THE fact thatINS is the onlyinsurance companyin Costa Ricadoes not meanthat INS medicalinsurance is theonly coverageavailable. Othersources of medicalcoverage are:The Internet.Since the popularizationof theInternet there arevarious medicalinsurance options available online. If youdecide to go through the Internet, makesure you deal with a recognized, reputableinsurance company.PRIVATE “Non-Insurance” plans.In recent years there have been someoptions offered by organizations related tosome of the major private hospitals, whichdo not violate INS’s monopoly as they aresomewhat unlike insurance.With these plans, thesubscriber of the privateplan invests X amountper month and builds upa fund upon which maybe drawn when medicalcare is needed. If thecost of the required careexceeds the amountaccumulated in thefund, the organizinghospital advances thedifference, but the subscribermust come up with guarantees.These funds are unregulated and do notaccrue interest to the subscriber, so it isreally a mechanism whereby persons whoare unable to save money and create theirown fund abdicate this burden and, in payment,the organizer earns the accruedinterest.The plans currently being offered areorganized by very reputable hospitals.However, in the past some companiesoffering similar plans disappeared and leftsubscribers high and dry. In the early1980s it was Hospital Ibero Americano, inthe late 90s, Medi-Pre.Apart from financial considerations,the main drawback of these plans is thattreatments can only be administered byand in the organizing hospital – which aresituated in Costa Rica’s Central Valley.TRAVEL policies. Sometimes peopleneed medical insurance for short periodsand often they need it as soon as possibleor right away.INS’s full blown medical policies alltake four to six weeks to get in place, sooften the time problem is solved bymeans of travel insurance policies, whichprovide some major emergency medicalcoverage and are written in five to 10minutes.COSTA Rican Social Security. “LaCaja” provides health care directly, so itis not really insurance.Some people use La Caja as a primarycare provider, but many others use“Caja” coverage as a supplement in caseone of the smaller INS policies were tobecome exhausted by a large claim or incase the insured person were to developan ailment excluded by INS.La Caja Costarricense del SeguroSocial (its officialname) was created toprovide medical careto Costa Ricanemployees and theirdependants. Allemployers have theobligation to enrolltheir employees.The monthly costis borne by theemployer and also bythe employee bymeans of a payrolldeduction.The Caja provides service through aseries of large, well-equipped, overstaffedand often inefficient hospitals – but, in allfairness, it must be pointed out that CostaRica has an enviably high life expectancy– largely due to the universal birth-todeathcare provided by the Caja.Costa Ricans and legal residents canobtain Caja coverage even if they are notemployees or if they are self-employed.Most foreigners who want this coverageobtain it through the Association ofResidents of Costa Rica (ARCR), whichhas negotiated a special rate for its members.Through the ARCR, the cost is $58 permonth for heads of family under 55 and$37 per month for those 55 or over.