Mexico Medical Expense Insurance without surprises | What you should know

Arturo acquired an insurance policy for major medical expenses in Cd. Juarez which is his place of residence. For work reasons, he travels constantly to Guadalajara and Mexico City. At some point he had a health complication while he was in Mexico City, so he went to the Angeles Interlomas Hospital and found that he had to pay a higher percentage of coinsurance than he paid at the same Angeles hospital in Cd. Juarez hospital.  His policy has a high hospital level, so he did not think there would be a problem attending the hospital in Mexico City but, then… why did he have to pay a higher coinsurance copay if it is the same hospital level he hired?

Carmen has Major Medical insurance. She was upset when she went to a hospital and had to pay out of pocket for the costs of medical care. She took care of all expenses and then had to request reimbursement for what she paid.

From the two previous cases, we will later see later what happened and how to prepare so as not to encounter surprises when using your Mexico medical expense insurance.

What should you consider before buying insurance for major medical expenses?

There are three topics that are of interest to you when it comes to obtain a quote for Mexico health insurance. There are three factors that on the one hand will impact on what you are going to pay and on the other, it will influence the attention you will receive and they are the following:

  • The premium (amount) to be paid for insurance
  • The coverage that insurance will reach
  • What you will have to pay at the time of an illness or accident (claim)

If your insurance advisor adequately explains these three factors, you will be better prepared when you have to use your mexican medical insurance policy. In this PROTEC blog, we share some points that are undoubtedly of your interest and will help you not to find “surprises”.

Key concepts to avoid surprises with Mexico medical expense insurance

At the time of quoting insurance for major medical expenses, most people go directly to the premium that must be paid and this is the first (and sometimes the only) factor they consider to obtain it.

hospital-level-mexican-medical-insuranceAs insurance advisors, at PROTEC we know that it is very important to find the best cost for you, but it is also essential to present a quote that really serves you, suits your needs, your lifestyle and your budget. We understand that the amount to be paid is very important but if you consider that you will make an investment in your health, you will surely want to have the best possible conditions.

Therefore, we present you with concepts that you should keep in mind when hiring Mexico medical insurance so that you do not get surprises at the time of use. In addition, this information will give you the weapons to ask your advisor so that you acquire the best possible policy.

Coverage (Plan hired): This is what is covered by the policy and that the insurer will pay according to the plan you are hiring. In this case, for the treatment and / or prescribed procedures derived from the medical care provided.

Tip: The insurance will not cover known conditions or illnesses that you already have before contracting the policy. It is very disappointing for people who buy insurance thinking that they will be able to use it in a disease they already had. The reality is that insurers do not contemplate payment for illnesses prior to contracting insurance. It is necessary that at the time of quoting, you inform your agent of diseases or conditions that you already have for him to take into consideration.

Hospital level: These are the hospitals where you can attend according to what you have. It is also known as hospital network.

Tip: Take into account the characteristics and the equipment available to the hospitals in which you are considering attending. When requesting a mexico medical expense insurance quote, you can choose between a high, medium or basic hospital level or network. This will depend on where you want to attend and your budget.

Do you travel a lot to CMDX, Monterrey and/or Guadalajara? If you travel within the republic and especially to these three cities and wish to attend the same level of hospitals to which you have access in your home city, ask your insurance advisor to guarantee you the same level throughout the republic. For example, if you reside in Tijuana and the hospital level you hired gives you access to the Angeles Hospital, you can pay the coinsurance that you have contracted without any problem while you are in Tijuana.

But if you want to go to Mexico City in an ABC Hospital, or the Hospital Angeles del sur or interlomas, there is a penalty in coinsurance – it will increase – if you attend there. In addition to that the Doctor fees for medical expenses are higher in CDMX than in most cities in the interior of the country.

Therefore, it is very important that you give enough information to your insurance agent so that he can “shield” your policy with full national coverage so that you do not have an increase in coinsurance and the medical tabulator covers the fees without inconvenience. doctors.

Sum insured: The sum insured is the maximum amount that the insurer will pay for an accident or illness.

Tip: You can choose between several insured sums but it is advisable to choose as high as possible. For example, in the face of a catastrophic disease such as cancer, a guaranteed sum of 2 million pesos is really insufficient. The highest insured amount that can be hired is 100 million pesos. We strongly advise you to hire that insured amount: 100 million.

And what should you pay? This is what you should know:

Deductible: The deductible is the amount you must pay for each condition or accident you claim to the insurer. This is paid only once per condition and is a fixed amount that you choose when hiring the policy. 

