Health Care in Costa Rica

Health Care in Costa Rica

A Healthy Country

Costa Rica is a very healthy country. Costa Rica’s health status is comparable
to that of developed nations. The country’s private health clinics have
international fame and attract people from around the world for everything
from dental care and ocular laser surgery to major cosmetic surgery and life
extension treatments.

Unlike other countries in Latin America, especially Mexico, Costa
Rica’s water supply is good and perfectly safe to drink in San José and in the
majority of small towns. In most places, you can drink the water without fear
of Montezuma’s Revenge (diarrhea) or other intestinal problems. However,
be careful when you drink water in the countryside. We have lived in Costa
Rica for years and have not heard many people complain about the quality
of the country’s water. If you prefer, bottled water is available. Just as in the
United States, there are about 20 brands of bottled water in different-size
containers sold at the supermarkets. You will be pleased to know that Costa
Rica’s water is soft for bathing and washing your hair.

Although the Costa Rican government takes precautions to monitor the
quality of the water and the country has high sanitation standards, there are
some precautions you should take. Wash and peel all fresh fruits and vegetables.
Avoid drinking water-based fruit drinks sold in stands on the street. You should
also watch out for raw seafood dishes, such as ceviche, served in some bars and
restaurants. This type of seafood is soaked in lime juice and not cooked with
heat. In general, restaurants are clean so you shouldn’t have to worry what
you eat. Low-end establishments display chicken and other food under lamps
to keep it warm. If the food doesn’t look fresh, use your judgment.

Costa Ricans are proud of their nation’s achievements in the field of
health care. Their up-to-date, affordable, state-run “cradle to grave” health
care system reaches all levels of society by offering the same medical treatment
to the poor as to those with greater resources. Hospitals, clinics and complete
medical services are available in all major cities and some small towns. More
than 90 percent of the population is covered by the Social Security System.
There is either a public clinic or hospital in almost every area of the
country, making medical care accessible to everyone including foreigners.

I know a U.S. couple near Dominical, on the southern Pacific coast, who
either use the public hospital in San Isidro or the one in Ciudad Cortez. The
wife said her husband fell when he was working on their house and sustained
a compound fracture of the wrist. He was treated at the public hospital in
Ciudad Cortez and was very pleased with the emergency treatment he received.

Medical Care Cost Comparison
by Martin Rice
Just got a really rude awakening that I thought I might share with
you, given the fact that there’s been quite a bit of discussion about
medical care here lately.

Robin and I went to the States for two weeks over Christmas. While
there, I had to go to the emergency room in Knoxville, TN where we
were visiting family. The hospital, Baptist Hospital, West, is a brand new
(1 1/2 years) super impressive place. They took great care of me in
the emergency room — all the speedy intense care you would expect for
chest pains. The reason it was a bit more scary than it might have been is
that just three months ago I had an angioplasty here at CIMA.

After they saw that I was doing OK and all the signs were on the
money, they said that I had to have a stress test. The kind of stress test
I get is a chemical one in the Department of Nuclear Medicine. I had
one at CIMA before the angioplasty. It’s this that tells them whether you
need to have the angioplasty done. Here comes the first cost comparison:
The doctor said that based on the results of the stress test, they’d decide
whether I’d need another angioplasty. I told him that if at all possible I’d
prefer to go back to CR to have it done because there it would cost me
about $13,000 in total and I figured in the States it’d be about $25,000.
He laughed and said “more like $40,000 or $50,000!” Now THAT
almost gave me a heart attack.

At any rate, the results of the stress test were great and I didn’t need
anything else at all. When the doctor told me that, he said that I’d be
able to leave right then. At this point I had spent a night at the hospital
and about a total of 24 hours.

That same stress test at CIMA cost me $750. There was also complete
blood work done which was another $150. I did it on an out-patient
basis, but I know that a nice room at CIMA, with a sitting room attached
is about $150 per night. No emergency care, but, again from experience
there, I’d estimate that what I had done at the ER in the States would
have been about $1,000 to $1,500. So a total of about $2,550.00.
What was the bill at the hospital in the United States? $8,000! One
night in the hospital and no operation or any other kind of invasive
procedure. Is that sick or what? Talk about a broken system. So when
people talk about the high cost of private medicine here and at hospitals
such as CIMA, remember that everything is relative, extremely relative.
Anyway, I’m doing just great now and feel fine.

Many international medical authorities rate Costa Rica as having one of
the best low-cost medical care systems in the world, when preventive and
curative medicines are considered. The United Nations consistently ranks
Costa Rica’s public health system as the best in Latin America and one of the
top 20 in the world. The world Health Organization (WHO) ranks Costa
Rica 36th out of 191 countries with respect to the quality of its health care
systems. The United States for example ranks 37th.

Costa Ricans are a healthy people. The infant mortality rate of less than
11 in 100,000 live births is lower than that in the United States. This figure
is on par with any industrialized country in the world. Life expectancy is
76.3 years for men and 79.8 years for women. Today, an 80-year-old man has
a life expectancy of at least eight (actually, 8.4) years. This puts Costa Rica
in first place in the world for life expectancy from this age up. Iceland and
Japan follow with 7.7 years. Costa Rican women at age 80 are expected to
live longer than men of the same age, 9.5 years, slightly behind the women
of Japan and France.

Hospitals have the latest equipment, and laboratories are excellent. You
can feel safe having most operations without returning to the United States
or Canada. Most surgical procedures cost only a fraction of what they do in
the United States. For example, a heart bypass operation costs about a third
of what it does in the United States.

It is no wonder a large number of foreigners are attracted to Costa Rica
because of its affordable health care. In the United States, for example, millions
of people do not have health insurance because it is prohibitively expensive.
For this reason, Costa Rica attracts many retirees from North America. It
doesn’t matter if you are a legal resident or a traveler. Everyone is entitled
to emergency care at a government hospital.

Even if you are in good health, the probability of needing medical care
increases with age. The security of knowing that good health services are
available presents an enormous relief.

