The IESS is an autonomous institution responsible for implementing mandatory general insurance. In other words, its main function is to protect the rights of Ecuadorian workers who are insured. The inclusion of voluntary affiliates, which includes expatriates, has allowed the general public to access healthcare services such as medicine, medical appointments, emergencies, laboratory tests, and surgeries. This opportunity has also been utilized by foreigners who chose to settle in Ecuador. They have been able to access low-cost healthcare services, but often lack the necessary understanding of how the IESS system works.
The current situation of the IESS is concerning, as it owes money to several external service providers. This lack of financial flow is affecting its affiliates, who have stopped receiving their monthly medications, and specialist appointments, or are facing months-long waits for surgeries. Consequently, a significant portion of the population has turned to low-cost private insurance to meet their primary insurance needs. This preference for private insurance, combined with the 2019 pandemic, resulted in the disaffiliation of around 300,000 IESS members, exacerbating the financial deficit. This not only impacts the affiliates but also strains the IESS system itself, as it lacks sufficient assets to cover payments to providers, doctors, nurses, and healthcare professionals.
However, not all responsibility can be placed solely on the IESS. The government, specifically during the socialist-led regime of Rafael Correa for over a decade, has left a significant economic impact on this institution. The government’s arbitrary use of pension funds for political campaigns without prior authorization has deeply affected the economy and security of the country. To this day, the government still owes $7.782 billion, accumulated since 2001, to the IESS. The only payment registered during this period was in 2022 when the government paid $140 million. Furthermore, the state’s debt for contributing to cover 40% of pension payments exceeds $2.676 billion. In summary, the IESS faces a larger deficit than expected, and its condition shows no signs of improvement.
The lack of financial flow within the IESS is more detrimental to its affiliates than to the institution itself. Many insurance advisors have proposed combined health insurance policies with the IESS. While this has good intentions, it’s unreliable if the chosen private alternative is not thoroughly analyzed. For instance, opting for a low-cost major medical expenses plan might seem like a good idea due to its affordable monthly cost and extensive coverage per event. However, the IESS, now more vigilant than ever, reviews the state of an affiliate’s private policy and the coverage value contracted through the ACESS system (Agency for Assurance of Quality of Health Services and Prepaid Medicine). After this review, the IESS will only provide care if the affiliate’s private coverage has been exhausted, an unlikely scenario in Ecuador where no medical condition would cost over $500,000. This renders the combination of plans pointless. As an alternative, you can opt for a low-cost policy with $10,000 coverage per event and an approximate monthly cost of $49.25, with a deductible of $150. This supplementary insurance allows easy access to medical appointments, laboratory tests, imaging, and minor surgeries in the country’s top clinics. This way, you will only use the IESS for rigorously necessary cases.
Successfully combining insurance plans with the IESS requires selecting the appropriate plan. A low-tier plan with $10,000 coverage per event and an annual $150 deductible also allows you to continue treatment directly with the IESS if you have a catastrophic illness or exceed the contracted value. In such cases, you need to request a certificate from your private insurer certifying the exhaustion of your coverage. Then, approach the clinic where you were receiving treatment, request your medical history, and visit the IESS’s social work department to review your case. The IESS will provide continuity of coverage for your ailment without the need for a general physician visit or months of waiting for confirmation.
If you have a combination of health insurance policies like this, our recommendation is to immediately switch to plans that guarantee payment for medical services and provide first-class care in healthcare centers suitable for your needs. With a low monthly cost and the assurance that only a long-standing, experienced, and responsible broker like BLUEBOX can offer, we will be delighted to assist you.