Finally, Catastrophic Health Insurance for Expats Living in Mexico
Boomers in Paradise.org
Health Insurance for Expats Living in Mexico
Best Doctors – “Specific Defined Benefit” Insurance
As a result of our alliance with Best Doctors in 2012, our first policy was offered in January, 2013. Best Doctors Is headquartered in Boston, Mass (founded by Doctors from Harvard). In Mexico, we are covered by their Latin American Division.
From it’s inception, our “group” plan is custom tailored for the expat residing anywhere in Mexico.
Most expats who relocate to Mexico are aware that daily, routine doctor visits are quite reasonable and question the necessity of Health Insurance. Many have already planned to “self-insure” and pay out-of-pocket for the routine expenses of health care here in Mexico. A majority of expats often retain their Medicare or Canadian Provincial Insurance plans or Medicare and consequently, in the event of a major health concern, plan to return to the U.S. or Canada to use their country’s health care system.
Make no mistake, however, there are extreme medical events that may prevent you from returning “home”: sudden stroke, heart attack, cancer (requiring a prolonged treatment), or an extremely bad accident (broken hip, knee, motorcycle accident, multiple injuries sustained in a car accident, etc.). These medical conditions require immediate hospitalization, surgery, etc. Admittedly. hospitalization and surgery are more affordable here in Mexico than in North American, however it is still expensive when it is out-of-your pocket. Mexican Hospitals have become quite aggressive in their collection efforts and will not discharge you until your bill has been paid in full by credit card or bank wire.
Most expats cannot afford such a “hit” to their nest egg. Our Best Doctor’s plan is a custom-tailored insurance policy providing specific coverage for some of life’s messiest and more expensive life-threatening events. These events can be devastating to our nest-egg if we have to cover these expenses totally out-of-pocket. While the policy provides worldwide coverage (including the U.S.), it is designed and priced more specifically for use in Mexico, as the reasonable premiums suggest. You must possess a valid Mexican Visa (Permanente or Temporal) and reside in Mexico for at least six continuous months a year.
This Specified Benefit Plan is not intended to replace a full major medical policy, but for those who have chosen to self-insure on a day-to-day basis, it can certainly assist in protecting your assets and warding off financial ruin as a result of a heart attack, stroke, cancer, etc. In this regard, think of our Best Doctors policy as a supplement insurance policy to your decision to “self-insure” and your choice to forego a full major medical policy here in Mexico.
Please email us for our 2021 Best Doctors Summary of Benefits including price.
So, what’s the catch! You must enroll and be accepted into this “group” insurance program before you are age 70 years, 8 months!! Once accepted, you have lifetime renewal privileges as long as your premiums are paid on time.
Don’t despair if you are over the enrollment age or have a pre-existing condition that precludes you from our Best Doctors “Group” policy , our international insurance advisors are happy to assist you in finding a plan that better serves your needs.
The Forms section under this heading will provide you with an overview of the Best Doctors application process. Once you become a Member, you will receive detailed instructions for the completion of these documents from our agent.
This “digital age” is what has made all of this possible, especially since the mail system in Mexico is irregular, at best. Please be confident that we successfully conduct all of our business via the internet. All the necessary documents are securely transmitted via the internet, by courier. All Payment transactions are conducted via Paypal or our secure credit card processor (for Boomer memberships). Your yearly premiums are processed via the internet using your individual, secure member portal provided by Best Doctors.
Please be assured that our group is NOT “self funded”. We have no financial limits constraining us to only what we collect in premiums as our reserve on which to draw during any specific year. The insurance company factors all their groups together into one big pool. Granted, our usage does play a small percentage factor into our renewal rate, however the most important consideration for us is that our “group” is factored in with all of the other Best Doctor groups. The insurance company’s “group pool” is mainly comprised of workplace employee groups, civic, and professional organizations whose membership base covers a much broader spectrum of ages. This is most favorable to us, as retirees.
We’re extremely proud of the modest price increases we have received over the past 9 years: 2013 – initial policy 2014 – 8 % 2015 – 6% 2016 – 8% 2017 – 8 % 2018 – 12% 2019 – 12% 2020 – 15% We’ve watched other policies soar in price — some in excess of 40-75% in just one year.
Our insurance application process is as simple as 1- 2- 3!
Join our Group first — your membership provides eligibility for our insurance program.
Complete the Best Doctors Insurance application (emailed directly from our insurance advisor, once you are a paid member and the results of a routine blood test.
Complete our Document checklist (a list of documents required to verify your Mexican residency).
All forms are sent and submitted by email directly to our Advisor! If you have email access anywhere in Mexico, you can apply.