Medical Costs
Medical Procedures USA Costa Rica Average Savings
Heart Bypass Up to $130,000 $24,000 70-80%
Heart Valve Replacement Up to $160,000 $15,000 80-90%
Angioplasty Up to $57,000 $9,000 70-80%
Hip Replacement Up to $43,000 $12,000 60-70%
Hysterectomy Up to $20,000 $4,000 70-80%
Knee Replacement Up to $40,000 $11,000 60-70%
Spinal Fusion Up to $62,000 $25,000 50-60%
Plastic and Reconstructive Surgery
Facelift $7,000-$9,000 $4,600 – $5,000 30-40%
Rhinoplasty $8,000-$12,000 $3,500 – $3,900 50-65%
Breast Lift $5,000-$8,000 $3,000 – $3,400 40-55%
Breast Augmentation $5,000-$8,000 $2,700 – $2,900 50-65%
Blepharoplasty (Eyelid Surgery) $4,000-$5,500 $2,000 – $2,200 50-60%
Brazilian Butt Surgery Up to $10,000 $3,000 – $3,300 55-65%
Tummy Tuck $6,000-$8,500 $3,900 – $4,200 45-50%
Facelift $7,000-$9,000 $4,600 – $5,000 35-45%
Male Breast Reduction Up to $6,000 $2000 – $2600 50-60%
Bariatric Surgery
Laparoscopic Gastroplasty Up to $30,000 $10,500 55-65%
Laparoscopic Roux-en-Y Up to $35,000 $14,000 50-60%
General and Cosmetic Dentistry
Bridges $1,000+ per tooth $250 – $400 per tooth 60-70%
Crowns $1,000+ per tooth $250 – $400 per tooth 60-70%
Implants $3,500+ per tooth $700 – $900 per tooth 70-80%
Porcelain Veneers $1,500+ per tooth $300 – $500 per tooth 65-80%
Root canal Up to $800 $315 55-60%
Teeth whitening Up to $700 $250 55-65%

Medical / Dental Costs in Mexico and Guatemala by Comparison
Dental Costs in Mexico – Clinics in Los Algodones with On-Site Labs
Medical Doctors Guide for Los Algodones – Best Physicians Serving Phoenix, Tucson, Scottsdale Arizona Residents
Medical / Dental Services for Mexicali, Serving San Diego, Palm Springs & Los Angeles Residents with Lower Costs
Los Algodones Dental Guide to over 250 Dentists with Reviews for Dental Implants, Crowns, Bridges and Dentures at Best Prices
Guatemala Guide to the Best Dentists for Dental Implants, Cosmetic Dentistry and All on 4 Reconstruction

Costa Rican Doctors
Most Costa Rican doctors are excellent and have been trained in Europe
or North America. If you don’t speak Spanish, you don’t have to worry.
Many local doctors speak English, but most receptionists and nurses do not.
Doctor’s fees for office visits vary. A good private specialist usually charges
between $40 and $60 for each visit, although some doctors charge a little
more and others a little less.

Unlike many other places, doctors in Costa Rica take time with patients
to answer questions and listen. Doctors usually give you their office, home
and cell phone numbers as well as pager number. It is not unusual for doctors
to call their patients at home to follow-up on care and medications, and they
will make house calls.

Doctors here are much less interested in making a profit than serving
the people. Considering there are no high malpractice premiums to pay,
physicians can make a good living without charging exorbitant prices.
If you join Costa Rica’s national health care system, you do not have to
pay for each office visit, only a small monthly membership fee. If you have
any questions about medical fees or doctors, you should direct them to the
Colegio de Médicos, which is the Costa Rican equivalent of the AMA.

To find a good English-speaking physician or specialist, talk to other
expats, look in the Yellow Pages under Médicos, look for doctor’s ads in the
The Tico Times or see the list at the end of this section.

Hospitals and Medical Facilities
Public medical facilities are so good that you don’t usually need private
care. Most private specialists are required by law to work part-time in public
hospitals. However, private clinics and hospitals provide quicker services
with more privacy, enabling you to avoid long lines and the bureaucracy of
the public system.

In Costa Rica, the term clínica is used for private institutions that generally
include inpatient medical/surgical facilities, doctor’s offices, laboratories,
radiology, pharmacy and outpatient services. Hospital generally refers to
public inpatient medical/surgical facilities that also provide laboratory,
radiology, pharmacy and related services.

Most Costa Ricans find the cost of private clinics too expensive. However,
foreigners will find private clinics very reasonable compared to similar
institutions back home.

You will be happy to know you can receive first-rate care at any of San
José’s three largest private hospitals.

If you have to enter a private hospital, costs will be lower than in the U.S.
A single room a spacious, with bathroom and cable TV including English
channels. Private and semi-private rooms often have an extra bed or sofa bed
so a relative may spend the night, if necessary. It is important to note that
the doctor’s bill will always be separate from the hospital bill.
A few years ago my son was operated on for an appendectomy at the
Clínica Bíblica. The total cost including the surgeon’s fee was under $3,000.
My INS insurance covered all but $140.

I know an American who spent a couple of days in the private Clínica
Católica hospital and said, “The attention was first-class, the food was as
good as home cooking, and the same care would have cost thousands of
dollars in the States.” It is important to know that payment can be made
at most hospitals and clinics with any major credit card. Foreign medical
insurance is accepted, if they cover you abroad. In some cases, especially if
arranged in advance, your foreign insurance can be used so you can just pay
the deductible. Talk to your private hospital.

• The Clinica Bíblica (Tel:2522-1000, 800-911-0800, Fax:
2255-4947,E-mail:asoserme@racsa.co.cr, www.clinicabiblica.com) in
downtown San José is now affiliated with the Blue Cross and Blue Shield
network. There is a small chance that Medicare may be accepted someday,
but don’t hold your breath. A first-class private hospital with an excellent
coronary unit, this fine facility is staffed with highly trained doctors. Complete
hospital services including maternity, an ER room, MRI equipment and
lab work are available. I have used the lab on many occasions and found
the service to be excellent. In order to keep pace with the country’s needs
for first-rate private care, the hospital acquired a new multi-storied medical
tower in the next block and added a large wing to the main hospital.

