Updated: Jun 3
By Carlos Ramirez
Both private and public health insurance in Ecuador can be easily combined with low-cost supplemental health plans which will cover specific needs such as outpatient medical care, emergency care, and coverage of medical tests. This type of basic coverage will be very useful if you have a health plan with IESS. IESS will provide you with medical assistance when you need it but you may experience long wait times when accessing your benefits, which is why we offer you the option of a supplementary plan.
A supplementary plan can be easily combined with any health plan you have contracted. One of the primary problems that IESS affiliates run into is the time it takes to access a specialist or to undergo medical tests that could be considered urgent. The problem lies in the number of members and the lack of medical centers that provide care. Hiring external medical providers has not met the desired expectations due to an unstable economy, which has left large debts to the establishments that provide this care. Access to the equipment located in the main hospitals of IESS would take approximately a month and a half in the best of cases. Additionally, a supplemental plan would benefit you if your medical insurance comes with a high deductible. The supplementary plan would cover the value of the deductible of a major expense policy and your final deductible would range between $100 and $180. This means that you would obtain the benefit of both policies at the same time and have some of the best coverage available in the Ecuadorian market.
The costs of a basic supplemental plan with coverage of up to $12,000 is around $49.25 per month, and it will perfectly compliment your IESS plan. With this plan you will have access to medical appointments, blood tests, imaging, and emergency care. Plan benefits such as dental coverage of $100 per year and eyeglass coverage of $80 per year among many other benefits are also included in your plan. We recommend this plan so that you use IESS medical care only in case of chronic diseases that require expensive, continuous treatments, such as chemotherapy sessions.
Currently, IESS as an institution has many shortcomings which force members to opt for other options. Wait times in emergencies and to obtain medical appointments can be exhausting. Language is another important aspect to consider, since you must always be accompanied by a translator to help you communicate with the staff. The combination of an supplementary plan to your IESS plan will allow you to enjoy different benefits and will guarantee you adequate medical attention in your language.
Combined plans are the most favored option today. These plans allow you to merge two different policies that, combined, provide you with the highest coverage possible and with friendly deductibles for your pocket. It is also important to be aware that some medical expenses are not covered by insurance companies and there are exceptions to coverage that are specified in the contracts acquired between you and insurance companies. Things that are not covered by insurance companies are excess fees, vitamins, sunscreens, moisturizing or hydrating creams, exams under normal parameters, and negative COVID tests. Insurance also does not cover podiatrists, chiropractors, acupuncturists, and doctors in general not authorized by SENESCYT, as these doctors will not be able to obtain coverage from your insurance. For this reason, we recommend that before opting for any medical procedure, you get a second opinion in which you compare prices, benefits of the treatment, and corroborate that your doctor has a valid medical degree.
We have had cases in which a minor emergency which would normally cost $800 to $1,200 has cost members up to $8,000 due to a doctor taking advantage of his professional ethics. In other words, members have been forced to pay excess fees applied by the doctor. The unfortunate thing in these cases is that the affected person cannot report these cases since there is no code, law, or regulation that regulates the price for medical fees. The only stated regulations, which are suggestions, are that of costs for care in operating rooms or emergency rooms, as well as the value for supplies and medications administered in hospitalization. Cases of members being taken advantage of are minimal but they do happen, which is why we always recommend a second medical opinion.
In Ecuador you can find different insurance plans, companies and brokers, but we recommend that before making a decision you always analyze the value of the deductible, the insurance company, the coverage of your medical plan, and its monthly payments. Once you have considered these points, analyze if keeping your insurance only with the IESS is the best option by trying to use your insurance, accessing medical appointments through the IESS, and evaluating the level of care. If after this you feel disappointed by the care you received, you can always opt for a supplementary plan. If your budget is small, don't worry, there are plans from $39.20 per month that could perfectly meet your medical needs while also using IESS for continuous medicine, care in case of pre-existing conditions, chemotherapy, or other ongoing needs.
The public health system will always be subject to the current government and its laws, while private insurance will maintain its coverage, regulations, and monthly payments regardless of the current government, which will guarantee you medical care on time and in the place of your choice.