I was in the U.S. visiting my mother when I received a picture of Ron in our tiny Moyogalpa hospital. Robinson said, “Don’t worry, Debbie. We are all helping Ron.” What??? I was frantic with worry. See my post, Love in the Time of Cholera
Chances are greater if you live in Nicaragua, or are visiting for long-term, that you will contact a tropical disease. We have had Dengue, food poisoning, Chikungunya, and maybe Cholera ( it wasn’t specifically identified, but Ron had all of the symptoms). I had a severe UTI infection that could be resolved with antibiotics without a visit to the doctor or a need for a prescription. This is where Dr. Google comes in handy for self-diagnosis, but what about a catastrophic accident or a life-threatening illness?
This is going to be a long post and I will take you through our search for health insurance options in Nicaragua and/or worldwide. So, let’s get started.
Let’s Get Real About Health Insurance in Nicaragua
I. Vivian Pellas Discount Plans
In 2012, we bought the Silver Discount Plan at Vivian Pellas Hospital in Managua, Nicaragua. We had the discount plan for two years, but it didn’t meet our needs for catastrophic events or a severe illness or disease. There were many procedures that were excluded, so it was back to the drawing board to find a health insurance plan that would meet our needs and would be accepted at Vivian Pellas Hospital and other private hospitals in Managua.
II. National Health Insurance Companies of Nicaragua
Since we have residency in Nicaragua, the process of applying for national health insurance should be easy, right? There is a catch! I went to the INISER Insurance company in Granada to fill out an application for health insurance. The first question the insurance agent asked me was, “How old are you and your husband?” I replied that we were both over 60 years old. Her response was, “Sorry. We do not insure anyone over 60 years old.”
You have to be kidding me! I shook my head in disbelief and asked her if there were any Nicaraguan National Health Insurance companies that would cover us in Nicaragua. “Nope,” she replied. As I was leaving, she ran to me with a brochure. Excitedly she announced, “We have burial insurance and we can cover all the costs of your vela (wake) and burial.” Alrighty then…back to the drawing board.
Here are a list of the National Health Insurance companies of Nicaragua. Note that they do not insure anyone with a pre-existing condition and the insurance premium is per person. From my understanding, if we would have purchased the national health insurance before we turned 60 years old, we would have been able to continue to renew a policy. In addition, the premiums are very expensive and the deductibles are high.
III. International Health Insurance Companies
I contacted two International Health Insurance companies for information. I will go through each of these companies in detail. Both companies are based in Central America and both insurances can be purchased with a passport only. My first question after looking through the premium rates and comparing them to companies that offered international health insurance in the United States was, “Wow! The premiums are so much cheaper if purchased in Central America. What is to prevent permanent residents of the U.S. from buying health insurance abroad to save on the cost of insurance?”
The answer was that to buy this international health insurance, you must have a residence and/or address in Central America in their service region. The health insurance can be used in the U.S. but, the deductibles are calculated differently and the insurance is only good in the U.S. for 180 days in a year.
A. Blue Cross/ Blue Shield of Costa Rica
I found a post on an expat forum advertising Blue Cross/Blue Shield through a new company in Costa Rica. I contacted Freddy Pacheco and he sent me the following information for three plans: Humanus, Sanitas, and Regius.
1. A sample of the medical benefits for the Sanitas Plan in English. The other plans are in Spanish. If you would like a copy of them, please ask and I will include them here.
BCBS GENERAL CONDITIONS
2. The cost of all the plans
Pros of Blue Cross/Blue Shield Costa Rica
1. You can apply with a passport. Legal residency in Central America is not required, however you must use a Central American address to apply for coverage.
2. All of the Blue Cross/Blue Shield plans are worldwide coverage. The coverage includes 180 countries, except for Vietnam.
3. No physical is needed if you are under 65 years old. If you apply when you are 65+ you will need to send an extensive list of exams performed within 2 months of the application.
4. All of the plans include travel insurance that cover $10,000 per person with a $75 deductible per event. It will not cover more than 60 days of travel.
5. Blue Cross/Blue Shield of Costa Rica insures all people living in any Latin American country.
6. Blue Cross/ Blue Shield is accepted at Vivian Pellas hospital and the new Militar hospital in Managua.
Cons of Blue Cross/Blue Shield Costa Rica
1. The Maximum Lifetime Policy coverage is low.
Humanus Plan – $100,000
Sanitas Plan – $300,000
Regius Plan – $ 1,000,000
As you may know $100,000 is nothing in the U.S. or Europe to cover medical costs. Most expats take the Sanitas or Regius Plan for more coverage.
2. There is no option to exclude the United States from a Blue Cross/Blue Shield Plan. If you have other options for coverage in the United States, Europe, or Canada, Blue Cross/Blue Shield may not be the best company for you.
3. Outside Latin America the deductible is 20% of the first $5,000. Then BC/BS will cover 100% up to the insured amount. Please focus on the Hospital Room and Intensive Care Unit outside of Latin America. These products were designed for the Latin American market, but give some coverage in the U.S. and the rest of the world for only 180 days a year.