In addition to the main branch in downtown San José, the Clínica
Bíbilica has smaller satellite branches with a doctor on duty, pharmacies
and express delivery of medicine in Heredia (2260-4959), Cartago
(2551-0511), San Francisco de Dos Ríos (2218-0035 ), and in the San
Pedro Mall (2283-6058). Since I live in Heredia, I have used the local
Heredia branch of the Clínica Bíblica on several occasions for minor
ailments and tests. The service has been very good and fast.

• The newely refurbished Clínica Católica (2246-3006, E-mail: info@
clinicacatolica.com, www.clinicacatolica.com) in Guadalupe, a suburb
of San José, is another fine private hospital with complete hospital and
emergency services 24-hours a day, 365 days a year. However, it is not as
popular with foreigners as the Clínica Bíblica or Hospital CIMA. This
facility takes private INS insurance, Blue Shield and Blue Cross. During
an acute asthma episode, I spent three days in this hospital and found
the care very good.

• Hospital CIMA (Tel: 2208- 1000, E-mail cimahsj@racsa.co.cr, www.
hospitalsanjose.net) in Escazú, right off the highway, is the newest private
hospital in the San José area and is affiliated with the Baylor University
Medical Center in Dallas, Texas. It is managed by International Hospital
Corporation of Dallas. It is a full-service hospital that boasts the latest
health care technology, state-of-the-art medical equipment and the
most sophisticated physical plant in Central America. It offers complete
services including X-ray, ultrasound, emergency and intensive care, as
well as an advanced coronary unit.

The average cost of a room per day is between $130 and $140,
which is very reasonable compared to the cost of a hospital in the United
States. An adjacent seven-story medical office building houses the offices
of more than 100 specialists.

Hospital CIMA plans to open a full-service branch near Flamingo
Beach in Guanacaste. The International Hospital Corporation (IHC)
announced the construction of CIMA Guanacaste, a new hospital in
Guanacaste, Costa Rica. Besides CIMA San José, IHC has other hospitals
in Brazil and Mexico.

Costa Ricans and foreign tourists will no longer have to travel to San
Jose for quality medical attention. Now, they will have access to general
physicians, specialists, surgeons, operating rooms, and hospital services
in Guanacaste,” said Carole Velos, General Director of CIMA San José.
The new CIMA Guanacaste will be the entry door for Pacific Plaza,
an international campus specializing in completely integrated health and
retirement community services.

CIMA Guanacaste will be strategically located next to Do-It Center
in Carrillo, Guanacaste, on the road to Liberia’s International Airport
and to the beach resorts and retreats of the region. This location will
provide tourists and residents with top quality medical services, and the
exact same standards as in CIMA San José.

Pre-construction works have already started, and they are expected
to be completed by the end of 2010 or beginning of 2011.
The Clínica Bíblica is one of Costa Rica’s best private hospitals.

Note: Lately there have been a lot of complaints about Cima’s high
prices from some of the contributors from the Costa Rica Living newsgroup.
You can look up these articles by going to ther site listed in Chapter 14.

• The Clínica Santa Rita (2221-6433), near the court buildings, has an
excellent maternity center and is used for cosmetic surgery procedures.

• The Hospital Cristiano Jerusalem (2216-9191), in Alto de Guadalupe,
offers limited services. Although not a hospital, the Clínica Americana
(2222-1010), next to Clínica Bíblica, offers private out-patient service
and some U.S.-trained doctors on call 24-hours a day.
• Hospital Clínica Santa María, (Tel: 2523-6000, Fax: 2523-6060,
E-mail: servicioalcliente@hospitalcsantamaria.com), offers a variety of
high-quality services in downtown San José.

• Hospital Universitario de La Universidad Iberoaméricana, (Tel:
2297-2242, Fax: 2236-0426, E-mail: admisiones@unibe.ac.cr), located
in San José’s suburb of Tibás, is the country’s newest private hospital.
It is a full-service university hospital where specialists treat all patients
with students as observers.

• C.A.R.E. 8353-7456 or 2282-2626 (beeper) or 2637-8606 (Los Sueños
Resort) or 643-1690 is a private emergency medical center in the Jacó
Beach area. It offers medical consultation, an advanced life support
ambulance, minor surgery and special events coverage. The clinic’s
regular hours are from 8 a.m. to 6 p.m.

• Emergencias Médicas (2290-4444) is a private company offering quick
ambulance service. For a small yearly fee you can take advantage of its firstrate
service. Emergencias Metro (2263-2983, emergenciasmetro@yahoo.
com) is another company offering emergency medical transportation
and care. Costa Rica Life Guard (8824-5227) offers emergency
transportation by airplane.

Public Hospitals
As you can see, public hospitals and clinics are found in most parts of
the country, with the three major facilities in the San José area. Although
public hospitals are generally crowded and waits can be long for appointments,
there is no problem when it comes to emergency treatment.

The author can personally vouch for the care at Costa Rica’s public
hospitals. After many hours in labor my wife gave birth to my son by
cesarean section at the public San Juan de Dios Hospital. He was taken to
the Children’s Hospital next door because he required some special care and
was placed in an incubator while my wife recovered. About three days later
both mother and baby were released without any complications. Today I
have a healthy 18-year old son.

