“Group” FAQs

The following is a list of our most Frequently Asked Questions.  The questions remain the same, even though we offer two rather diverse insurance policies.

We’re trying to make your research and decision simple by combining the answers for both policies into one convenient drop-down answer configuration, thereby saving you valuable time.

Simply click on the Question below and the Answer will be revealed!

If the answer is the same for both policies, the print is black.

Answers pertaining to our Best Doctors Catastrophic policy are posted in green

Answers pertaining to our WEA Major Medical policy are posted in teal.

Please use our Contact tab, if you require additional info.  If you have a question that is of a confidential, private medical nature, please Contact us and we will provide you with specific info for contacting our agent directly to answer your question.

This page is being posted on Tuesday, April 20, 2016. 

  • 1."Group" FAQs
  • What is an insurance "group" policy?


    fish copy

    Think of our group as a school of fish.

    Within our group, each member has the  ...

    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.


    There are many legal qualifications, standards, rules and regulations that a "group" must meet and 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  is 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,  PayPal is required to report all of our income to the IRS .  Our periodic IRS tax filings must match the PayPal records.


    Most of the "groups" insured through an insurance company are workplace groups, civic and professional organizations.  Unlike our group,  the spectrum of those being insured encompasses a much broader age group.  This is certainly to our benefit!


    At renewal time, our actual usage rate is a relatively small factor, when we are considered with all the other groups; large, small and of a much greater age variance.   The average group premium increase over the past 3 years has been between 6 and 10% for both insurance companies.


    The renewal rates for individual policies have seen yearly premium increases averaging between 12 and 25% per year, over the last decade!


    This is the perfect illustration of the old adage that there is "strength in numbers".


  • What makes this North-American style policy different from other policies purchased here in Mexico?


    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 the 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.


    WEA's pre-existing conditions are treated differently since it is a major medical policy covering everything.  Their policy exclusions take into account your medical history over the past 10 years, your blood test results and the Medical Examiner's report that accompanies your WEA Insurance application.


    2.  Unlike most Mexican policies, we accept new enrollees into the Best Doctors and WEA policies through age 74 years, 11 mos.  Once a member has been accepted they have lifetime renewal privileges as long as their premiums remains paid in a timely manner, and they still qualify as far as any residency requirements are concerned.


    3.  There are no insurance application fees required for either  group policy.   


    A routine Blood test/urinalysis is the only test required for the Best Doctors policy.


    The WEA policy requires the Blood Test/Urinalysis (dated within the last 6 months) AND if a new member is over age 65, the member must have submit a WEA Attending Physician's Statement completed by a licensed physician as well.  Mammograms and pap tests are also required for females.  Depending on the results of the Attending Physician's Report, other tests or reports may be required.


    4.  Unlike Mexican policies, your policy is written in English, not Spanish, for both the Best Doctors and WEA policies.


    5.  You have worldwide coverage with the Best Doctors policy.


    Our WEA policy provides worldwide coverage excluding the U.S.   Our rationale for this is quite sound.  Our membership is roughly 2/3 American, and 1/3 Canadian.  Of our U.S. expat membership approximately 90% already have Medicare coverage when they are in the U.S.  Medical care in the U.S. ranks among the most expensive in the world.  By excluding the U.S., we have been able to trim the cost of our health insurance premium by almost one-half.  That is substantial when you consider that 1/3 of our membership is Canadian and not concerned with travel to the U.S.  The vast majority of our U.S. members already have coverage there, so this coverage would be duplicative.


    If a member is travelling to or through the U.S., it is far cheaper to obtain travel insurance for the relatively short time spent in the U.S. as opposed to having a policy that covers us there -- when we live here!  Our agent will be happy to provide you with travel insurance information!


  • Is there a Waiting Period?


    Our Best Doctors policy is a catastrophic policy covers 8 major health events only.

    There are no waiting periods 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.

    WEA iCare is a full, major medical policy.  If you have a pre-existing condition the insurance medical underwriters will review your medical history, your blood test and the results of the Medical Examiner's Report.  At that time they may issue an exclusion relating to your pre-existing condition.  In most cases, the exclusion will be permanent. fAt a later date, if your pre-existing condition is no longer applicable, you may petition the insurance company, providing medical documentation, to waive the exclusion.  Or, WEA may provide you with a moratorium.  This is a prescribed time period after which, if there are no claims arising from your pre-existing condition, then coverage for that pre-existing condition will be recognized and any incidents relating to that condition will be covered going forward.

    If you are a new applicant with no current insurance (Medicare and Provincial Health insurance excluded), then there is a 180 day waiting period for treatment relating to the following conditions, illnesses or surgeries which manifest themselves or are recommended, or which symptoms occur during the first 180 days (6 months) from the effective date of coverage and will not be covered:  asthma, allergies, any conditions of the breast, any condition of the prostate, tonsillectomy, adenoidectomy, hemorrhoids or hemmorrhoidectomy, disorders of the reproductive system, intervertebral disc disease, gall stones or kidney stones.

