- Thread starter frank recktenwald
- Start date
A warning for ex pats with low budgets
I think that's right - but once you're in, you can stack them, the policies by upping the level - which is what I'm doing.
My International carrier doubled me at 65, so I am backing off there and upping the RD policy.
Yes, I have both
ARS Universal.
I would NEVER go through an "Agent/Broker", they have a history of taking your money, and NOT paying the insurance company.
You get to the "ER" and find that your coverage was cancelled!
Go ONLY to the "Home Office" of the ins. co.
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"Fish" maybe you were refused due to a "Pre-Existing Condition"????
I have heard you are UGLY!!!!!!!!!
:cheeky::cheeky::cheeky::laugh::laugh::laugh:
Couldn't resist!!!!!!
I would NEVER go through an "Agent/Broker", they have a history of taking your money, and NOT paying the insurance company.
You get to the "ER" and find that your coverage was cancelled!
Go ONLY to the "Home Office" of the ins. co.
CCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCC
"Fish" maybe you were refused due to a "Pre-Existing Condition"????
I have heard you are UGLY!!!!!!!!!
:cheeky::cheeky::cheeky::laugh::laugh::laugh:
Couldn't resist!!!!!!
palic was the only insurance requiring pre-authorization of some meds when i worked in the pharmacy. it seems an overkill to have to go to the insurance office to get your prescription stamped.
universal or humano may be more popular and therefore more widely accepted but generally large insurances offer similar packages.
universal or humano may be more popular and therefore more widely accepted but generally large insurances offer similar packages.
I got in after 60 but before 65.
They tell me I can up my coverage........ we'll see
As far as I know, nobody does the 'over 65's'....
to clarify.... coverage can continue after 65 but you cannot sign on after 65.
FishMan is about to test that threshold .
Stay tuned..........
They tell me I can up my coverage........ we'll see
As far as I know, nobody does the 'over 65's'....
to clarify.... coverage can continue after 65 but you cannot sign on after 65.
FishMan is about to test that threshold .
Stay tuned..........
Well, you're about 24 hours late with that little token of advice! I guess I'll just have to call the insurance company every once in a while and make sure it's paid
Yes, and it's the same stuff. Prescription strength is 500 mg twice a day, that's the only difference, so you have to take more. Same with Motrin/Advil, OTC is 200 mg, prescription strength is 600 or 800 mg 3X a day - so just take 3 or 4. My DR maid calls them 'magic' pills because they work so well for her aches and pains.
I am looking at the quote we got from Universal. About $65 a month each person. ANNUAL LIMIT $350,000 pesos. You better hope medical care is cheap here. Also, it looks like one should shop around. This quote seems high, but the agent says the difference is the company will pay. (Plan is "Supremo, covers most things 100 percent, some only 85 percent.)
I've been doing some research in health insurance lately.
Many say they have "insurance" gut it's the lowest level, most basic kind with low coverages. If you go to a private clinic with a serious condition that clearly exceeds the limits, indeed you may be asked for cash before services are rendered.
Some laws were passed the last year or two that forbids clinics from turning anyone with a serious, acute condition...like the states. 'Course, this is the DR and that doesn't mean the law is followed by spirit or letter. But it's getting better.
Basic coverage is available to anyone under 60 in every insurance company. Over 60? May have to do some fancy footwork if you want more than the most basic policy.
But it's doable.
Keep in mind that health insurance is different here. There is a basic policy, then excess policies. They get stacked, one on top of the other and are NOT on the same policy...and may very well be with different insurance companies. So if you have a "better" policy what it means is the primary policy pays first, then the better, secondary policy pays above and beyond the basic.
I know of two ways to get a "better" (i.e. higher levels of coverage than basic) policy, at least through Palic (I cite Palic because we are on a Palic basic policy by law through a family group policy.)
Good luck!
Many say they have "insurance" gut it's the lowest level, most basic kind with low coverages. If you go to a private clinic with a serious condition that clearly exceeds the limits, indeed you may be asked for cash before services are rendered.
Some laws were passed the last year or two that forbids clinics from turning anyone with a serious, acute condition...like the states. 'Course, this is the DR and that doesn't mean the law is followed by spirit or letter. But it's getting better.
Basic coverage is available to anyone under 60 in every insurance company. Over 60? May have to do some fancy footwork if you want more than the most basic policy.
But it's doable.
Keep in mind that health insurance is different here. There is a basic policy, then excess policies. They get stacked, one on top of the other and are NOT on the same policy...and may very well be with different insurance companies. So if you have a "better" policy what it means is the primary policy pays first, then the better, secondary policy pays above and beyond the basic.
I know of two ways to get a "better" (i.e. higher levels of coverage than basic) policy, at least through Palic (I cite Palic because we are on a Palic basic policy by law through a family group policy.)
- Have your spouse or any immediate family member be employed in a company that offers health insurance. By law, any family member can be attached to that basic policy. Then get three friends together to form a "group." The "group" can buy the same policy at higher limits, but all must have the same policy.
- This is a little more complicated, but an option if 1) is not available. Form the least expensive corporation possible. Buy a basic policy for yourself & family; over 60 is OK since it's part of a business policy. Then get three people together to buy a "better" policy as a group.
Good luck!
CB, I do not know how with Palic, but with ARS Constitucion you can have the (what you call "better policy") for just one person. It's properly called "Plan Complementario", and as far as I know, you have to buy complementario at the same insurance company that offers you the Basic Plan. Basic Plan is all the same across all insurance companies. The only difference are contracted clinics, doctors, etc. But coverage %-wise and limit-wise is the same.
The difference comes with Plan Complementario.