The major public medical centers in San José are:

Hospital Blanco Cervantes………………………………… Tel: 2257-8122
Hospital de la Mujer (Carit)
(Maternity Hospital)…………………………………………… Tel: 2257-9111
Hospital México……………………………………………….. Tel: 2242-6700
Hospital de Niños (Children’s Hospital)………………. Tel: 2222-0122
Hospital Psiquiátrico Manuel A. Chapul
(Psychiatric Hospital)………………………………………….. Tel: 2232-2155
Hospital Rafael Angel Calderón Guardia……………. Tel: 2212-1000
Heredia’s new hospital is the largest public hospital in Central America
Tel: 2257-6282

Major public medical facilities in other areas of the country:
Heredia
San Vicente de Paul………………………………………….. Tel: 2277-2400
Alajuela
Hospital San Rafael………………………………………….. Tel: 2436-1001
Cartago
Hospital Max Peralta………………………………………… Tel: 2550-1999
Saving Money in Costa Rica 171
Ciudad Neily
Hospital de Ciudad Neily…………………………………….. Tel: 2783-4111
Guanacaste (Liberia)
Hospital Dr. Enrique Baltodano………………………. Tel: 26690-9700
Limón
Hospital Dr. Tony Facio……………………………………. Tel: 2758-2222
Los Chiles
Hospital Los Chiles…………………………………………….. Tel: 2471-2000
Nicoya
Hospital de la Anexión………………………………………………. 2685-8400
Pérez Zeldón
Hospital Escalante Pradilla………………………………….. Tel: 2785-0700
Puntarenas
Hospital Monseñor Sanabria……………………………… Tel: 2663-0033
San Carlos
Hospital San Carlos…………………………………………….. Tel: 2460-1176

Alternative Health Care for Drug and Alcohol Addiction
Costa Rica, unlike the United States, does not prohibit some controversial treatments for drug and alcohol addictions. One such drug is Ibogaine, which in the US is classified as an addictive substance. However, other countries, like Brazil, recognize its addictive breaking tendencies and have legalized it use, and in other countries, there are no laws prohibiting its use. One such clinic that treats patients in a medically supervised atmosphere in Costa Rica is the Envision Recovery Ibogaine Treatment Center

Health Care for Veteran’s in Costa Rica
The Clínica Bíblica now accepts medical coverage through Tri Care Latin
America and CHAMPUS for hospital and pharmacy services.

Here are the requirements for medical benefits for U.S. military retirees
and their families:
1. A current U.S. military retiree ID card (20 years of active duty)
2. 65 years or over and have Medicare Part B.
3. Current ID cards for all dependents under 21 years of age if in college
with proof of enrollment
4. Unmarried widows must have the related documents above for their
husband.

Medical benefits for U.S. veterans:
The disabled veteran can only be treated for the disabilities listed on the
Treatment Authorization Sheet from the VA. If the veteran is 100 percent
disabled, all dependents will receive total health care, not including dental
and glasses. The following documents are required:

1. Current CHAMPUS VA card.
2. Current ID card for all dependents under the age of 21 and up to 23
years of age if in college with proof of enrollment.
4. Copy of DD 214
5. Unmarried widows must have the related documents above for their
husband.

To find out about benefits for military retirees and their families and for disabled
veterans, call 2522-1500/221-7717 or E-mail: sguros@clinicabiblica.com.
Low-Cost Medical Insurance

Costa Rica’s health care system is available to retirees and other foreign
residents. Residents may join the Caja Costarricense de Seguro Social
(Costa Rican Social Security System) and enjoy the same inexpensive medical
coverage as most Costa Ricans do. Most foreigners do not enroll in this system
because of the long waits for medical appointments, some medications and
other delays. However, despite being overburdened, the emergency care
provided is very good. There are clinics all over the country. At a low cost
of around $80 monthly, the Caja is a good deal for foreigners.

The cost to affiliate directly is about 13 percent of your monthly income
by law; however the ARCR (www.arcr.net) has a legal contract with the Caja
to affiliate at a very reasonable price.

As just stated, according to the law you must pay 11 to 13 percent of your
income to the Caja for voluntary medical insurance. Some foreigners who
try to get around this by lying about their income and paying the minimum
of about $25 monthly. If they are legal residents, the government will know
they have at least an income of $600 per month and should be paying about
$70 monthly. If they are caught underpaying, they can be fined and ordered
to pay the difference in what was not paid in the first place. My advice to
you is: Don’t try to cut corners.

If you are a resident or hold a work permit, the first step is to join the
Caja. If you need a medical consultation, go to the EBAIS or clinic closest
to home and request an appointment (go early, as there is usually a long line
for appointments). If your case merits attention by a medical specialist, you
will be referred to the nearest clinic or hospital for evaluation.

Most foreigners opt for the medical insurance offered by the government’s
insurance company—the National Insurance Institute or INS. Everyone
is eligible to apply, including permanent residents, pensionados and rentistas
and even tourists. Elderly people have to submit to a physical before they
can be insured. The medical policy covers expenses resulting from illness,
accidents, hospitalization, office visits, lab work, medicines and medical costs
in foreign countries. However, if you incur medical expenses abroad, INS
will pay only the amount equivalent to the same treatment in Costa Rica
and you have to pay the difference.

When you purchase a policy, INS will supply you with an identification
card and a booklet that lists the names of affiliated groups such as hospitals,
doctors, labs and pharmacies. Most surgical procedures are covered 100
percent. You pay a small deductible for office visits, labs, medicines and
treatments. If you seek medical services not affiliated with INS, you have
to pay up front. You then submit a claim to INS and will be reimbursed in
a few weeks.

Depending on age and sex, the annual cost of this insurance is about
$800 for a man 50 to 69. For example, rates for a man 18-39 years run
about $250 per year; $1,800 for a 70-year old man ; and women of all ages
pay an average annual rate of about $1,500. Women of childbearing age
pay slightly more than men. There is a discount if more than one person
is insured on the same policy. It is easy to enroll an entire family for a low
monthly rate. If you belong to a group of 15 or more people—such as the
Association of Residents (ARCR) or the American Legion— you can obtain
an approximate five percent discount.

Since medical costs are so low in Costa Rica, this policy is more than
enough to take care of your medical needs. Retirees and other residents
need not worry about lacking adequate medical coverage in Costa Rica. For
information, go to the (ARCR) or contact them at: (Tel: 2233-8068, Fax:
011-(506) 2222-7862) or see www.arcr.net or contact Franklin Martinez
2258-7041 or 8318-2255.

