Health care – Health insurance
SISBEN
In Colombia there are three types of health care. The first does not apply to foreigners living or visiting the country. This system is called SISBEN and it is a free government subsidized package created for very poor Colombians.
EPS
The second line of health care is called EPS – Entidades Promotoras de Salud. The Superintendent of National Health decides which organizations may qualify as EPS depending on their capital, infrastructure, number of users, etc. These businesses then sell packages to the general public and contract the services with various health care providers. The premiums are usually based on one’s basic income. If they are an employee they pay 11% of their income and the government subsidizes them 1.5%. For self-employed individuals the amount paid is 12.5 %. The EPS system requires appointments and referrals from a participating doctor if you wish to see a specialist. Most services also carry a small co-payment. Some pay a percentage of prescription costs and most cover 2 dental cleanings per year. Some companies providing these services are Coomeva, Café Salud, Comfenalco, Sanitas and Suramericana or Sura. When choosing an EPS, make certain that they have a facility close to where you live or you could find yourself going completely across town for your appointments.
PREPAID HEALTH INSURANCE
The third level of health insurance is Colombia is Prepaid or Medicina Prepagada. The costs vary on these policies depending on the service offered. One thing to note, if you are over 60, no insurance in Colombia will enroll you into the prepaid program. By law, once you have a visa you are entitled to participate in the EPS system, but there is no legislation requiring an insurer to accept you as a client in the prepaid system. If you qualify some companies will require you to have both EPS and prepaid. In this case you should obtain them from the same insurer.
Both the EPS and Prepaid carry a co-payment which will vary depending on the company and the service. Sura and Coomeva only have two options 1. EPS 2. Medicina Prepagada. Comfenalco is ahead of the curve. The have EPS specialized health plans for people over 60.
If you are traveling and have health insurance, you should always carry a copy of your policy with you. Sometimes there are ”surprises around every corner” and having a copy of your passport and policy with you at all times is a good precaution to take. You should also know your policy well. If you have to call for approval of a service, then may you need to have some kind of international calling card because the odds are the clinic or hospital will not let you call or they may not have a long distance connection. If you are buying your travel insurance you should also be aware that generally these packages do not cover pre-existing conditions, something that you might not be told at the time of purchase.
The great majority of clinics and hospitals in the bigger cities are private. They are more than happy to have your business. There are no short term coverages, rights or allowances in Colombia. If you do not have a policy issued by an outside insurance company you may be required to pay cash for the services received. In the larger cities most hospitals will accept credit cards. In some cases, even if you have health insurance you may have to pay in cash and make a claim with your personal insurer at a later date.
Generally costs of seeing a doctor are much lower in Colombia. An appointment with a GP may cost around $35.00 USD and about $80.00 USD with a specialist. Surgeries, minor or major are much less expensive here and generally, especially in the larger cities and clinics, the care and service is excellent. Interestingly enough here, nurses look like nurses as most still wear the little caps.
The level of health care in the major centers is excellent. The doctors are well trained. Although more and more speak English, there is still a mix of capabilities. The Colombia government is working diligently to improve the level of bilingualism within the medical community.
Some of the best health care in Latin America is available in Colombia and it is only getting better.
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