non resident insurance?

retiree

New member
Jan 18, 2008
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To buy medical insurance here in the Dominican Republic do you need to have a cedula - be a resident? I searched and found alot of information about medical insurance but could not find the answer to this question.
 

whirleybird

Well-known member
Feb 27, 2006
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To buy medical insurance here in the Dominican Republic do you need to have a cedula - be a resident? I searched and found alot of information about medical insurance but could not find the answer to this question.
No, we got our health insurance long before we got our residencia.
 

DrChrisHE

On Probation!
Jul 23, 2006
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No you don't need residency. Humano sells insurance for use IN the DR to people with passports. IF however, you want International Insurance--where you can go outside the DR and have services covered--you'll need international documentation and SOME plans are tricky. Again, no residency is required for MOST...however, SOME US-based companies DO actually require you to show you are a resident of another country to pay a reduced rate for the "opportunity" to transport to the US in the event of an emergency. There are usually "waiting periods" and "exclusions" for these plans. I'm assuming you want your insurance for IN the DR but case not, let me know and I'll give you even more tedious insurance details for coverage out of the country.
 

zoomzx11

Well-known member
Jan 21, 2006
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Stay away from Humano. I have had nothing but problems with them and at present am looking for another carrier.
 

DrChrisHE

On Probation!
Jul 23, 2006
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Zoom--fair enough comment. WHEN Humano IS accepted by a provider, they tend to do a good job. BUT, finding a provider who actually will take Humano is an entirely different story. In SPM Humano is relatively widely accepted. I had a broken arm over a year ago and they paid without issue (but I went to THEIR facilities). One little dicho...I had the arm casted at one hospital and went back there a week later for an x-ray (because the orthopedist screwed up and put the wrong sized cast on--not Humano's fault but I should have argued harder with him initially). Anyway, THAT hospital wasn't accepting Humano THAT DAY. So, it is a tad like the US emergency room crisis where they "close down" for particular carriers. I simply drove (had my teen drive) 10 min to the next facility. Still, it was annoying.

In our neck of the woods, they are actually viewed as one of the better ones but we are thinking of switching to an International company with coverage in the DR. Their dental plan pays well enough to attract some decent dentists but certainly not the higher end ones that cater to tourists. I've had very sporadic success getting docs to take Humano (for non-emergency or elective issues) in the Cap even though their institution/clinic is on Humano's list.

So, I definitely would caution the OP to think of how they would use their coverage.
 

DrChrisHE

On Probation!
Jul 23, 2006
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DrChrisHE - what insurance company are you thinking of switching to?
Well, that's a great question. We've done an analysis of many companies. The problem is that one can buy affordable insurance that will cover you everywhere BUT in the US or one can buy ridiculously priced insurance that includes the rest of the world and the US (as we all know, the US prices for health care are the highest in the world--not necessarily the best; just the most expensive.) However, because Dh travels back and forth and we'll have a kid in college in the US (plus two here) we decided that we needed something that WOULD include US services.

That long drawn out explanation is there to tell you what my reasoning is. The one we believe we have settled on after months of debate is Global Healthcare Plan which is administered by Goodhealth Global. It isn't cheap but isn't it most expensive. What one needs to look at is how much do you use health care services, what types, are you particular about your providers, how much can you pay out of pocket, do you like big or small deductibles and copayments (flat amount) or coinsurance (%), what the exclusions/inclusions and waiting periods are. We are no longer looking for coverage for pregnancy BUT I will tell you as an insider, plans that cover pregnancy tend to attract a younger and healthier population so sometimes it makes sense to throw yourself into one of those plans. If you select a plan for that covers long term care, you are going to automatically get thrown into a higher-risk, older population risk pool. It's just the way insurance rating works.

