premiums are a fraction of what people pay for similar coverage in the U.S.
The Mexican Insurance Companies have a deductible per medical condition. Every time an insured submits a claim for a new medical condition or illness, he or she has to cover the deductible. After the deductible is met, the insurance company will continue paying bills related to that illness or medical condition as long as the policy remains in effect and the policy coverage limit has not been exhausted. With these policies, it is better to choose the lowest deductible. With Foreign insurance companies, just one deductible is applied per person per year. You can accumulate medical bills during the year. Once the policy deductible has been reached, the insurance company will pay the rest.
It is the date on which the policy begins. The policy begins on the exact date which the insurance company accepted the application, not the date the policy is delivered. Waiting periods begin on the inception date.
This is a period in which you are not covered for a specific condition or conditions. If you present any symptoms or expenses during this waiting period, the insurance company will not be covering any expenses related to this condition even after the period is met. This is the dynamic of the waiting period with any insurance company. It is important to understand what the waiting period implies to avoid false expectations. Once the waiting period is met while in good health, then the insurance company is responsible to cover your illness/es from this moment onward.
Cancer, neurological conditions, any medical conditions that occurred less than 90 days from signing the application. Conditions not accepted vary from company to company and Novamar Insurance Mexico’s mission is to find the best policy to suit your individual situation.
Applicants 65 years and older must submit to a medical examination which normally consists of urinalysis, blood chemistry of 6 elements, electrocardiogram at rest, and a medical examination. Applicants who are younger than 65 years of age may be required to submit to a medical examination if certain medical conditions are present.
The age limit with some Mexican Insurance companies is 64. Now in Mexico you can find some Health Insurance companies who accept you up to 74 years old and we work with some of them. Underwriters may require a medical exam before being if they consider it necessary.
Chronic preexisting conditions like hypertension will most likely be excluded from coverage or will have a specific restriction of coverage. At times you may be offered a waiting period for this condition so that it is open for reevaluation at your policy renewal with updated results. Other minor existing conditions may well be covered without restrictions. When you receive an insurer’s approval of coverage, it will be honored for life once you enroll so we recommend applying for a plan as soon as you can. Before contracting any minor (or major) illness that can be linked to a coverage exclusion.
If you are uncertain about disclosing every single treatment from your past, ask your health executive for advice. It’s better to be on the safe side as undeclared preexisting conditions will be denied of coverage by your provider should any complication arise in the future. This is a common denominator among all health insurance companies so we encourage to review your health insurance application with your executive carefully before submitting it for review.
In addition, there are specific uninsurable risks. When we have clients with one of the following preexisting conditions, our insurance providers cannot offer any coverage unfortunately: Present Cancer, Insulin Dependent Diabetes, HIV, Parkinson’s Disease, Multiple Sclerosis, combination of Hypertension and Overweight, among others. These are the most common. For further information please contact your health insurance executive, and we will gladly assist you.