Caveat: I have no medical training.  Please use the information in this article as a reference only, and consult with your physician before taking any medication.

The first time you get sick and go to the doctor in Chile, you will probably discover two things:

1. Chilean doctors prescribe a lot of drugs
2. In many cases, you don’t need a prescription to buy those drugs

You’ll also be surprised by how cheap some medications are (US$1.50 for a full prescription’s worth) and how expensive others are.  In general, health insurance plans do not cover medications, so whatever the pharmacy is charging is what you’ll pay.  The government does subsidize drugs for certain illnesses and in certain population segments.

Prescription drugs

Until around 2005, many pharmacies sold antibiotics without a prescription.  This allowed overuse and improper use of antibiotics.   The government has since clamped down on antibiotic sales; pharmacies require a valid prescription, which they will keep (this is referred to as receta retenida). But the damage is already done: Chile’s infectious bacterial population is particularly robust and drug-resistant.

Some medications available without a prescription in Chile are:

• birth control pills and other hormonal contraceptives
• certain less common NSAIDs such as diclofenac
• desloratadine and other anti-allergy medications
• pseudoephedrine, the original active ingredient in the decongestant Sudafed, now all but unavailable in the U.S. due to its use as a raw material in the preparation of the street drug crystal methamphetamine

Of course, even you should always see your doctor before taking any medication other than common pain and cold remedies.  However, if, for example, you discover you have a yeast infection on the first morning of a long weekend, being able to head straight to the drugstore to buy a dose of Diflucan (fluconazole) can save you some serious time, money and discomfort.

This lack of supervision over the sale a majority of medications may seem reckless, but I think it just recognizes a basic fact: people tend not to abuse drugs that aren’t either mind-altering or performance-enhancing. Medications that fall into those two categories are duly controlled, and the rest are doled out under the assumption that you know what’s wrong with you and how to properly treat it (antibiotics, as mentioned above, are an important– and likely unique– exception to this rule.)  A side effect of this is that pharmacists in Chile do a quite a lot of diagnosing and consumer education about medications and treatment options.  Do take advantage of their knowledge and experience when buying medicine without a prescription.

Tylenol

If you are from the United States, perhaps the most valuable thing I can tell you about over-the-counter medications is that Chileans use the British word for acetaminophen (Tylenol): paracetamol.  In many other cases, you can employ the append-a-vowel-to-the-English-word rule to get a drug’s name in Spanish, e.g. ibuprofen -> ibuprofeno, aspirin -> aspirina.

Alternative medicine

If you find, as many expats do, that you (or your children) are prescribed far too many medications even for illnesses that would seem to call for rest, lots of liquids and better future hygiene, there is a large and well-established alternative medicine community in Santiago and other large cities.  You can choose health providers who are conventional physicians who prefer to treat non-life-threatening illnesses with homeopathic, anthroposophic and/or natural remedies before resorting to conventional medications.

It is not my desire for expat.cl to be a medium for criticism for criticism’s sake, but there is one company that has provoked so much frustration among my fellow expats that I feel obligated to warn newcomers to the country about it.

HELP is a company that provides medical services such as ambulance and doctor visits to your residence for a monthly fee, and for some services with an additional per-event fee.  Subscriptions are per person.  Expats often sign up for HELP because Chile lacks a universal, reliable public ambulance service.

Some complaints I hear about HELP have to do with the service itself, such as incorrect diagnoses, failure to acknowledge the need for a doctor visit or ambulance, and long waits for an ambulance.  Just as often I hear complaints about administrative issues.  It can be extremely difficult to terminate or modify a HELP contract.

If you do decide to sign up for service with HELP, make sure that you know the answers to the following questions.  If not, pose them your salesperson.

• Puedo poner término al contrato en cualquier momento?  Si no, cuándo?  Cuál es el procedimiento para terminar el contrato?
• El costo mensual va a seguir igual hasta el final del contrato?  Si no, por qué motivos podría subir?  Cómo me van a avisar del aumento, y con cuánto tiempo de anticipación?  Podré optar por poner término al contrato en vez de aceptar el aumento?
• Puedo cambiar la forma de pago en cualquier momento?  Si no, cuándo?

Links

• El Mercurio 15-APR-2009
• El Mercurio 17-JUL-2005
• El Mercurio 22-JUL-2005

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:

1. 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.
2. 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

AFP stands for Administradora de Fondos de Pensiones and refers to one of several private companies in charge of managing the mandatory and voluntary retirement investments of the majority of Chile’s workers.  (Some still have their retirement funds with the INP, the pre-privatization government entity that was charged with the same task.)

When you first become an employee in Chile you will be required to choose an AFP to receive your salary retirement withholding.  You will need to instruct your AFP to allocate your contributions to one or more retirement funds.  Each AFP has 5 funds, A to E; A funds have the highest risk and E the lowest.  If you don’t make the choice, they will allocate all of your contributions to one fund depending on your age.