INS now offers a new international insurance policy that covers your
needs in Costa Rica and the rest of the world. This new medical policy covers
medical expenses resulting from accident or sickness. Here are some of the
items covered: hospitalization and ambulance expenses, maternity, prosthesis,
organ transplants, air evacuation, repatriation of remains, funeral costs and a
yearly check-up and eye test. The rates are high but the coverage is complete.

Mixed Medicine
One of the services offered by Caja is that of mixed medicine, whereby a
patient can go for treatment to a private doctor, pay those bills and receive
medications and other services from the Caja. In this sense, the Caja uses
mainly generic medications certified by quality control laboratories, even
in some cases using the original medications. The idea of Mixed Services
is that the patient can been seen by a trusted physician and avoid the long
line for treatment at an EBAIS or rural clinics.

Some Costa Ricans and many foreigners use the Caja as a type of
back up insurance for extra protection. They see a private doctor for minor
ailments and the Caja for major problems, while others use the Caja for
certain tests and expensive medicines and minor illnesses. Another way
to do it is to use a private physician for problems that require a long wait
through the Caja. The waits for some tests and procedures can take months,
so people with cancer and other serious problems often go to a private lab
to get faster test results.

Many doctors who have a private practice and also work in the public
system will operate on their patients in a public hospital to reduce costs.
Be careful of a biombo. A biombo is a medical practice that has been used
from time to time by some unscrupulous individuals in the medical profession.
For example, a couple of medical professionals employed by the Caja were
just arrested for taking samples of blood at their own private laboratory and
then using equipment at a public hospital to do the analysis.

Comparing Costa Rica’s Public and Private Health Care Plans
.What follows is a brief comparison of the Caja and the INS medical plans
available in Costa Rica.

Caja — National socialized system.
1. Covers doctor’s visits, medications, examinations and hospitalization.
2. Doctors are assigned to the patient.
3. Covers pre-existing conditions.
4. Covers all medications including dental and eyes.
Some reasons to consider this plan:
1. Have pre-existing health condition and do not qualify for INS insurance.
2. Take medication on a regular basis.
3. Have it as major medical in case of serious illness.
Monthly premiums cover all illnesses for the member and his immediate
family for that month. The cost through the ARCR if younger than 55 years
old is $58 per month; $37 per month if 55 years or older.

INS — The semi-autonomous government insurance company.
1. Covers 75 percent of the cost of doctor’s visits, medications, examinations
and hospitalization.
2. Individual chooses the doctor.
3. Does not cover any pre-existing medical condition.
4. Does not cover most dental or eye exams, treatments or glasses, preventive
medical check-up, illness or disorders related to female reproductive
organs during the first 12 months of coverage, or birth of a baby during
the first six months of coverage.

Some reasons ARCR members have the INS plan.
1. Can choose a doctor.
2. Can make doctor’s appointments with less red tape.
Rates of coverage depend on age and sex; 20 percent deductible for each
doctor’s visit.

Plan 16 Medical Insurance Policy
Plan 16 is the medical insurance policy INS has been selling since 1990,
and a lot of people from the foreign community have obtained coverage
through the Canadian Club, the American Legion and the ARCR.
Who can be insured? Anyone up to age 100, regardless of legal status
in Costa Rica. Applicants over 69 must undergo an examination by an INS
doctor. It takes INS about three weeks to study applications; you can’t pay
until your application is accepted. The policy parallels the calendar year;
if someone applies and is accepted part way through the year, the yearly
premium is prorated.

What does the policy pay for? It covers expenses due to sickness,
accident or childbirth. Outpatient services are paid for up to 10 percent of
the insured amount, per year. The rest of the policy, the other 90 percent,
is for hospitalization, surgery, pre- and post-operative care, private room,
food, support systems, intensive care, rehabilitation, ambulance, home care,
therapy, medication, etc. In case of death, 50 percent of the insured amount
is paid to the named beneficiary. Please note that there is no payment for
checkups or “preventive maintenance,” No changes.

What does it exclude? Pre-existing conditions. Also not covered are
medical expenses as a result of cataclysmic events, fighting, except in self defense,
tournament sports, martial arts and other dangerous activities.
Accidents when under the influence of alcohol or drugs. Mental or nervous
disorders. Checkups. Allergies. Stress. Plastic surgery. Only accident related
eyeglasses, dentist’s bills or reconstructive surgery are paid. Some ailments
(e.g. glaucoma, cataracts, ENT, women’s reproductive organs, breasts,
asthma, hernias, pregnancy, prostates, stones, osteoporosis) have a 12- month
moratorium during which claims are not allowed.

How much does it cost? You can choose from three levels of insurance.
The insured amount refers to the maximum amount INS will pay for your
health in the calendar year. Premiums depend on the level of insurance, and
on the age and sex of the insured.

Group policies for companies Associations or Clubs, (ARCR, American
Legion, etc.) cost about 40 percent less. Cost of renewal may increase if
there is a high claim/premium ratio.

How does it work? In case of ambulatory care (when hospitalization
is not needed), you must pay for your care and later submit an INS claim
form signed by you and your main doctor, attaching original receipts and
corresponding prescriptions for medicine, treatments and lab tests. Your
agent will push your claim through INS, which usually pays after three to six
weeks, based on usual and reasonable charges. If you require hospitalization,
a week before you go into hospital, through your agent you should obtain
pre-authorization from INS, which will negotiate prices with your caregiver.
When released from the hospital, you must show your insurance card and so
pay the deductible only. If you didn’t get the pre-authorization, you must
pay the entire bill and make a claim as described above.

Deductibles?  Providers are classified as A, B or C. If you go to an A
provider, INS will pay 80% of usual and customary prices; B providers, INS
pays 75%; C providers, 70%. CIMA is classified A. Clínica Bíblica is B. For
additional information contact the author of this last section, David Garrett,
at 2233-2455 or E-mail: info@segurosgarrett.com.