1. Same exact coverage
2. Same Premium
3. Same Deductible
4. Same Term (effective coverage dates)
... regardless of a member's age or sex!
Sex and age are the two most common factors that determine an insurance premium when purchasing an individual insurance policy.
We are resolute in our belief that ... Older Lives Matter, Too!
There are many legal qualifications, standards, rules and regulations that a "group" must adhere to in order to be recognized as a "group" by the insurance industry.
One of the most important qualifications of our corporation is to be registered with the U.S. Internal Revenue Service, and be compliant in filing and paying taxes on all income.
Membership Dues constitute the sole income for our group. PayPal and Square are the means we use for tracking all of our income, and consequently why all payments must process through them. As a U.S. Corporation registered with PayPal and Square, both are required to report all of our income to the IRS . Our periodic IRS tax filings must match the credit card company's records.
Most of the "groups" insured through an insurance company like Best Doctors are workplace groups, civic and professional organizations. Unlike our group, the spectrum of those being insured encompasses a much broader age group. This is of the utmost importance for our group.
At renewal time, our actual usage rate is a relative factor, when we are considered with all the other groups; large, small and of a much greater age variance.
Unfortunately, even here in Mexico we are not immune to yearly policy increases.
This is the perfect illustration of the old adage that there is "strength in numbers".
There are actually 5 major points that sets us apart from the Standard Mexican policies:
1. If you have no pre-existing conditions (that may provide for an exclusion for a certain time period) your policy coverage is effective on the start date of the policy. In Mexico specifically, regardless of any pre-existing conditions, coverage is often phased-in over a period of two to three years, as is the case with IMSS. During that phase-in period, should you receive a diagnosis of Cancer -- you will have a permanent exclusion from anything cancer-related for the life of your policy -- even though in the interim you were, in effect, paying for the cancer coverage all along.
Unlike most Mexican policies, if you have a pre-existing condition with our Best Doctors policy, if you have no claims arising from the pre-existing condition within one full year of having the policy, the pre-existing condition is automatically lifted after the one year time frame, without petitioning the insurance company and providing test results to that effect.
2. Unlike most Mexican policies, Best Doctors will accept new enrollees up to age 70 yrs., 9 mos. However, once you are accepted into the plan you enjoy lifetime renewal privileges (regardless of your age) as long as their premiums remains paid in a timely manner, and you meet the residency requirements.
3. There are no insurance application fees associated with our Best Doctors Specified Benefit policy.
Currently, only a routine Blood test/urinalysis (dated within the last 6 months) is the only test required for the Best Doctors, policy if you have no pre-existing conditions. If you have a pre-existing conditions, then you may be requested to submit further documentation in that regard.
4. Unlike Mexican policies, your policy is written in English.
5. You have worldwide coverage with the Best Doctors policy, eliminating the need for special travel insurance should you desire to travel to other countries.
Our Best Doctors policy is a Specified Benefit policy covering 8 specific major health events only.
There is no waiting period per se, unless an enrollee has a pre-existing condition (determined by prescription medications). If so, the underwriting team considers the nature of the pre-existing condition and may issue an exclusion for any event occurring where the pre-existing condition may be considered as a mitigating factor in causing the event.
If no claims arise from the pre-existing condition within the period of the first full year the policyholder has the policy, then at the end of the one year period that pre- existing condition is automatically waived without further testing or petitioning on behalf of the policyholder.
Yes, unfortunately there are certain medical conditions that are high risk and not insurable through either of our insurance company.
In addition to the Uninsurable Risks listed below, if you have "retired" on a medical disability, you are not eligible for our insurance policy. It is deemed that if your disability is severe enough to warrant that you are not able to work any longer, then it is a condition that is quite serious and thereby disqualifies you from obtaining private insurance.
Below is a list of the Uninsurable Risks. Be assured that if, after joining the group, you incur one of these risks, you will be fully insured since that particular medical condition was not an exclusion on your policy.
Our Best Doctors Specified Benefit policy covers neither gall bladder nor appendectomy surgeries. Under normal circumstances both of these surgeries may be obtained here for less than the cost of our deductible of $4,400 USD (roughly $85,000 pesos). Neither gall bladder surgery nor Appendectomies are considered life threatening since the symptoms present well-in-advance of the life threatening event. This is where we need to pay attention to our bodies, and not be remiss in ignoring a pain or ache.
Our Best Doctors policy offers a unique benefit, inasmuch as we have a 15 month deductible window.
For instance, should you encounter an event during the last quarter of the year (October through December) that requires utilizing part or all of your $4,400 deductible, those expenses will carry forward into the next year toward satisfying the new policy year deductible.
