San José, Costa Rica, since 1956

Alternatives to INS Medical Insurance

The fact that the National Insurance Institute (INS) is the only insurance company in Costa Rica does not mean that its medical insurance policies are the only options available. Other sources of medical coverage are:

Foreign insurance. Since the popularization of the Internet, various medical insurance options have become available online. In addition, several outfits in Costa Rica offer service for foreign medical insurance – in advance of the breaking of INS’s monopoly once the Central American Free-Trade Agreement with the United States (CAFTA) goes into effect. Every week there are several ads in The Tico Times. If you decide to go through one of these, ask around and make sure you deal with a recognized, reputable insurance company with a good track record.

Private “non-insurance” plans. In recent years there have been some plans, offered by organizations related to some of the major private hospitals, that do not violate INS’s monopoly as they are somewhat unlike insurance.

With these plans, the subscriber invests X amount per month and builds up a fund upon which he may draw when he needs medical care. If the cost of the required care exceeds the amount accumulated in the fund, the organizing hospital will advance the difference – but the subscriber must come up with guarantees.

These funds are unregulated and do not accrue interest to the subscriber, so what we are really looking at is a financial mechanism whereby people unable to save money and create their own fund abdicate this burden and, in payment, the organizer earns any accrued interest. The plans currently being offered are organized by very reputable hospitals. Ask at Clínica Bíblica and CIMA hospitals.

Apart from financial considerations, the main drawback of these plans is that treatment can be administered only by and in the organizing hospitals, which are situated in the Central Valley.

Travel policies. Sometimes people need medical insurance for short periods – often for forays abroad into dollar areas. Often they need coverage ASAP. INS’s full-blown medical policies all take four to six weeks to get in place, so the time problem is solved by means of travel insurance policies, which provide some major emergency medical coverage and are written in five to 10 minutes. Coverage is for short periods only, and is fairly inexpensive.

Social Security System (Caja). The Caja provides health care directly, so this is not really insurance. Some people use the Caja as a primary care provider, but a lot of people use Caja coverage as a supplement in case one of the smaller INS policies were to become exhausted by a large claim or a multitude of small ones, or in case the insured person were to develop an ailment excluded by INS.

The Caja was created to provide medical care to Costa Rican employees and their dependents. All employers have the obligation to enroll their employees. The monthly cost is borne by the employer and also by the employee by means of a payroll deduction.

The Caja provides service through a series of large, well-equipped, overstaffed and often inefficient hospitals. But, in all fairness, it must be pointed out that Costa Rica has an enviably high life expectancy, largely due to the universal birth-to-death care provided by the Caja.

Costa Ricans and legal residents can obtain Caja coverage even if they are not employees, or if they are self-employed. Most foreigners who want this coverage obtain it through the Association of Residents of Costa Rica (ARCR), which cuts the red tape._

The purpose of this column is to give the reader a better understanding of insurance in Costa Rica. The opinions and viewpoints expressed are those of the writer and do not necessarily represent the official position of the National Insurance Institute (INS). For more information, contact David Garrett at 2233-2455 or


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