INS Medical Regional
INS Medical Regional is an alternative to Plan 16 and provides broader
coverage.
Who Can Be Insured?
Residents of Costa Rica ages 18 to 65 can apply. Sometimes people up to 70
have been accepted. Once insured, INS will renew indefinitely so long as the
premium is paid. Dependents from birth up to age 24 can also be insured.
What is Covered?
Medical expenses due to accident, sickness or maternity, up to $200,000
per year. For people over 69, the coverage is reduced to $60,000 per
year. The policy will also pay for an eye test and checkup, as of the second
year. It covers hospital care and ambulatory care. Subject to sub-limits,
also maternity, cancer, epidemic diseases, prosthesis, organ transplants,
ophthalmic care, air ambulance if treatment can only be administered
abroad, repatriation of remains, death benefit for burial, etc. By means of
surcharges you can increase the cancer coverage, and coverage for severe
medical conditions, to $400,000.

Where is coverage offered?
Worldwide coverage. But the policy is designed for and works best in Central
America.
What are the main exclusions? Conditions existing when the insurance
is bought. Treatments for obesity, cosmetic surgery, sterility, congenital
conditions, dental care, sex change, insemination, mental disease, addictions,
attempted suicide, self-inflicted lesions, pregnancy of dependents except
spouse, accidents when the insured was under the influence of drugs or
alcohol, correction of vision, AIDS and HIV positive, erectile dysfunction,
chiropractic and podiatrist care, tranquilizers, antidepressants, vitamins,
non-prescribed expenses, experimental treatments, accidents while practicing
high-risk or speed sports, medical expenses as a result of cataclysmic events,
terrorism, civil insurrection or war.

What about preexisting Conditions?
Chronic conditions, at the discretion of INS, can be covered if the applicant
has had no symptoms in the last two years.
How are claims and deductibles handled?
In Central America there is a network of providers (doctors, hospitals, labs,
clinics and pharmacies), which includes Clínica Biblica, Hospital CIMA,
Clínica Católica and others, where you pay less because they are bound to a
price limitation imposed by INS, and you pay a lower deductible. Also, for
hospital care you use your insurance card to cover the balance. With preferred
providers, for hospital care you pay for one day of hospital room, plus 10
percent of the following $5,000; for ambulatory care you pay $10 per doctors’
visit, plus 10 percent of other prescribed expenses. With outside providers,
for hospital care you pay for one day of hospital room with a minimum of
$200, plus 20 percent of the next $20,000; for ambulatory care, you pay
$20 per doctor’s visit, plus 20 percent of other prescribed expenses.
How much does it cost?
You can choose from three levels of insurance. Premiums depend on the
level, and on age and sex of applicants (costs shown in U.S. dollars). Some
averages of yearly premiums:
Adults
Age Men Women
0-18 US$ 448 US$ 524
19-25 470 562
26-29 526 633
30-34 553 678
35-39 640 783
40-44 692 865
45-49 829 931
50-54 953 1,086
55-59 1,068 1,179
60-64 1,348 1,364
65-69 1,625 1,599
70-75 2,090 2,046
Children to 10 years.
Both genders
1 child………………………………………………………………………… US $ 226
2 children……………………………………………………………………………. 291
3 + children…………………………………………………………………………. 376
* Check for current rates
Applications
No medical examination is normally necessary. For bureaucratic reasons,
policy applications are best filled out by an agent. You must pay the first
premium at the time of applying. The policy goes into effect 30 days later.
Some medical conditions have a 10-month moratorium.
What numbers do I phone for medical assistance when I am away
from Costa Rica ?
• Within the United States: 1-866-543-6307 (toll free)
• Any other country except Costa Rica : +1 (305) 463 9635 (you may
call collect)
INS Medical International
Who can be insured?
Residents of Costa Rica ages 18 to 65 can apply. Applications from people up
to 70 have sometimes been accepted. INS will renew indefinitely so long as
the premium is paid. Dependents from birth to age 24 can also be insured.
What is covered?
Medical expenses resulting from accident, sickness or maternity, up to $2
million per year. For people over 69, coverage is reduced to $600,000 per
year. The policy will also pay for a yearly eye test and checkup, as of the
second year. Covers hospital and ambulatory care. Subject to sub-limits,
maternity, cancer, epidemic diseases, prosthesis, transplants, ophthalmic care,
air ambulance if medically required, repatriation of remains, death benefit
for burial, etc.

Where is coverage offered?
Worldwide coverage.

What are the main exclusions?
Conditions existing when the insurance is bought. Treatments for obesity,
cosmetic surgery, sterility, congenital conditions, dental care, sex change,
insemination, mental disease, addictions, attempted suicide, self-inflicted
lesions, pregnancy of dependents except spouse, accidents when the insured
was under the influence of drugs or alcohol, correction of vision, treatment for
AIDS and HIV positive, erectile dysfunction, chiropractic and podiatrist care,
tranquilizers, antidepressants, vitamins, non-prescribed expenses, experimental
treatments, accidents while practicing high-risk or speed sports, medical
expenses as a result of cataclysmic events, terrorism, civil insurrection or war.

What about preexisting conditions?

At the discretion of INS, these can be covered if the applicant has had no
symptoms in the two years before an application is submitted.

How are claims and deductibles handled?
In Central and North America there is a network of providers (doctors,
hospitals, labs, clinics and pharmacies) where you will pay less because they
are bound to a price list imposed by INS — and you pay a lower deductible.
Also, you use your insurance card to cover the balance for hospital care. (You
can also get this insurance with a blanket, per-year deductible, where you
accumulate your medical expenses and, if in the policy year they exceed the
limit, you can claim for the excess.)

With preferred providers, for hospital care you pay for one day of hospital
room, plus 10 percent of the following $5,000; for ambulatory care you pay
$10 per doctor’s visit, plus 10 percent of other prescribed expenses.
With outside providers, for hospital care you will pay for one day of hospital
room with a minimum of $200, plus 20 percent of the next $20,000; for
ambulatory care, you will pay $20 per doctor’s visit, plus 20 percent of other
prescribed expenses.

How much does it cost?
You can choose from three levels of insurance. Premiums depend on the
level, and on age and sex of applicants (costs shown in US dollars).

