Before 1981, health insurance was provided by Fonasa (Fondo Nacional de Salud). In that year the industry was privatized and the ISAPRE system was created. ISAPRE stands for Instituciones de Salud Previsional, and they are Chile’s private health insurance companies. Fonasa continues to operate, effectively in competition with the isapres, and still providing health coverage to the vast majority of Chileans. Participation in the ISAPRE system reached a high of 26% in 1995 and has since declined.
When you first become an employee in Chile, you will be required to sign up with an Isapre or Fonasa and contribute 7% of your gross monthly pay (up to a salary limit or tope of 60 UF (linkme #)) to your health insurance plan. If you would like to purchase a plan that costs more than 7% or the tope you may ask to have more of your pre-tax pay withheld for that purpose.
Signing up
How do you choose an Isapre and plan? Talk to people. Talk to coworkers, friends, in-laws, everyone. Look at the Isapres’ website and the ranking at the Superintendencia de Salud, the government oversight body. Some questions you should consider are:
- Do you have children and/or are you planning on having children in the next 1-5 years?
(There are plans with reduced or no maternity coverage for women, that compensate with cheaper premiums or better coverage in other areas. These plans are affectionately known as sin útero- without uterus.) - Do you expect to get most of your medical attention at one clinic?
(There are plans that give you excellent coverage at one clinic in exchange for reduced coverage elsewhere.) - Is the coverage for mental health services (e.g. psychiatry consultation) important to you?
- How often, on average, does someone in your family end up needing to go to the emergency room?
- What are your and your family’s existing medical conditions?
- Do you already have one or medical providers that you would like to continue to use?
(Doctors, clinics and laboratories may be affiliated with one or more Isapres but not others.)
Once you have an idea of what plan(s) interest you, call the Isapre(s) to have a salesperson come visit you at home or at work.
If you are getting your spouse and/or family insured, either you or your spouse will be designated the policyholder (titular) and the other spouse and any children are included in the policy as dependents (cargas). Your premium is calculated based on the gender and age of the policyholder and each dependent. Often Isapres charge a higher premium for a woman as a policyholder than if she is a dependent, so make sure and ask the salesperson to check this to give you the lowest possible premium.
Getting some attention
Now, you’ll want to review the reading material the Isapre gives you to make sure you understand the processes for getting planned and unplanned medical attention. Basically you do one of two things:
- Go to the isapre and purchase a bono de atención for the provider you’ve made an appointment with, then use it that same day as payment at the appointment.
- Get your planned or urgent medical attention and pay out of pocket, then go to your isapre and get reimbursed a percentage of what you paid.
Which of these procedures you use will depend on several factors:
- Whether or not the provider has an agreement with the isapre (if not, you won’t have the option of buying a bono beforehand)
- Whether or not the isapre has a physical presence at the provider’s location (if so you may be able to purchase a bono right before your appointment; this is the ideal setup since it saves you the trip to the isapre)
- Whether or not the total cost to you is higher using the reimbursement procedure (some providers charge more for an out-of-pocket consultation than they do for an isapre-coverage-plus-copay consultation)
So as you’ve probably guessed, before your first visit to any provider, you should call your isapre and find these things out. In the case of individual doctors, it’s helpful for you to have their RUT handy as well as their name and specialization.
Ojo
Isapres are for-profit companies and unfortunately some of those profits come from illegal but uncontested rate hikes and coverage denials. If you receive notice that your premium will be increasing or that you have been denied coverage for a particular event, make sure that the isapre was within its rights to do so. Do your homework with regards to the plan and the specifics of your situation. If necessary file a formal complaint with the isapre, and when a response upholding the rate increase or coverage denial arrives, file a complaint with the Superintendencia.
Other types of health insurance
Seguros de Salud para Gastos Médicos de Alto Costo
This is additional insurance to cover medical costs that your isapre does not cover. Some companies provide it as a benefit to their employees.
Seguro Escolar
This is accident insurance for students of all ages who have Isapre coverage. You contract it on a yearly basis with a single hospital, usually via your child’s school. These plans are low-cost and are generally considered a good deal. Taking into consideration the emergency-room coverage of my health plan, the seguro escolar pays for itself with one emergency room visit.
Related vocabulary
- bono de atención – pre-paid copay
- clínica – private hospital
- cobertura – coverage
- convenio – an agreement between an isapre and a provider; a provider that has a convenio with an isapre could be considered “in-network”
- cotización – insurance premium
- laboratorio – laboratory
- licencia médica – medical leave
- posta – public hospital
- reembolso – reimbursement
- titular – policyholder, primary insured
- tope – limit; the highest amount of money taken into account for a given calculation, such as health plan cost or medical event coverage