Tip: The higher the deductible, the cost of the policy is lower. For example, you can choose between a deductible of 9, 25 or 55 thousand pesos. If you choose the deductible of 55 thousand pesos, the insurance will be cheaper but you must take into account that if you have to attend to it, the expense must pass the amount you hired in the deductible so that the insurer starts paying the loss. For example, if you need medical attention and you contracted a deductible of 9 thousand pesos and the expenses generated are 7 thousand pesos, the insurer would not pay any of the expenses since you have not exceeded the deductible. On the contrary, if your deductible is 9 thousand pesos and your expenses are 35 thousand pesos, then the insurer would pay the expenses since you have exceeded the deductible.

Co-insurance: Co-insurance is the percentage you will pay in relation to the total cost of medical care, once the deductible has been deducted. Unlike the deductible that is a fixed amount, co-insurance is a percentage of the total amount that the insurer will pay.

Tip: In the quote you request, make sure that the coinsurance cap does not affect your finances. For example, if the co-insurance of the policy you hire has a cap of 35 thousand pesos and a percentage of 10%, although the cost of medical care is 1 million pesos, the most you will pay for coinsurance will be 35 thousand pesos.
To show you the amounts in an example using 10 percent Coinsurance:

    • Total health care expense: 80,000 pesos
    • Deductible: 9,000 pesos
    • 80,000 – 9,000 = 71,000
    • 10% coinsurance: 7,100
    • Total compensation by the insurer: 63,900 pesosTotal to be paid by the insured: 16,100 pesos

Medical tab: The medical tabulator is a list that contains the maximum amount that the insurer will pay for medical fees. For example, if the medical fees are 800 pesos and the tab you have chosen covers a cap of 1200, the insurance will pay 800 pesos without problem; but if the fees are 1500 and the tab you hired has a cap of 1200 pesos, the insurer will cover the amount you have hired and you will have to pay the difference.

Tip: Take into account the medical fees charged in your area or in areas where you travel frequently. For example if in your place of residence the fees range between 800 and 1200 pesos, a cap of 1200 sounds reasonable but if the places where you travel frequently have fees of 800 to 1800 pesos on average, you will have to pay the difference if it is that you have to attend there. As you can see, it is very important that when quoting you tell your insurance agent if you are a frequent traveler and what are the cities to which you travel. In our experience, cities like Guadalajara, Monterrey and Mexico City have higher fee costs, so if you travel constantly to those cities, it is recommended that you have a high medical tab so that the insurance you hire, covers the total cost.

Hospital network:  The hospital network are the Hospitals, Clinics and Sanatoriums that are in agreement with the insurer that you have hired.

Tip: Each insurer has a list that contains the Hospitals, Clinics and Sanatoriums that are in your hospital network. It is highly recommended that you review the network so you know which hospitals to give priority to in case you need to go to one.

Why is it important to know the network? Because if you attend a hospital in agreement, the insurer will make the direct payment – the payment will not have to be made by you. If you do not attend a network hospital, you will have to make the total payments in the hospital and then, ask the insurer to reimburse the spent – which implies a series of procedures, time and paperwork. As you can see, it is better that you and your family know the hospital network so that you can take care of yourself without worrying about making any payment to the hospital.

Important: Share your policy and the hospital network with your close relatives so that if they need it, they will transfer you to a network hospital as much as possible.

In conclusion

From the experiences we raised at the beginning of this blog, Arturo had to pay a higher coinsurance and a difference in the payment of the treating physician’s fees since he had not contracted the total national coverage that guarantees access to them. hospitals in your hometown, without any penalty. In addition, the tabulator that he had hired was low to cover the highest fees that places like Mexico City have.

mexican-medical-insurance-total-national-coverage In Carmen’s case, she was not treated at a network hospital, so she had to pay the hospital and then request reimbursement. Hence the importance of attending a network hospital when possible. This, in order not to make any payment to the hospital. The insured will only have to pay the deductible and coinsurance, if applicable.

The acquisition of Mexico health insurance is something serious that you should consider with a professional insurance agent. The agent must answer your questions, ask key questions and offer options that fit your needs, lifestyle, and your budget.

Do not get carried away only for the price. If you are considering the purchase of major medical insurance, it is much more advisable to pay for something that covers your needs as much as possible.

When we are in health situations, what we most want is to be well cared for, and that the economic factor is not a concern anymore. Get advice from a professional insurance agent like PROTEC.



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