Large Individual Deductibles Minimum Deductible
Standard Deductible US$ 5.000
Age Men Women Men Women
26-29 1,043 1,254 539 634
35-39 1,332 1,622 674 803
45-49 1,715 1,921 863 951
55-59 2,199 2,425 1,116 1,206
65-69 3,331 3,279 1,720 1,668

Minimum Deductible Minimum Deductible
US$10.000 US$ 15.000
Age Men Women Men Women
26-29 402 463 323 365
35-39 495 580 392 451
45-49 630 684 493 530
55-59 819 873 647 680
65-69 1,279 1,226 1,023 972

How to apply?
No medical examination is normally necessary. For bureaucratic reasons,
policy applications are best filled out by an agent. You must pay the first
premium at the time of applying. The policy goes into effect 30 days later.
Some medical conditions have a 10-month moratorium.

What numbers do I phone for medical assistance
when I am away from Costa Rica ?
• Within the United States: 1-866-543-6307 (toll-free)
• Any other country except Costa Rica: +1 (305) 463 9635
(you may call collect)
Courtesy of 2005 Garrett & Associates www.segurosgarrett.com

Alternative International Medical Plans
In addition to the medical plans mentioned above, companies such as Blue
Cross and Blue Shield offer international coverage for their policyholders.
The majority of private clinics in Costa Rica work with companies offering
international medical coverage.

With some of these policies you may have to pay out of your own pocket
and provide receipts for reimbursement at a later date. Other companies
will pay “right on the spot.” It is a good idea to have a policy that provides
international evacuation which in some cases may be a viable option. A friend
of mine went on a trip from Costa Rica to Nicaragua and became very ill
while there. He developed a problem with internal bleeding. Because he had
an international evacuation policy, he was flown to New Orleans. He was
unconscious for several days but eventually fully recovered. Needless to say,
he would have probably died without this policy that allowed him to go to
the United States for specialized treatment.

I.M.C. Asociados, S.A. offers BUPA International’s health plan in
Costa Rica. They have health care plans specifically designed for residents of
Central America with worldwide coverage wherever and whenever needed.
They guarantee lifetime coverage without excessive increases in premiums with
age. Contact them at: Tel: 2256-5848 or E-mail: imccr2002@yahoo.com.

Global Insurance offers medical plans for people living abroad. You
may contact them at: Tel: (305)-2274-0284, Fax: (305)-2675-6134, tollfree
1-800-975-7363, E-mail: cperez@globalinsurancenet.com or www.
globalinsurancenet.com.

Medibroker (Tel: 0-191-297-2411/44-191-297-2411, Fax: 0-191-
251-6424, www.medibroaker.com, e-mail: medibroker@aol.com offers
medical coverage for retirees, expats and others living abroad. They have
various plans from which to choose.

The AARP may also offer a program for foreign coverage.
While checking out Costa Rica, to see if it is the place for you to settle,
you can get temporary medical insurance as a tourist through the Costa
Rican Social Security office and the International Organization of Cultural
Interchanges (O.I.C.I.). Contact them at 2222-7867.

Medicine and Pharmacies
Pharmacies are numerous in Costa Rica and they stock most standard
medicines available in Europe, Canada and the United States. In general,
the cost of most medicines is lower than in the U.S. However, it pays to
shop around. There has been a continuous price war going on among most
of the pharmacy chains. So, good bargains may be found.

Many drugs requiring a prescription in North America are freely available
“over the counter” in any Costa Rican farmacia .Exceptions are strong pain
relievers and narcotics that require a special prescription. In Costa Rica,
pharmacists are permitted to prescribe medicines as well as administer onthe-
spot injections. They are also available to answer your questions and give
free medical advice about less complex conditions. In general, Costa Rican
pharmacists usually give you the correct advice and appropriate medication.
This can save you a trip to the doctor’s office.

Foreigners who can’t find their specific medication will have no problem.
Pharmacists have a thick medical guide listing most medicines in the world and
their generic equivalents. Some caution should be taken when figuring out the
specific dose. I have a friend from Fort Lauderdale, Florida, who mistakenly
purchased blood pressure medicine that was twice as strong as what he needed.
He ended up feeling very ill and had to be taken to a local hospital. The problem
was quickly resolved when the doctor realized the dosage was incorrect.

Some pharmacies open 24-hours a day are in downtown San José at
Clínica Bíblica, 2223-6422; at the Clínica Católica, 2225-9095; and the
Farmacia del Este in San Pedro 2253-5121.

The main branch of the Fischel pharmacy 2223-0909, across from the
main post office in San José, has a doctor on duty to give medical advice.
Fischel will deliver medicine and prescriptions in most areas. Many of their
employees speak English. They also have smaller pharmacies in other locations
around San José and in Heredia, Alajuela, Cartago and Puntarenas.
For home delivery call them toll-free at 800 Fischel 800-347-2435.
Recently, Fischel opened the country’s first online pharmacy. They offer the
sale of prescriptions and over-the-counter products. In addition, their staff of
pharmacists and doctors will answer your questions. Their site also provides
general information on topics such as proper use and storage of medicines.

You may view their site at www.fishel.co.cr. Fishhel doesn’t give very good
discounts. You can find the price of most medicines by accessing their site
at:www.fischel.co.cr/Default.asp?Usu=Anonimo.

Farmacia Sucre and Farmacia Catedral are other large pharmacy chains
in the Central Valley.

MEDICINA (800-633-4246). They offer 24-hour home delivery seven
days a week and don’t close for holidays. They have 14 locations and plan
to open more. Contact them to find out about their discount programs.

Cosmetic Surgery
Costa Rica has long been the destination for those in search of the “Fountain
of Youth.” People from all over the world flock to Costa Rica for cosmetic
surgery because prices are lower than in the United States for comparable
procedures. Costa Rica’s surgeons are among the world’s best. Most of
Costa Rica’s plastic surgeons are trained in the United States or Europe.
They keep up-to-date on new trends and methods in their field and attend
professional seminars regularly. Rates for different operations vary from
doctor to doctor. You can combine several procedures to reduce the price
substantially. There are even package prices that combine surgery, hotel
and hospitalization.