4. As with all insurance, pre-existing conditions must be reported when applying for health insurance. Depending on the severity of pre-existing conditions, BC/BS of Costa Rica has the right to deny you health coverage.
5. Each year, the Blue Cross/Blue Shield policy will cost 9% more.
6. Since Blue Cross/Blue Shield automatically offers limited coverage in the U.S. it may open the door for higher rates down the road. Mixing the U.S. with non U.S. Expat global coverage opens the door for quickly rising rates.
7. Blue Cross/Blue Shield has companies based in Panama, and now Costa Rica. When the U.S. health insurance companies get a foothold in a Latin American country, expect very expensive renewal rates.
8. For Internal or Outpatient hospital services in Costa Rica, the United States or outside the United States: The Insured must use a hospital or facility or similar institution that is a member of our network of affiliated providers, in order to receive any benefit payable for such services.
Website for Blue Cross Blue Shield of Costa Rica Note that this website does not give you the option of paying online or filling out an online application and submitting it electronically.
B. WEA Signature Plan
Here is his initial letter:
Welcome to Offshore Health Benefits, and the WEA Signature Series, our represented CEMG group medical insurance plan (a Lloyd’s of London backed product).
The WEA plan is one of our top performing represented global medical insurance plans now. The rates are some of the lowest in the business and they do a good job at paying claims. Let’s talk over Skype when you are free, I have a few questions. Through our group, you will receive 5% off the total premium, once approved and processed.
Please review the attached information from the PA group, our partner. The WEA Signature plan allows for more time in the States than many global medical plans. They give you the option of not including coverage in the States and saving premium dollars. Plus, through our group, we will have the annual fee waived for each member.. Keep in mind that the Medical Underwriting process is more rigid than other carriers, and a medical questionnaire is required for those 65 years of age and older.
WEA boasts decades of service to expats communities all around the world and it focuses its efforts on providing quality international medical plans with comprehensive coverage solutions for global citizens. It forms part of the PA Group, an international benefit organization that designs, distributes, and delivers solutions to protect the assets, health and well-being of global citizens. WEA works with trusted global Medical Network Providers and reliable Assistance Services to ensure complete client care and support.The best thing about WEA is that you can customize your health care solution according to your needs and lifestyle, and not the other way around, so that being a citizen of the world will not affect you or your beloved ones.
The flag product of WEA for expats is the Signature plan that works for individuals, couples and families and offers a comprehensive health care solution worldwide. You can choose among three different options within the Signature plan, Care, Select and Elite, with a maximum coverage of $5,000,000 USD.
There are impressive standard benefits included with all three plans such as worldwide coverage with optional U.S. Coverage, hospitalization, emergency medical evacuation, repatriation, maternity benefits, and finally, dental and vision benefits.
The Signature plan covers both in-patient and out-patient benefits from standard routine procedures to complicated oncology treatment giving you a peace of mind when it comes to your health and wellness.”
Sounds wonderful! I like the options of excluding the U.S. for cheaper premiums.
1. WEA Brochure and Overview of the Signature Plans
WEA Brochure Jan 2015
2. A comparison of the medical benefits with the three Signature Plans.
WEA Signature Product Comparison 2014
3. WEA Signature rates
WEA Signature Rates Aug 2015
4. WEA Signature Application Form
WEA Signature Application 2014 (with member fee)
Pros of WEA Signature Health Insurance
1. The lifetime maximum coverage is much higher for all three plans. The Care Plan starts at $1,000,000.
2. You can opt out of U.S. coverage if you have other options for health care in the U.S. making the premiums much lower. Plus, you can go anywhere in the world, excluding the U.S. and Canada, and it offers direct billing and discounts.
3. The premiums are divided into male and female costs.
4. You can purchase WEA Signature Health Plan with a passport and a Central American mailing address.
5. Vivian Pellas Hospital and Hospital Bautista, both in Managua are covered by the AXA network insurance provider. But the best thing is that one may go anywhere of their liking and the PA Group can call any hospital direct and work out payment, they do this often.
6. It usually takes 2-4 days to process the application form for WEA health insurance if no other medical records are required.
7. Payments and claims can be made online and they have a 24 hour chat line so that they may serve you better.
Here is the WEA Signature Website
Cons of WEA Signature Plans
After a thorough comparison of these two insurance companies, I cannot find any cons for the WEA Signature plans. They are completely individualized to meet the needs of most expats.
So, which insurance will we choose? What options will we explore for coverage in the U.S. when we return to visit friends and family? Stay tuned for Part Two: Two Happy, Healthy Expats with International Health Insurance… or something like that. 🙂
Update: I have had many people give me other suggestions for International Health Insurance coverage. So, I am making a list here. Please add to my list if you have International Health Insurance.
1. BUPA website
A friend who lives on Ometepe Island is going through chemotherapy treatments at Vivian Pellas in Managua and this is her health insurance.
2. VUMI website
Friends in Panama have this health insurance
3. IMG website
Friends that are moving to Portugal presently have this health insurance.