I have ARS Constitucion and pay RD$400 per month and I have coverage 100% (0 copay) on everything, and about RD$8,000 per day room/lodging (anyway, here n Higuey no clinic charges more than RD$2,500 for a private suite) so this would most likely cover Abreu and CEDIMAT private room as well.
The same coverage (Plan Complementario) at ARS Humano costs over RD$1,500 per person.
If you are on TSS insurance plan (Basic plan through a company/employment) and are thinking of buying Plan Complementario, these are my recommendations:
1) ARS Constitucion
2) ARS Universal
I do NOT like PALIC because they require pre-authorization for almost everything costlier. I was at CEDIMAT nuclear Medicine last year and there was a fellow patient frm La Romana, he had to go through 4-5 various exams and bring all paperwork for approval of nuclear medicine testing. And had to go get authorization from Palic HQ in SD. My insurance was Constitucion, I got authorization in less than 60 seconds from ARS Constitucion booth at CEDIMAT and all that was needed was the doctor's prescription (all test results came back well).
Bot PALIC and HUMANO require a lot of paperwork. Constitucion and Universal do a lot of pre-authorizations over the phone.
Example: I suffer from long lasting nasal congestion (when they come they last months) because of absolutely bad environment in Higuey (heavy air contamination). I was prescribed a CT exam. When I was at clinic's Insurance department, somebody else was in there for the same exam. She had Humano and she was sent to the office to get authorization. In my case, the clerk looked on my insurance card and did the whole authorization procedure over the phone.
If you have private insurance (not through a company)
the order is a bit reversed, but it's almost a tie-up
1) Universal
2) Constitucion
Hope this helps.
The difference comes with Plan Complementario.
I have ARS Constitucion and pay RD$400 per month and I have coverage 100% (0 copay) on everything, and about RD$8,000 per day room/lodging (anyway, here n Higuey no clinic charges more than RD$2,500 for a private suite) so this would most likely cover Abreu and CEDIMAT private room as well.
The same coverage (Plan Complementario) at ARS Humano costs over RD$1,500 per person.
If you are on TSS insurance plan (Basic plan through a company/employment) and are thinking of buying Plan Complementario, these are my recommendations:
1) ARS Constitucion
2) ARS Universal
I do NOT like PALIC because they require pre-authorization for almost everything costlier. I was at CEDIMAT nuclear Medicine last year and there was a fellow patient frm La Romana, he had to go through 4-5 various exams and bring all paperwork for approval of nuclear medicine testing. And had to go get authorization from Palic HQ in SD. My insurance was Constitucion, I got authorization in less than 60 seconds from ARS Constitucion booth at CEDIMAT and all that was needed was the doctor's prescription (all test results came back well).
Bot PALIC and HUMANO require a lot of paperwork. Constitucion and Universal do a lot of pre-authorizations over the phone.
Example: I suffer from long lasting nasal congestion (when they come they last months) because of absolutely bad environment in Higuey (heavy air contamination). I was prescribed a CT exam. When I was at clinic's Insurance department, somebody else was in there for the same exam. She had Humano and she was sent to the office to get authorization. In my case, the clerk looked on my insurance card and did the whole authorization procedure over the phone.
If you have private insurance (not through a company)
the order is a bit reversed, but it's almost a tie-up
1) Universal
2) Constitucion
Hope this helps.
The issue is the over 60 issue.
If you're under 60 all manner of plans are available.
I think you can get into Plan Basico (and later plan complementario) even if you are over 60 ... either if you are legally employed and your company pays into TSS, or as a family member of someone employed.
Plan Basico allows you to "add in" children over 18 *, and parents, for as long as you pay additional premiums for them.. I think it is something like 1200 pesos per month. Once in Plan Basico, you can get Plan Complementario.
* Children under 18 are included, upon request (filling out a form), at no additional cost, and they get Plan Basico. They do pay, however, for Plan Complementario. Takes about 1 month for inclusion and you only need original Dominican Birth Certificates (legalization not needed).
Also, as CB mentioned, spouses (even common law) can be also included for free, you need Marriage Certificate or Notarized Declaracion de Union Libre http://www.sisalril.gov.do/pdf/formularios/modelo_declaracion_jurada.pdf
If you are over 60, and need insurance and cannot get one, and you have cedula, the easiest way is for one to form a Dominican company (EIRL, SRL etc.), get inserted into TSS (Tesoreria de Seguridad Social) both as a company (contributor) and employee, pay yourself a minimum wage, and pay premiums into TSS every month. Or get a friend who has a company to insert you as a minimum wage employee, and you pay the premiums to him (and he pays to TSS).
Plan Basico allows you to "add in" children over 18 *, and parents, for as long as you pay additional premiums for them.. I think it is something like 1200 pesos per month. Once in Plan Basico, you can get Plan Complementario.
* Children under 18 are included, upon request (filling out a form), at no additional cost, and they get Plan Basico. They do pay, however, for Plan Complementario. Takes about 1 month for inclusion and you only need original Dominican Birth Certificates (legalization not needed).
Also, as CB mentioned, spouses (even common law) can be also included for free, you need Marriage Certificate or Notarized Declaracion de Union Libre http://www.sisalril.gov.do/pdf/formularios/modelo_declaracion_jurada.pdf
If you are over 60, and need insurance and cannot get one, and you have cedula, the easiest way is for one to form a Dominican company (EIRL, SRL etc.), get inserted into TSS (Tesoreria de Seguridad Social) both as a company (contributor) and employee, pay yourself a minimum wage, and pay premiums into TSS every month. Or get a friend who has a company to insert you as a minimum wage employee, and you pay the premiums to him (and he pays to TSS).
I do not take primicia from you