as for my friends case, he went for a sheduled operation(no emergency nor accident or such), which been sheduled several weeks ahead of time, to fit his work shedule.
at a hospital where he was many times before during many years for minor stuff, with the same insurance card,
always covered, but never any big sum been involved, just the usual check up stuff.
this time the whole procedure been calculated, he been told what the total cost will be and his insurance card been accepted as always in the past.
on "payday" he got the nice notice, that the insurer (ARS Humano) will only cover the maximum of 100.000.- pesos, because of a "clause" in their contract which restricts the coverage of his plan to maximum 100.000.- pesos for a non resident.
he did check that stuff with his company, who have their knowleagable staff for legal things, and they came to the conclusion that it is correct, coverage for him, as a non resident, limited to 100K Pesos.
i never read the full fineprint of a insurance plan myself, not in germany, not here, and i have no intention to start such "studies". i rely on such things always on the opinions/explanations of the ones in the know, to decide which one is the right one for me.
as for insurance prices,
my own one is the ARS Humao Platinum Plan and costs actually(my august 2015 bill) RD$ 5.373,03.-Pesos per month.(that's US$120.- per person for the Platinum Plan).
they rise their premiums every july by 8%.
when i travel abroad, like during october and november with my babygirl, i pay a travel insurance for both of us, a german contract, which costs me less than 1 euro per day per person. never needed it for the Baby, but used it a few times for minor stuff/doctor visit myself in prior years, coverage been always complete and straight on, but again, i never had any biggie to report with them.
so that's cheaper than a local DR insurance plan.
i just mention that because someone mentioned a local DR insurance plan for snowbirds/several months visits.
i don't know what such travel insurance would cost for a Canadian or us-american,
to me the travel insurance taken in germany is cheaper than a local DR insurance.
i used that same travel insurance during my first time when in the DR.
it is limited as for the time frame to stay.
i would recommend, that the ones without papers, who have a insurance plan, check with their insurer directly about their own specific coverage. make clear that you have no papers and ask straight on about your coverage for that.
i can't tell such from myself, as i have always had my residency, even before i switched from my former german insurance on their so named "Exotic Plan"/for germans living in da Tropics permanently, to the local DR ARS-Humano Platinum Plan, which i have since well over 10 years now.
for the ones who work here in DR,
well, if you have a real job, a legal one, then you are registered with TSS.
their coverage is not bad at all, and for the same 5.91% of your monthly salary, which is your premium to pay(your employer has to pay 14.19% of your salary into the same plan), you get your self covered and can include(without extra payment, included in your 5.91%) one spouse and up to 3 children(children have to be minors), a good deal for beginners.
if you wish superior coverage, you can add a private plan(like for example a ARS Humano plan), hospitals accept combinations of several plans.
you use your 1st card and in case there is a good sum still open, use your 2nd card to get that sum down.
Mike