The percentage of your gross salary you contribute to your AFP is not standard but rather varies slightly among AFPs; you may want to consider this when choosing one.  This is also important to keep in mind when calculating withholding for domestic employees (link).  You can compare the AFPs’ fee structures here.

As a foreigner, you can liquidate your retirement account (at any time, as far as I know).  Contact your AFP for details.  If your home country has a social security reciprocity agreement with Chile (as the U.S. does), it may make the most financial sense to leave your AFP account intact.  An accountant can help you decide.

The Superintendencia de Pensiones is the governmental oversight body and has a useful web site.  See Information for workers and retirees including an AFP comparison tool.

In Chile, telephone number formats and call costs vary depending on the type (landline or mobile) and location (Metropolitan region or other regions).

In the metropolitan area, landline phone numbers

• have a single-digit area code (2)
• and a 7-digit number

Outside of the metropolitan area, they

• have a 2-digit area code
• and a 6-digit number

Mobile numbers

• have 8 digits and begin only with the digits 6, 7, 8, 9
• belong to one national area code (9)

How you dial these numbers, of course, depends on where you are.

Within the same area code (be it landline or mobile), you just dial the number:

• 8765-4321 (from one mobile phone to another)
• 765-4321 (landline in the metropolitan region to another landline in the metropolitan region)
• 654-321 (landline “en regiones” to another in the same area)

From another area code within Chile, you dial one of two ways:

1. 0, then the area code, then the number
2. a long-distance carrier code, then the area code, then the number

When dialing from a cell phone and many landline phones you don’t need to dial the carrier; your local service provider will make the long-distance connection.  It’s handy to review carrier costs and memorize one or two of the carrier codes to use when at a pay phone or another phone that requires it.  (Also, you might be able to save money on long-distance calls from your home by dialing a carrier code.)

So a domestic long-distance call will look like one of these:

• 09-8765-4321 (any landline to any mobile)
• 02-765-4321 (mobile or outside Santiago, to Santiago)
• 111-2-765-4321 (with carrier, to Santiago)
• 012-654-321 (Santiago or mobile to outside Santiago)
• 111-12-654-321 (with carrier, to outside Santiago)

How do you know if you need the carrier code or not?  Just dial without it, and the phone will complain if it wants one.  Also, pay phones should have dialing instructions on them.

From outside Chile, you don’t need a 0 or a carrier code, just prefix the area code and number with Chile’s country code, 56.  Below, the plus (+) sign is a placeholder for the international long distance dialing code for the country of origin (011 in the U.S.A., for example).

• +56-9-8765-4321
• +56-2-765-4321
• +56-12-654-321

To call another country from Chile, use the same format as for domestic long-distance calls, but with an extra 0.  That is

1. 00, then the country code, area code, and number
2. a long-distance carrier code, then 0, then the country code, area code, and number

A U.S. number will look like this:

• 00-1-123-456-7890
• 111-0-1-123-456-7890

Be sure and check out Voice Over IP (VOIP) options for your international calls.

More on the cellular phone system

When cell phones were first introduced in Chile, the billing method was Receiving Party Pays, in which the mobile phone owner paid for both incoming and outgoing calls and the caller did not pay more for a cell phone call than for a landline call.  This is the system used in the U.S.

Today Chile’s billing method is Calling Party Pays, which means making cell phone calls can be expensive, but that owning a cell phone and receiving calls on it can be very affordable.

When I got my first Chilean cell phone in 1999, cell phone numbers had 7 digits.  When writing down your mobile number for someone, you would probably write it like this:

(09) 876-5432

…using the area code to show that it was a cell phone number.

Several years later, when cell phone use exploded and it became necessary to increase the number of new phone numbers available to be assigned, the government added a 9 to the front of all existing 7-digit mobile numbers, and began assigning 8-digit numbers beginning with 9 or 8 (numbers beginning with 7 and 6 appeared later on).  So the mobile number that you used to dial from a landline like this

09-876-5432

you now have to dial like this

09-9876-5432

So you’d think that now, years after the 8th digit was added, people would give out their mobile number using the full 9 digits, or just the 8-digit number, since people would no longer confuse it with a landline.  But no.  More often than not I see mobile phone numbers written this way:

• (09) 876-5432 instead of (09) 9876-5432
• (07) 876-5432 instead of (09) 7876-5432
• (06) 876-5432 instead of (09) 6876-5432

The 9xxx-xxxx guy you can forgive; his phone number probably used to look like that and maybe he just can’t accept the change.  But those last two are just plain WRONG.  There are no area codes 7 or 6 in Chile, never were.  You cannot dial any of those numbers from any phone and have the call go through correctly.  This is a major pet peeve for me.  So I ask you as a personal favor, when you give your cell number out, please please please write it in one of these two ways:

• 8765-4321
• (09) 8765-4321

Thanks!

See also:

• Dialing information from the Subsecretaría de Telecomunicaciones, including area codes and long-distance carrier codes