On Health Insurance

There has been a discussion on another forum about health care here in Mexico including health insurance company options, the IMSS and the poor person´s local option of Seguro Popular.

First of all, let me state that we are not members of either IMSS or Seguro Popular even though years ago we contemplated joining IMSS when we first moved here (to Ajijic) in 2001. We never did join IMSS because we found their financial shakiness a bit disconcerting. What we did do when we moved to Mexico at ages 59 and 54 was take out a group major medical group health insurance policy offered in those days by the LCS covered by New York Life/Seguros Monterrey which was warranted to us back then to be non-cancellable but, of course that group plan was soon thereafter cancelled - mercilessly - for all group members and New York Life tried to substitute a far inferior product in its stead so, as we were relatively young, rather than accept the inferior policy proffered by New York Life (with a per-event maximum coverage of $600,000 Pesos - a completely unacceptible proposal) we went with ING and purchased what was presented as non-cancellable unlimited major medical health coverage and we have been covered by those policies ever since. Now, we are 69 and 64 years old respectively and those policies have been taken over by AXA which purchased ING´s Mexican insurance business perhaps five years ago. We only carry this major medical insurance in the hopes of covering us financially in the event of serious medical problems that could ruin us financially as, of course, we have no U.S. Medicare coverage unless we move back there which we are loathe to do. The AXA policy is meant to cover us for major costs in the event of serious illness so we have a $27,000 Peso deductible each and pay out of pocket for routine medical care utilizing local doctors at Lakside and also San Cristóbal de Las Casas where we also live. That major medical coverage is meant to cover us anywhere in Mexico but also with emergency medical coverage up to $50,000 USD when we are out of the country. Now, I bring this up because this seems to be a subject which interests many retirees who contribute to and read these forums of interest to folks retiring to Mexico whereever that may be.

Bear in mind that, while we have been assured that our health insurance policies will never be cancelled, of course our premiums increase every year as we become older and more vulnerable healthwise. We just renewed our policies last month with AXA and my policy was more expensive than my wife´s of course since I am a male and five years older than she (69 vs. 64). Our aggregate premium cost for this unlimited major medical coverage which includes care with top physicians and private rooms at the best hospitals in Mexico, comes to the equivalent of just under $500USD a month and about $300USD a month of that is the cost of my personal coverage. Interestingly, when we quit our jobs in the San Francisco Bay Area in 2000, we were offered COBRA coverage at a local HMO at the then cost of $1,100USD a month - God knows what that would cost today and keep in mond we were being offered HMO coverage at Kaiser Permanente which iimplies communal rooms in a meat factory.

Now, what about claims we have made? So far, our most serious claim has been major gall bladder surgery I received on an emergency basis in Chiapas and, while hospitals and physician billing practices in that region leave much to be desired, AXA came though with the outstanding help of my excellent insurance agent Jesus Tejeda who lives in Guadalajara.

We find it most disturbing that some posters on other forums are claiming that IMSS has arbitrarily cancelled their coverage after years of their membership. We had always heard that IMSS was non-cancellable after perhaps three years and by now we would have made a substantial investment in IMSS coverage thinking our coverage there was sacrosanct. Pretty scary stuff if the reports we have been reading are true.

Any input from those of you with experience in these matters?

Thanks for your summary. Your account is most helpful, as I just asked on the other forum what a ballpark figure is for the cost of these private health plans through Edgar of Jesus.
So, you recommend going with a high deductible policy and pretty much self-covering out of pocket for every day medical needs?
The IMG Global Medical Insurance that I saw on ajomexicaninsurance.com would cost us as a couple of 58 and 51 about $3,200 USD per year with a $500 deductible. BUT, I have no knowledge of how well they pay claims or their network covers local docs.
So, I am inclined as David, Simpsca, and now you recommend to go with a local agent.
Muchas Gracias.

The good companies include AXA and Allianz.

jschl453 wrote:Thanks for your summary. Your account is most helpful, as I just asked on the other forum what a ballpark figure is for the cost of these private health plans through Edgar of Jesus.
So, you recommend going with a high deductible policy and pretty much self-covering out of pocket for every day medical needs?
The IMG Global Medical Insurance that I saw on ajomexicaninsurance.com would cost us as a couple of 58 and 51 about $3,200 USD per year with a $500 deductible. BUT, I have no knowledge of how well they pay claims or their network covers local docs.
So, I am inclined as David, Simpsca, and now you recommend to go with a local agent.
Muchas Gracias.

Glad I could help. As I stated in my earlier post, We have been with Jesus Tejeda or his father as our inurance agents for some ten years first with ING and then with AXA after they bought ING´s insurance business in Mexico. We have been so pleased with these guys that we moved all of our business to them and AXA including our auto insurance and two household policies here in Ajijic and in San Cristóbal de Las Casas. We have had only two claims over the years thank God, but coincidentally both occured in Chiapas. I already mentioned the major gall bladder surgery in San Cristóbal where Jesus was instrumental in maximizing reimbursement for the surgery and many other expenses we incurred in that remote city where some medical business practices are not as professioal as one would expect in, say, Guadalajara. The other claim involved an autombile accident one of us had at the Chiapas/Guatemala border in a rural and somewhat primitive area on the slopes of the Tacaná Volcano. Jesus was very helpful from his office in Guadalajara acting as a liaison with the local claims office but we were also very pleased with the excellent service we got from AXA´s Tapachula office for significant car repairs.

