DR Health Insurance

canned oj

Member
Oct 24, 2013
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Was reading some threads last week ( Real estate collapsing, Foreigners Leaving ) and some posters said that DR health insurance wouldn't be honoured if not legal resident. I have had DR insurance ( Universal ) for some time but have never used it. In the thread it mentioned new changes is this true. I'm a snowbird 5-6 months and getting local insurance is more reasonable than travel insurance. Anyone have info on this. Thanks
 

xstew

Member
Jul 4, 2012
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Why not without residency No Banking- No drivers Permit- No credit-No Company. Residency is big income for the D.R.
 

william webster

Platinum
Jan 16, 2009
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It was mentioned earlier that coverage limits are compromised.

Mike Fisher cited his friend... who had a several hundred thousand claim (300,000 pesos?), but because was a 'visitor' (for 15 yrs or so), his claim was restricted to a very small amount.

The fellow immediately sought and obtained residency but still needed to pay the shortfall.

It is posts like Mike's like should awaken the sloth in all of us.... if not legalized yet and want to participate in the system
 
Feb 7, 2007
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Get the whole insurance contract . Consult with a lawyer. If the small print does not say coverage is reduced without residency, and they deny claim, get a lawyer and sue. Also most of these companies have accounts in the USA or Europe for dealing with reinsurance they contract, sue sue sue in the developed country.

I think that Mike Fisher's friend story was not the whole story presented, most likely the friend slipped on payment or there were other issues involved. Maybe it was true and the insurance company counted on not being sued because if he was not a resident he would have been required to pay a bond in order to sue. But had they been sued they most likely would have come up with the payment. Or maybe the procedure was carried out in a medical facility they do not have contract with (out of network provider), etc. Again, I don't think we had the whole story there.

But the same might happen with any insurance for anything, resident or not. Insurances do not like payouts and they will always delay any claims payment. No insurance company would just jump happy out of joy to pay out your claim just because of the fact you are a resident, while they would be slamming door in your face in case you are not a resident. Insurance simply does not operate that way. Residency might be a factor, but it is not THE factor that determines insurance company's DNA (the way it behaves and does business).
 
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Cdn_Gringo

Gold
Apr 29, 2014
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As always, the best advice is to read and completely understand the terms and conditions of your insurance policy, especially at renewal time when wording will be added or removed. "The fine print" is important. Sales people the world over for any product will tell you whatever they think you want to hear to make the sale. Reality can vary significantly.
 

william webster

Platinum
Jan 16, 2009
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I'm sure we'll hear from Mike himself about this.

His friend was no 'rube' (pun intended)... he has lived here long enough to know his way around and not get fleeced.
I understand it as legitimate clause in the contract limiting non-residents' claims.

Vamos a ver...... from Mike
 

william webster

Platinum
Jan 16, 2009
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Taking it a step further.... and looking from the other side.

Name me an insurance company that will let you travel at your pleasure and maintain your coverage... no matter where you are or how long you're there.

All policies ahve limits on time and geography........... at least mine do.
 

the gorgon

Platinum
Sep 16, 2010
33,997
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Taking it a step further.... and looking from the other side.

Name me an insurance company that will let you travel at your pleasure and maintain your coverage... no matter where you are or how long you're there.

All policies ahve limits on time and geography........... at least mine do.

it cannot happen, because insurance premiums are calculated based on risk. if you have a health insurance policy which covers perils such as injuries from accidents, that portion of the rating will not be the same in the DR as it is in a country where road transit is safe. if you wanted a policy from the USA which covers you in the DR, the premiums would be higher than they would be for a US effective policy.
 

william webster

Platinum
Jan 16, 2009
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My point exactly.

And it speaks to why temporary residents of RD cannot expect full coverage ... or why temporary residents of any country can expect it.

Rubio's thought process is wrong - IMO.

Wait for Mike to clarify.

My policy, an international one covers me in RD, Canada and the USA.... provided i do not spend more than 6 months in the US.
Thats the only stipulation.

People make more of this health insurance than they should..
It's not that difficult.
 

the gorgon

Platinum
Sep 16, 2010
33,997
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My point exactly.

