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4 things to know about Health insurance policies in Mexico

Published Date: Mar 10, 2022

4 things to know about Health insurance policies in Mexico

If you have a health insurance policy or plan to protect yourself with one, these points will be of interest to you

1. Difference between a Travel vs Health (Major Medical Expenses) insurance policy.

The main differences are the coverage period and coverage limits: travel insurance covers you from a single day and up to six or twelve months and is NOT guaranteed to be renewed. The limit can be as low as ten thousand dollars and can or up to five million dollars. Another difference is that the travel policy does not cover pre-existing conditions, that is, treatments prior to the start of the trip. An advantage these policies have is that travel policies do not have a deductible or coinsurance. The payment to doctors and hospitals may or may not be direct. It is usually handled by insurance company reimbursement to the client/insured. Health insurance policies, whose minimum coverage period is one year, are automatically renewed. Your limits can range from one million to fifty million dollars. Coverage for pre-existing condition can be covered after a waiting period for all diseases and accidents that are not excluded. These policies work with a network of hospitals and doctors across the country with whom the insurance company has a direct payment agreement, and the insured only pays the deductible and coinsurance.

2. What is coinsurance and how does it work?

Co-insurance is the financial participation of the insured with the insurance company. It is typically a percentage of ten or twenty percent and normally capped up to a fixed dollar amount. In a claim payment by the insurer, the deductible is applied first to the total claim amount and then the applicable coinsurance is applied. For example: from a payment of one hundred thousand dollars with a deductible of five thousand dollars, there would be ninety-five thousand dollars to pay, and if you have a co-insurance amount of ten percent, that amount is also applied so, nine thousand five hundred dollars is subtracted, resulting in eighty-five thousand five hundred dollars paid to the insured. But, if the coinsurance is capped up to an amount of two thousand dollars, only these would be subtracted from the ninety-five thousand, which results in a payment to the insured of ninety-three thousand dollars. Nowadays almost all policies have co-insurance capped.

3. Waiting periods.

Waiting periods are the periods in days that must run within the term of the policy for certain diseases to be covered. Insurers use this practice to prevent people from buying health and medical expenses policies for the sole purpose of being treated immediately for a pre-existing condition. Insurance policies are meant to cover sudden and unforeseen events. The most common waiting periods apply to back, knee, HIV, cancer and pregnancy complications. Coverage for accidents is covered from the very beginning of the policy term, that is, they do not have waiting periods.

4. Why check-ups are not covered in a Health Insurance (Major Medical Expenses) policy.

Major medical expense policies are intended to cover the insured's expenses for illness and accident. These incidents are considered major medical expenses when the time in the hospital is equal to or greater than twenty-four hours. Minor medical expense policies are intended to prevent illnesses and monitor health. These offer various consultation services and medical examinations during the year with a network of clinics and hospitals approved by the insurer. The insurance companies that offer these policies are registered as specialized health insurance companies.

Call or email Novamar Insurance Mexico and we will set up an appointment to discuss your individual situation and work with you to find the best plan for medical expenses, travel, or minor medical expenses that fit your needs.

For more information you can visit us on our page
México Health Insurance
Or contact us at
México - 322-297-6440
México - 800 627 46 37
USA / CANADA - 949-274-4111