Best Doctors is becoming totally digital, however each new member will receive a hard-copy of their Conditions of Coverage at the initial time their coverage begins.
Renewing members receive their subsequent Conditions of Coverage via email only, in a .pdf format. We recommend you keep the .pdf updates in a folder on your desktop titled "Boomers Insurance", for easy access.
Our Best Doctors policy is a Specified Benefit policy, mainly covering 8 life-threatening events only. Our policy provides for a one-year exclusionary period for any pre-existing conditions. However, if you have a pre-existing condition (as evidenced by prescription medication) and you have no claims arising from that pre-existing condition(s) within one full year of having your policy, then that pre-existing exclusion is automatically lifted from your policy for your second year of coverage. Going forward, you have no exclusions from coverage for those 8 medical events.
As of March 1, 2015, if you have NEVER had an occurrence of cancer you are covered immediately with the Best Doctors policy.
Unfortunately, the insurance community has adopted the stance that if an individual has had an occurrence of cancer, then the likelihood of a recurring cancer event is highly probable and consequently, and therefore it is considered an uninsurable pre-existing condition.
As of March 1, 2015, only a routine blood test and urinalysis (plus PSA test, for men) are required for the Best Doctors Catastrophic coverage, regardless of your age.
The cost for these required tests here in Mexico are quite nominal compared to the cost in the U.S. and Canada.
As a cost-effective measure going forward, in 2022 we may require a full medical physical in order to join. The results of the physical ensures the insurance company that there are no existing conditions that may require expensive procedures in the near future that can effectively jeopardize the loss ratio of our group.
Month 1: You become a paid Member of Boomers-In-Paradise. Your paid membership entitles you to begin the application process and, as a benefit, if you submit your insurance application and blood test to our agent by the end of that month you are entitled to be part of our once-monthly batch submission on the 10th of the next month.
Month 2: Your application is submitted to the insurance underwriters on the 10th of the month. The underwriting (approval) process takes approximately 10 business days, so our agent is notified around the 20-25th of the month of your acceptance. Our agent instructs you as to how to payment of your premium. Your insurance becomes effective on the first of the next month.
The 1st Day of Month 3: Your insurance becomes effective on the very first day of the month after your received approval from the insurance company, provided you have paid your premium to the insurance company.
The Best Doctors Catastrophic policy is specifically priced for use in Mexico, although it does provide a worldwide travel coverage benefit.
An individual must reside in Mexico for at least six continuous months a year, and possess either a Mexican Temporale or Permanente Visa (or provide documentation from a Mexican Embassy that you are "in process").
Copies of the following items are required as Proof of your Mexican residency.
1. A copy (front and back) of your valid Mexican Visa (Temporal or Permanente)
2. A copy of your current "paid" Mexican Real Estate Tax, establishing ownership OR
3. A copy of your Lease Agreement (one year minimum, no short term leases accepted.
4. A copy of either a CFE (electric) or TelMex bill matching the MX residence address on
your Membership and insurance applications. (the name on the bill is inconsequential, but the address must match.
Our Document checklist helps keep you organized during this phase of the insurance process.
"Groups" are entitled to certain, special benefits by insurance companies.
There are certain legal formalities, rules and regulations that a "group" must adhere to -- in order to be accepted as a "group".
The expenses involved to become and maintain both a U.S. and Mexican Corporation are ongoing and sizable. The membership fees offset the expenses of the above and the day-to-day operations of the "group" as a business.
Our insurance package includes exclusive benefits to only members of the "group".
For the Best Doctors the following is required (the Document Checklist will keep you organized🙂
1. Boomers Paid Membership
2. Completion of the Best Doctors Insurance Application
3. Completion of the required Blood/Urine test dated within the last 6 months from the date of your insurance application.
4. A legible copy of your US or Canadian passport.
5. A copy of the Lease Agreement (for a period of one year or longer) or your paid Mexican real estate taxes if you own your own home, as evidence that you reside in Mexico for 6 continuous months each year.
6. A copy of a recent TelMex or CFE bill showing the lease address or owned property address that is listed on your Insurance application. The name on the bill is inconsequential, it is the address that must tie with the Lease Agreement or Tax bill above.
6. A legible copy of your Mexican Visa, front and back
Correct, in our group we do not offer joint policies for the following reasons:
1. In a "group" situation, joint policies are not necessarily cheaper, you are already getting a discount by being a member of the group.
2. The majority of us do not have minor children we must consider.
3. Insurance regulations state that with a "joint policy", if either one of the parties dies or the parties divorce, the policy is terminated, and each party must pursue a new policy.