And it speaks to why temporary residents of RD cannot expect full coverage ... or why temporary residents of any country can expect it.

Rubio's thought process is wrong - IMO.

Wait for Mike to clarify.

My policy, an international one covers me in RD, Canada and the USA.... provided i do not spend more than 6 months in the US.
Thats the only stipulation.

People make more of this health insurance than they should..
It's not that difficult.

the policy figures that the exposure with more than 6 months residence is just too high for the results of the actuarial calculations. if you stayed in Canada for the year, you would be safer than you would be in the USA for the same period of time.
 

the gorgon

Platinum
Sep 16, 2010
33,997
83
0
Get the whole insurance contract . Consult with a lawyer. If the small print does not say coverage is reduced without residency, and they deny claim, get a lawyer and sue. Also most of these companies have accounts in the USA or Europe for dealing with reinsurance they contract, sue sue sue in the developed country.

I think that Mike Fisher's friend story was not the whole story presented, most likely the friend slipped on payment or there were other issues involved. Maybe it was true and the insurance company counted on not being sued because if he was not a resident he would have been required to pay a bond in order to sue. But had they been sued they most likely would have come up with the payment. Or maybe the procedure was carried out in a medical facility they do not have contract with (out of network provider), etc. Again, I don't think we had the whole story there.

But the same might happen with any insurance for anything, resident or not. Insurances do not like payouts and they will always delay any claims payment. No insurance company would just jump happy out of joy to pay out your claim just because of the fact you are a resident, while they would be slamming door in your face in case you are not a resident. Insurance simply does not operate that way. Residency might be a factor, but it is not THE factor that determines insurance company's DNA (the way it behaves and does business).

insurance companies do not deny any claim payment. that is patently false. in most states of the USA , for example, insurance companies are governed by the State Insurance Department. they set the parameters of operation. the companies are bound by law to operate within those prescriptions. you have to respond to notifications within a specific amount of hours, attend to the claim, and pay it within a certain time. as far back as the early 2000s , most major automobile insurers were paying automobile damage claims within hours of the accident. if something looks fishy, they have to notify the claimant in writing that the claim is being investigated, and give them a timeframe for which the investigations will proceed. absent solid proof that the claims are bogus, they have to be paid, like it or not.
 

canned oj

Member
Oct 24, 2013
52
0
16
As always, the best advice is to read and completely understand the terms and conditions of your insurance policy, especially at renewal time when wording will be added or removed. "The fine print" is important. Sales people the world over for any product will tell you whatever they think you want to hear to make the sale. Reality can vary significantly.

Good advice am in the process of trying to get policy translated into English. Can't seem to learn Spanish something about old dog new tricks.
 
Feb 7, 2007
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625
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And it speaks to why temporary residents of RD cannot expect full coverage ... or why temporary residents of any country can expect it.


I don't think so! You are wrong. While Mikes friend did not have any kind of residency, even as a temporary resident if your insurance is via TCS you have rights to full coverage as stipulated in PBS.
 

william webster

Platinum
Jan 16, 2009
30,247
4,329
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TCS & PBS --- I'm lost.

But , I think you're wrong......... wherever that gets us !!

Mike's friend paid full premiums, unaware that he getting partial coverage.... as I read it.

We'll see
 

franco1111

Bronze
May 29, 2013
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Gringo
Slightly off topic, but also look at the annual maximum the insurance will pay. Ours is 350,000 pesos per person. Everything medical in the DR costs less, so that amount goes a long ways. Nevertheless, it is worth thinking about. You can pay cash for many lesser medical situations and save on insurance premiums. Weigh your own risk.
 

franco1111

Bronze
May 29, 2013
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63
Gringo
I'm pretty sure mine is the same. Per person per year. I'm a resident. I think you can go higher by paying more per month, with a higher "level" plan.

Yes, ours is Universal Suprema or something and I think there is a policy that is one step better. This one met our needs at the time (about a year and a half ago), but that reminds me I should review again. Based on some things others have said since, we might be paying too much - 120 USD/month for two aduilts. Kids are much less.