I would have to say, unequivocally, that having a good and responsive local agent in Mexico representing a Mexican based insurance company with an international reach is something we will always insist upon based on our claims experience with AXA. One of the things we like about Jesus is that he regularly works the Ajijic market and, unlike many business people in Mexico, he is very responsive to either cell phone calls or e-mails. He can be reached at jtejeda17@hotmail.com or at his cell phone number (333) 667 0499. I´m sure he will be pleased to give you a timely quote on health, homeowners or automobile coverage. I personally don´t know whether or not they have the cheapest insurance around as my claims experience with them has been so good I wouldn´t shop aroud for a lower rate on any of our policies. My father was a very successful independent insurance agent in South Alabama for some 40 years and he taught me over the years that, to say the least, the cheapest insurance is not always the best purchase.

Well, Dawg...I am sure that we would have done as you all have, were we as well endowed financially.
As we must perforce live more modestly, we find that wintering 300 mi SoB works very well.
Bob has the VA and I am thankfully, ans finally, fully covered under Medicare and a Medigap policy from the Mutual. Cost... about $230 US a month. Considering the annual tests I need and the cost of medical care NoB... it's not a bad deal.
Summers in our mountain town suit us just fine...short as they are... great morning discussions at the Coffee Shop, more good friends, fun dinners and good Life is good.
For Spring and Fall we like a delightfully funky little town with a ridiculous name in "The Land of Enchantment." It's halfway between the Winter and Summer digs and the Rio Bravo runs through town. All the modern conveniences at one third the price. Can't beat it.. and best of all... we can ride our bike almost everywhere in all three towns. Lizzy

I have been insured with Allianz since Feb. 2006. Our agent< Parker insurance, submitted our claim to Allianz...International Coverage for medical emergency requiring 36 hour hospital stay IN USA (12/25/2010). All documents were received by Allianz Guadalajara on 2/15/2010. Allianz refused to process until we found $17,000 USD, and provided proof of payment.

Our policy states direct bill/payment for this type of emergency. We have now discovered direct bill/payment is processed through Mexico City, and 4 months later, have yet to receive any communication from Allianz....other than receiving our new cards for 2011 in March.

Since this is our first claim after 5 years of coverage, I can honestly say Allianz would be the last place I would insure, or at least do more research when selecting an agent.

jschl453 wrote:Thanks for your summary. Your account is most helpful, as I just asked on the other forum what a ballpark figure is for the cost of these private health plans through Edgar of Jesus.
So, you recommend going with a high deductible policy and pretty much self-covering out of pocket for every day medical needs?
The IMG Global Medical Insurance that I saw on ajomexicaninsurance.com would cost us as a couple of 58 and 51 about $3,200 USD per year with a $500 deductible. BUT, I have no knowledge of how well they pay claims or their network covers local docs.
So, I am inclined as David, Simpsca, and now you recommend to go with a local agent.
Muchas Gracias.

I Googled IMG Global Medical Insurance and most of the posts by policy holders were negative. Most of them said when they needed the insurance, even though they had paid the premiums, at the time of a claim the insurer's claims agents said they were not covered because it was a pre-existing condition. Another person complained that the doctor he saw charged $95 US and the insurer told him they cover only up to $50 US per doctor visit.

Finally, After 5 months frustration, Allianz has stepped up, and directed their International carrier to pay claim....3 days before we were to be turned over for collection, $18,500.00 USD. We have been required to provide all medical records dating back to 2006, at a small expense, however inconvenient. Having lived thru this ordeal, I would suggest, everyone covered by Mexican Medical Insurance, submit a claim after every procedure, while it falls below deductible, this creates a paper trail, it will protect you from our unfortunate experience.

Fially

Jim W wrote:I have been insured with Allianz since Feb. 2006. Our agent< Parker insurance, submitted our claim to Allianz...International Coverage for medical emergency requiring 36 hour hospital stay IN USA (12/25/2010). All documents were received by Allianz Guadalajara on 2/15/2010. Allianz refused to process until we found $17,000 USD, and provided proof of payment.

Our policy states direct bill/payment for this type of emergency. We have now discovered direct bill/payment is processed through Mexico City, and 4 months later, have yet to receive any communication from Allianz....other than receiving our new cards for 2011 in March.

Since this is our first claim after 5 years of coverage, I can honestly say Allianz would be the last place I would insure, or at least do more research when selecting an agent.

Yeah! Congratulations. Now maybe your blood pressure will go even lower. I don't doubt all the stress right now contributed to that.

Dawg,

What I hear about IMSS is that this is a problem in the Chapala office. I moderate a group called Westenders - those who live in the municipality of Jocotopec may belong. One poster asked had anyone had a similar problem with the IMSS office in Jocotopec and no one replied. I know several people who use that office regularly.

While nothing in life is guaranteed, what I have seen in Mexico, is insurers who want to get out of the business sell that business to another company. I don't know anyone in the 12 years I have lived here who had private insurance and was cancelled after the 3 year period as long as they continued to pay premiums.

It always puzzles me how IMSS is "on the brink" and not Seguro Popular. IMSS is funded by employer contributions and for my secretary who is not old at all I pay MORE than 70 year old retirees pay in premiums. The employer paid premiums are huge and I wish all I had to pay was the premium for an 80 year old man, I'd pay much less. Now Seguro Popular seems, from the postings on the web boards to charge almost nothing in premiums.

So the rhetorical question is, how can an insurance fund (IMSS) with high premiums be in worse shape than another fund (Seguro Popular) that barely collects any premiums?

Spencer, my friend's cardiologist explained to me that the problem with IMSS is that after working 20 years, IMSS employees retire at full salary for the rest of their lives. I know one person who started as a secretary at age 18, went to medical while working there, became a doctor, and retired at age 38. After many years of operation, most of the money, according to this doctor goes to pay the salaries of retired employees. He said it used to be a good system but the money problem is from the retirees.

I don't know how Seguro Popular is funded but I see them popping up everywhere. There is a fairly new one in San Juan Cosala and within the last year one opened in San Antonio. They are tiny clinics but I hear the one in SJC is busy all the time with the people in town.