Some other things to consider: Is there an upper limit (patient's stop-loss) on how much YOU would have to pay in a catastrophic event? Is there a limit to how much the insurer would pay (upper limit)? Do you want alternative services covered (acupuncture, chiropractic, NDs, etc.)? Do you need pharmacy coverage? Do you need dental coverage? LTC/long term care, mental health, drug treatment, etc...are all spelled out and you need to be careful about how insurance companies define them and what they consider an "episode" to be. Sometimes they will count from the beginning of a year, other times from a new illness event.

Any other ?s, I'm happy to answer. Once upon a time, I taught university grad and undergrads "Health care reimbursement mechanisms.":bunny::bunny::bunny:
 

DrChrisHE

On Probation!
Jul 23, 2006
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A few definitions:
Insurer=insurance company
Insured=the person(s) covered by said insurance company
Deductible=usually a set amount of money that the insurer requires the insured to pay PRIOR to the insurer paying anything.
Co-payment= usually a set amount (e.g $20 per visit) to be paid by the insured for each service OR episode of care delivered
Co-insurance= usually a percentage (e.g. 20% of each hospitalization) to be paid by the insured for each service OR episode of care delivered
Acute conditions= usually illnesses resolving in under 3 months or less
Chronic conditions= usually illnesses lasting OR EXPECTED to last more than 3 months; note: pregnancy fits neither.
Illness Episode= From the time one seeks care for a particular complaint or diagnosis until either the acute flare up (in a chronic condition) or the resolution (in an acute condition).
Waiting Period=the period of time before benefits for that particular service or condition will "kick in" or be in effect. Sometimes used to exclude people from buying insurance for services that they know they'll need soon (e.g. someone buys insurance covering prenatal care and gets pregnant the next month or someone with a possible cancerous growth buys insurance specifically covering that.)
Exclusions= those services NOT covered by the plan
Upper limit or stop loss for patient= the point where the patient doesn't have to pay any more...not to be confused with the
Insurer's Maximum Benefit Amount/Limit=sometimes around $2M USD (which is NOT hard to rack up in the US if you are really sick)--the best plans have NO limit.

Need more, just ask!
 

cobraboy

Pro-Bono Demolition Hobbyist
Jul 24, 2004
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I met with the Health Insurance specialist @ El Monumental recently, and asked about the residency requirement. There is none, and they have a variety of plans available.
 

DrChrisHE

On Probation!
Jul 23, 2006
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It is very important to find out who accepts the plan in your area. For example, Bournigal Clinic in Puerto Plata accepts our plan to pay for the emergency room, hospital stays and most of the basic doctors accept it. BUT and this is a big BUT, there are specialist doctors that grace Bournigal with their presence that take NO insurance plans. I am talking about the brain surgeon, maxillofacial and plastic surgeons at Bournigal. They DO NOT accept any type of insurance for their fees. Cash only or you don't go home.

Also, the plan covered the operating room costs, but not the assistant to the doctor, go figure. Please be aware of these limitations on any plan purchased locally.
Exactly--you need to fully investigate what you expect to be covered and whom will accept it. The cash-only practice here is much more prevalent that most ex-pats are used to. One thing someone who HAS a specialist that they like and intend to continue using might do is ASK the specialist which plans they accept. If you can't find a plan that the docs/clinics you want mesh, then one approach is to find an indemnity plan. These are plans that will REIMBURSE YOU for the expenses as long as the provider is licensed or appropriately recognized by their professional body.

The problem that many specialist have is that they think the reimbursement rates are too low and the administrative burden of dealing with third party payers is too high. Therefore, if you can get a plan that will pay you after you've paid the provider (and this is tricky because there's a difference between UCR=usual, customary and reasonable fee reimbursement and CHARGES), you might be able to "have your cake and eat it too." Be careful about leaving yourself open for "balance billing" where the actual bill is much higher than what the insurer will pay and you are responsible for the difference (this can happen with indemnity plans as well.)

Clearly in the case of large bills, this is not a tenable situation for many of us. Having had brain surgery twice, I can say that there is no way we could have put up the money and waited to be reimbursed. It would have required a loan. Insurance is tricky stuff...if the plan seems "too good to be true" it probably is!;)