At our "mature" ages that could have a devastating effect on the remaining partner. The remaining partner might be too old to qualify for insurance, or perhaps they now have a pre-existing condition that will make it difficult, or even impossible, to qualify for health insurance.
Consequently, it is for every member's protection that we each have an individual policy under the "group" policy umbrella.
Unlike the U.S., most doctors here do not accept insurance. They are not proficient in filling out the required insurance forms and many are small independent physicians that do not have access to a "Billing Office" as our physicians do in the U.S. Unbeknownst to you, most doctors in the U.S. subscribe to a "Billing Service" to assist with their insurance filings and/or are affiliated in some way with a larger "group" of medical professionals that provide the billing service as a benefit of belonging to that particular medical group.
Additionally, a licensed doctor in Mexico has hospital privileges at almost any hospital in their area. In the U.S., physicians have authorization to practice only at one or two licensed hospitals.
To offer you worldwide coverage, the insurance company agrees that they will reimburse you. You must still follow their specific insurance guideline protocols regarding notification of the insurance company for emergency situations and pre-authorization Protocol for planned medical treatments/surgeries.
Especially in the case of our catastrophic policy, most often hospitalization is required. It is the hospital that has the direct pay relationship with the insurance company, not the physician. Consequently, the hospital is responsible for collecting all the costs related to your stay (doctor, operating room, anesthesiologist, hospital charges, etc).
If you choose a direct-pay hospital, the hospital will verify your coverage and review your insurance pre-authorization papers. You pay them your deductible and they will then settle with the insurance company for charges incurred over the amount of your deductible.
If you utilize the services of another hospital, outside of the direct pay network, you are responsible for paying the incurred charges to the hospital upon your discharge. Then you must complete a Claim Form to the insurance company. All of your receipts must be explained and show evidence that the 16.9% Mexican IVA tax was paid, to be legally reimbursable. YOU MUST ALWAYS REQUEST AND SUBMIT A FACTURA FROM YOUR MEDICAL PROVIDERS. Be assured, this is the ONLY acceptable receipt for services the insurance company can accept as legal payment for the services you received. This is not a negotiable option. It is illegal for a medical provider to deny issuing you a Factura if you request one. If you are denied a Factura, you may report the offender to the SAT (Mexican equivalent of our IRS).
The normal time for reimbursement from the insurance company is 30 days from the date that the Claim Form is submitted with all the appropriate documentation.
Factura, Factura, Factura ...
We cannot emphasize this enough! It is somewhat customary in Mexico for the small, independent physicians to not report all of their income to the Government. So, while you are provided with a receipt for the medical services, if it does not have the word FACTURA printed on your receipt, it is not considered a legal, reimbursable receipt by insurance standards. The receipt will also show that the Mexican IVA tax is being collected and paid.
While the above warning may seem a bit trivial, when it comes to paying a sizable amount to a physician for his services, if you are remiss in getting the Factura Receipt, you may be left "holding the bag" and a non-reimbursable receipt from your physician.
Our Best Doctors "Group" Policy has a one year effective date. It commences on January 1st of each year and completes on December 31st.
Should you decide to join us mid-year, you will simply pay a pro-rated portion of the premium for that time you have coverage. Then, on January 1st of each year you will have the full year of coverage.
We begin the Reminder process for all of our members once we have notification of what the new yearly premium amount will be. We received that information just before the Thanksgiving Holiday and then we contact all our members by email. It is a relatively short time in which to renew your Boomer Membership. In mid-December, Boomers-In-Paradise provides a membership list to Best Doctors acknowledging that those members are eligible and will be renewing their insurance.
In either case, if you should have current insurance with another provider, please apply to us approximately 3 months BEFORE the expiration date of your current policy so your coverage does not lapse.
First, remember that our policy is a Specified Benefit policy covering 8 major medical events that are considered life-threatening.
These life-threatening events are simply not treatable in a majority of the smaller hospitals here. Often surgery is required and the majority of hospitals here in Mexico are not equipped to handle these surgeries.
Without exception, major surgeries should be performed only in larger hospitals that have the following services: A full staff on duty 24/7, a blood bank, immediate accessibility to an ambulance.
Local hospitals are most often used to stabilize patients so they can be relocated to the nearest larger hospital with the aforementioned facilities.
If you have utilized a hospital that is not on the direct pay list, Best Doctors will do their best to make direct pay arrangements with that hospital, but be aware that in Mexico and many other parts of the world, many hospitals simply do not have the capability to wait 30 days for payment. In that case, make sure you get facturras and then you can submit them to Best Doctors for reimbursement.