    The above exclusions protect both the insurance company AND the group from individuals joining, knowing full well they require immediate attention and expect the insurance company and the group to assume the liability for related medical treatment.


  • Are there certain medical conditions that are uninsurable?


    Yes, unfortunately there are certain medical conditions that are high risk and  not insurable through either of our insurance companies.

    In addition to the Uninsurable Risks listed below, if you have "retired" on a medical disability, you are not eligible for either of our insurance policies.  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.

    Uninsurable Risk List


  • Are emergency appendectomies and gall bladder attacks covered?


    As of January, 2017, our  Best Doctors catastrophic policy does  cover gall bladder surgery, with a cap of $3,500 USD.  The $3,500 insurance coverage plus your $3,500 deductible equates to $7,000 USD, which should be more than ample to cover the cost of gall bladder surgery here in Mexico.  Appendectomies are not considered life threatening and they 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.


    Both of the above conditions are covered with the WEA major medical policy once each member has satisfied their 180 day waiting period.  Both these conditions are outline in the 180 day Waiting Period exclusionsl  If a new member currently has Credible Coverage with another international insurance company (a worldwide policy), then they receive a CTT (Continual Transfer Term) and they will be covered immediately upon the effective commencement date of the WEA policy.

  • Are joint replacements covered?


    Once again, a routine joint replacement is not a life-threatening condition, so it is not covered under the Best Doctors policy unless the replacement is result of an accident.


    With the WEA major medical policy, a joint replacement is covered after the 180 day waiting period and as long it meets the strict medical standards warranting joint replacements.  Certain tests and other medical protocol are required, thereby justifying replacement.  If the tests and physician reports substantiate that replacement is the recommended protocol, then the joint replacement will be performed.  Our 2017-20189 policy may amend the waiting period for joint replacement.  We anticipate having details available in early May, 2017



    Joint replacement surgery should not be taken lightly at our age.  There are numerous side effects that may occur as a result of  any surgery and the effects of anesthesia at our age!


  • Concerning extended treatments, if the treatment spans more than the one year coverage period is there another deductible due for the second year into which the treatment spans?


    Our Best Doctors policy offers a unique benefit, inasmuch as we have a 15 month deductible window.


    Should you encounter an event during the last quarter of the year (October through December) that requires utilizing part or all of your $3,500 deductible, those costs will carry forward into the next year toward satisfying the new policy year deductible.


    Our WEA policy has the normal $2,500 USD deductible each calendar year.  There are no carry-overs and the deductible "clock" resets on the first day of each policy year.  

    The WEA deductible of $2,500 USD each year is $1,000 USD less than the above Best Doctors policy that has a $3,500 USD deductible.

  • Do members receive their own copies of the Conditions of Coverage, providing more detailed benefit information?


    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.


    WEA still provides hard-copy Conditions of Coverage each year.  I expect that soon this expensive protocol that involves printing and shipping of policies will end.  We will advise when that is on the horizon.


  • Is a pre-existing condition a lifetime exclusion?


    Our Best Doctors policy is a Catastrophic 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.


    Since the WEA policy is a major medical policy in most cases providing more robust coverage, a pre-existing condition may provide for a permanent exclusion.  There are numerous pre-existing conditions that can be corrected.   If the pre-existing condition disappears or is remedied, then the policyholder may petition the insurance company to remove the exclusion by providing requisite medical tests and doctor's reports substantiating the "request for removal of the exclusion."  There is a certain medical protocol for reviewing medical histories and prescription medication.

    We have noted that for certain conditions there may be a "moratorium" of coverage exclusion for a specific period, after which if there are no complications from the pre-existing condition, the exclusion expires.


    After a review of your medical paperwork by WEA underwriting, they will provide our agent with an offer of coverage for your specific situation.  It will detail what exactly is to be excluded or perhaps given a moratorium period.  At that time you will have an opportunity to accept or deny the policy.  If you should decide to decline the coverage, then Boomers-In-Paradise will certainly refund your membership fee in full via PayPal, no explanation required.


  • In the case of Cancer, are we covered immediately or is there a waiting period?


    As of March 1, 2015, if you have never had an occurrence of cancer you are covered immediately with the Best Doctors policy.


    Our WEA policy has a 180 waiting period for certain cancer coverage (breast and prostate) to become effective unless you converted to the WEA policy from a previous worldwide coverage policy with another carrier and had no previous exclusion for Cancer.  In this case, the waiting period does not apply and you have immediate coverage.

  • Are we covered immediately upon submitting our application and blood test results to the agent?


    With both insurance companies, during the initial stage while you are applying for insurance, you are not covered.