In general, prices average 25 to 60 percent less than in the United
States, although the final cost is open to negotiation with the surgeon.
The low cost of cosmetic surgery should not, however, be interpreted as
a sacrifice of quality for affordability. The cost of a full-face lift is between
$2,000 and $3,500 (add a few hundred dollars per day in the hospital to
recuperate from the surgery); nose surgery about $2,000; liposuction $800
and $1,500; with a tummy tuck, $2,000 to $3,000, breast implant $2,500
to $3,500 and eyelid surgery between $800 to $1,500. Many doctors send
their patients to special recovery houses for about $70 a day. Rates vary from
surgeon to surgeon. I suggest you contact Dr. Arnoldo Fournier (please
see the article in this section). He is among the best plastic surgeons in
Costa Rica and will be more than happy to send a brochure and answer any
of your questions.

For information about travel arrangements or cosmetic
surgery vacations
see
Unique Costa Rica Tours at www.costaricabooks.com/travel. You
may combine cosmetic surgery, dental work or language study vacation with
Christopher Howard’s Retirement Tour.

One quick word about cosmetic surgery in Costa Rica. There are a
couple of doctors who advertise their services as cosmetic surgeons but have
no specialized training in the field. Therefore to get the best results from
your surgery, we suggest you do the following:
(1) Ask the U.S. Embassy for a list of certified plastic surgeons; (2) Check
with the Colegio de Médicos (the local equivalent of the A.M.A.) to see if
a particular doctor is trained as a plastic surgeon. All doctors in Costa Rica
must be registered with the Costa Rican Doctor’s Association or Colegio
de Médicos (Tel:2 232-3433, Fax: 2 232-2406, E-mail: medicos@racsa.
co.cr, www.medicos.sa.cr). Only registered plastic surgeons may advertise
their services; (3) Ask a local family doctor for a recommendation for a
good plastic surgeon. (4) Talk with former patients of the doctor of your
doctor.

Plastic Surgery in Costa Rica
By Arnoldo Fournier M.D.
Within the American Continent, Costa Rican Cosmetic, Plastic and
Reconstructive surgeons, has been recognized more and more for
their natural post-surgical results.

Most of these surgeons, most likely, are fluent in more than two
languages because they have earned the opportunity to study abroad
for their post-medical graduate studies in cosmetic procedures.
For the last ten years, cosmetic tourism has increased significantly.

One of the pioneers in this field is Arnoldo Fournier, M.D., F.A.C.S.,
Founder and Board Member of the Society of Plastic Surgeons in
Costa Rica, Correspondent Member of the American Society of Plastic
Surgeons, and the American Society for Aesthetic Plastic Surgery.
“When I came back to Costa Rica (more than twenty years ago) from
St. Luke Hospital in New York, I was told by a former Plastic Surgeon,
that cosmetic procedures were not in demand by Costa Ricans.”

As a result, this stubborn Surgeon decided that if he was not going
to have Costa Rican clientele, he was going to look for a demand outside
the borders of Costa Rica. He placed his first advertisement in the Tico
Times (a national English language newspaper) offering his services
for Cosmetic, Reconstructive and Plastic Surgery. As time went by, he
also placed more advertisements in other well known magazines such
as LACSA Magazine, Eastern Magazine, Skyword Magazine, Passages
Magazine, etc. “I was the seventh Cosmetic Surgeon in the world to
own a web site when the era of the internet began”.

The majority of his patients come from overseas, especially from
the United States. Cosmetic Surgery Vacations have become more
and more attractive, due to the natural beauty of Costa Rica. Most
people come to Costa Rica, and tour around for one week, and then
have their procedures done. Others, simply come for their procedure,
relax during their post surgical recovery, and do day tours to nearby
volcanoes, National Parks, etc. Costa Rica’s wonderful year round
weather (75 º F year round!), is an adequate place to recover. Its not
too hot, and not too cold, and it has the humidity every skin desires.
The most attractive things about the Cosmetic Vacations, are their
affordable costs, excellent quality surgery, and safety. “Within the U.S.,
you can find rates that vary from $10, 000 to $15,000. In Costa Rica,
for the same procedures, I offer rates that are $3,000 and lower The
Secretary of Health, annually supervises several public and private
hospitals in Costa Rica. They all need to have the appropriate, updated
equipment for the procedures performed at hospitals’ operating rooms.

There is a requirement for the patients receive their pre-surgical medical
exam results prior any procedure, and antibiotics. The procedures are
done with local anesthto esia and sedation to reduce the risk of general
anesthesia. “This means, that the patients are given pills for sedation
prior to and during the procedures, and intravenous medication that
is given by an anesthesiologist”. Therefore, the patients will not be
aware or awake during the procedures.

Dr. Fournier leads a Surgery team that includes his assistant,
anesthesiologist, and two certified nurses. Over time, more and
more patients have called and written to him from around the world
for his services. He is known for his personal care with every patient.
“I do one to two procedures a day in the morning time. I perform
all procedures myself”. Dr. Fournier, says that he likes to work first
thing in the morning because he feels fresh, clear and energetic for
the procedures he performs. “It is better to do one or two procedures
a day, than five to twenty supervised or half done. As a result, I can
explain to the patient precisely was done in the operating room”.

He personally answers all the emails and telephone calls he receives
from his patients. He personally visits them in their hospital rooms,
and accompanies them throughout their post-op period. Patients
are asked to stay in San José for a few days at any recovery center
after surgery. During this time, he sets up appointments in his office
several times a week, and revises the recovery time for every patient.

Today, his best advertising is done by the “word of mouth”. His
former patients spread the news about the good things good things
dome by Dr. Fournier who has “the hands of an surgeon, the eyes of
an artist, and the heart of a Friend”.

For more information you can visit his website at www.drfournier.
com, E-mail at: fournier@racsa.co.cr , or call him at 011-506-
2223-7314.

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