    Your Effective Date of Coverage is the first day of the month after you have been accepted by the insurance company and you have paid your insurance premium.

  • Are many expensive tests also required in order to apply?


    As of March 1, 2015, only a routine blood test and urinalysis are required for the Best Doctors Catastrophic coverage, if you are age 64 +.  No blood test is required if you are under age 64.


    The WEA Major Medical policy requires a Blood Test and Urinalysis from all members, regardless of age.  An Attending Physician's  Statement (a routine physical) is required for all applicants age 65 and over.   See our Document Checklist in the Forms section for more information.

    For females, the usual mammogram and pap tests are required.  

    Certain pre-existing conditions (i.e. heart problems, high blood pressure, high cholesterol, etc) may require the completion of additional medical forms.

  • How fast can I obtain coverage?


    Here is the timeline for coverage, for both our Best Doctors and WEA policies:

    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.

  • Are there residency requirements?


    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, to be eligible and considered a Mexican resident.  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 WEA policy has no residency restrictions, other than you cannot use the policy in the U.S., and you must reside outside the U.S. for at least six months per year.   This policy is strictly limited to expats, so you must possess a valid passport from another country (other than Mexico).The same items listed above are required to verify your Mexican address.


    Our Document checklist helps keep you organized during this phase of the insurance process.

  • Why must I be a Boomers Member to be eligible for coverage?


    "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 "grou" as a business.

    Our insurance packages constitute a huge benefit  exclusive to only those members of the "group"

  • What other documentation needs to accompany my insurance application?


    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 copy (front and back) of your valid Mexican Visa (Permanente or Temporal)

    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 your are a full-time Mexican resident.

    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

    7.  The Document Checklist is completed.


    If applying for the WEA Insurance, we require the following (the Document Checklist will keep you organized):

    1.  Boomers Paid Membership

    2. The Document Checklist be completed

    3.  Complete the Blood Test/Urinalysis/PSA test (for men)

    4.  Complete the WEA Insurance Application

    5.  If age 65 or over, have a licensed physician complete an Attending Physician's Statement.  Females are required to submit the results of a recent mammogram and pap test.

    6.  If  a member has certain pre-existing conditions, then  additional Medical Reports may be required to accompany the  Insurance application.  Our insurance agent can provide information regarding what additional reports may be required

    8. Copy of your Mexican Visa, front and back.

    9.  A copy of a recent Tel-Mex or CFE bill showing the same address as the applicant's Mexican Address.  (The name on the bill is inconsequential, as long as the address matches the applicant's Mexican address).

  • Why do you not offer "joint" policies for couples?


    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.  You complete the enrollment process ONCE and you are "set", regardless of the curves life may throw your way in the future.

  • There is a list of direct-pay hospital providers, but where is the list of doctors?


    The information below applies to both the Best Doctors and WEA insurance plans:


    Unlike the U.S.,  most doctors here do not accept insurance.  They are not proficient in filling out the required insurance forms and 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.

    Following the guidelines of your insurance carrier, you then pay the doctor and fill out a Claim Form for reimbursement.  Reimbursement into your account normally is within 30 days from the date you submit a fully-documented Claim.  Fully-documented means that you have taken the necessary steps to insure that you have everything the insurance company requires to substantiate your claim.


    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.



  • What if I have only a MX Tourist Visa -- do you offer an alternative, short-term insurance program?


    We know that not everyone is eligible for a MX Permanente or Temporal Visa.  Sometimes it is due to the financial requirements mandated for the above visas.  A MX Tourist visa permits short-term stays of up to 6 months at a time.

    We believe that insurance is just as important for our Snow and Sun Bird visitors, short term vacationers, those who are visiting as a "test trial" before deciding to relocate "lock, stock and barrel",  as well as those who remain here for longer periods.  Accidents can happen anywhere!  Anyone can trip -- anywhere,  at any time, and at any age.

    We do offer short term programs for visitors and also for those expats who have moved here permanently and relinquished their Medicare benefits.  It is not wise to return back to the U.S. or Canada with no coverage whatsoever.

    Please contact us and we will be happy to assess your situation and advise how we might be able to assist you in coverage.   Use our contact info page to email us, or simply call us at 376/106-0900

  • My current insurance does not expire until mid-year, can I join then or do I have to wait for your new policy year to start?


    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 policy so your coverage does not lapse.  If you provide a copy of your current policy and it is from an International Company providing you with worldwide coverage, then you may be eligible for a CTT (continuous Term Transfer) and 180 Day Waiting Period for coverage relating to some medical conditions will be waived and you will enjoy full coverage immediately.

    Our WEA policy has its policy year from July 1st through June 30th of the next year.  As above, you may certainly join mid-year and pay a pro-rated insurance premium.  You will be contacted at the end of the insurance term about renewing your policy and then your premium will be due in full at the beginning of the next policy year on an annual basis.