Sample Private Health Insurance Policy

INS MEDICAL is a new International Medical Insurance Policy that according to the needs of the client, is available in two modalities.

For that individual who wants to have a medical insurance policy that offers a high coverage in any part of the world, we offer an International Plan that provides medical protection for up to $2 million a year, including coverage for critical illnesses.

But if what you need is less coverage, in order to be protected only in Costa Rica and the rest of Central America, the solution is the Regional Plan with which you will obtain protection for up to $200 thousand a year.

With the Regional Plan, the policy holder can acquire two optional coverages: critical illnesses and cancer. In both cases, you have the option of increasing the insurance coverage in an amount of $200 thousand.

Both plans are sold in American dollars and include, among their benefits and coverages:

Ambulance and hospitalization expenses
Maternity
Oncological illnesses
Epidemic illnesses
Newborn congenital illnesses
Surgical prosthetics
Organs transplants
Ophthalmic expenses (once a year)
Ambulance transportation expenses as a result of an accident
Air ambulance transportation expenses as a result of an accident
Evacuation transportation
Repatriation for medical reasons
Funeral
Release of the insurance payment for death of the policy holder
General medical checkup

OPTIONAL COVERAGES FOR THE REGIONAL PLAN:

 Coverage of critical illnesses
 Cancer coverage

To improve its service, the National Insurance Institute has negotiated, with some clinics, to have its clients enjoy the benefits of a selected group of highly qualified health providers with discounts and reduced rates.

In Costa Rica and abroad, if you select a member clinic you have the benefit of paying lower deductibles and coinsurance, and you will receive discounts on part of the provider.

The National Insurance Institute (INS for its abbreviation in Spanish) will provide its services abroad through its administrator of medical services, represented by the firm IMCS (Internacional Managed Care Services).

IMCS is specialized in the management and administration of health care, and provides access to high quality medical services.

CHARACTERISTICS:

REGIONAL INS – MEDICAL: Costa Rica and Central America

It works through a Network of Member Providers. A group of MEMBER PROVIDERS (physicians, drugstores, laboratories, clinics and private hospitals) will provide medical services to policy holders with the presentation of an identification card that the INS issues at the moment of signing up, as well as with a proof of the premium payments and the payment of the corresponding participation (deductible), according to the service that is provided.

The insured will have the freedom to select a provider from a list of system members.

The insured can also use goods or services of NON-MEMBER PROVIDERS. In this case, the policy will work with the traditional reimbursement system.

REGIONAL INS – MEDICAL: Worldwide

In case of using INS – Medical International, the mode of operation is very similar to the last. The only point to highlight would be that in order to use the insurance, it is essential to contact the Administrator of Medical Services, represented by the firm IMCS (Internacional Managed Care Services), that will counsel the Insured in regard to the required medical need.

Likewise, the insured can use goods and services of NON-MEMBER PROVIDERS. In this case, the policy will work with the traditional reimbursement system. (As long as they are authorized by IMCS.)

EXCLUSIONS:

Illnesses, pre-existent injuries at the start of the insurance policy.

Excluded illnesses among others:

Nervous problems
Acquired immune deficiency syndrome (AIDS)
Venereal illnesses
Cosmetic surgery treatments

3 – Expenses due to odontological treatments, except if the cause is an accident.

4 – Orthopedic shoes and/or non-surgical prosthetics, as well as braces and audition aids.

5 – High risk sports and professional sports such as:

Motorbiking
Scuba diving
Mountaineering or mountain climbing
Bungee jumping

6 – Treatments expenses derived from the consequences of overweight and obesity.

SHORTAGE PERIOD:

It is the period of 30 days after the start date of the insurance policy for attention in Costa Rica and Central America, and of 60 days for attention in other countries, during which the insurance policy can not be used, except in the case of an accident or emergency as defined in the policy.

Likewise, illnesses such as appendicitis, aneurysm, testicular torsion and myocardial infarctions are exonerated from any shortage period, as long as they are not pre-existent.

After 10 months, it covers maternity, uterus treatments or fibromas or genitourinary prolapses.

Tonsils or adenoids extraction, sinusitis, hernia of any kind, HARTOS-COPIA, hemorrhoids and vesicular lithiasis.

On the other hand, a shortage period of 24 months is applied to organs transplants.

TABLES OF COSTS

INS – MEDICAL
INTERNATIONAL PLAN
$ 2.000.000.00

AGE MALE FEMALE
11-18 $ 941.00 $ 1.096.00
19-25 $ 986.00 $ 1.173.00
26-29 $ 1.043.00 $ 1.254.00
30-34 $ 1.154.00 $ 1.409.00
35-39 $ 1.332.00 $ 1.622.00
40-44 $ 1.437.00 $ 1.788.00
45-49 $ 1.715.00 $ 1.921.00
50-54 $ 1.967.00 $ 2.236.00
55-59 $ 2.199.00 $ 2.425.00
60-64 $ 2.770.00 $ 2.801.00
CHILDREN BOTH SEXES
0-10 $ 478.00
1 CHILD $ 478.00
2 CHILDREN $ 610.00

INS – MEDICAL
REGIONAL PLAN
$ 200.000.00

AGE MALE FEMALE
11-18 $ 474.00 $ 553.00
19-25 $ 497.00 $ 592.00
26-29 $ 526.00 $ 633.00
30-34 $ 582.00 $ 712.00
35-39 $ 672.00 $ 820.00
40-44 $ 726.00 $ 904.00
45-49 $ 867.00 $ 971.00
50-54 $ 995.00 $ 1.131.00
55-59 $ 1.112.00 $ 1.227.00
60-64 $ 1.402.00 $ 1.418.00
CHILDREN BOTH SEXES
0-10 $ 246.00
1 CHILD $ 246.00
2 CHILDREN $ 313.00
3 CHILDREN $ 400.00

COVERAGE FOR CRITICAL ILLNESSES AND ACCIDENTS
INSURED ILLNESSES AND ACCIDENTS

Clause 1.- This coverage is limited, uniquely and exclusively, to cover the illnesses, surgeries and/or diagnoses indicated below, according to the specified conditions for each case.

It is understood and agreed that this Coverage covers only expenses in regard of or as a result of any illness, surgery or diagnosis that is not a cardiac surgery, neurosurgery, organ transplant, dialysis, third grade burn and polytraumatism, as it is defined in this Coverage, even if this non-covered illness or condition has been caused, aggravated, complicated or affected directly by any treatment provided in relation to a case covered by this Coverage.

CANCER TREATMENT AND SURGERY, INCLUDING CHEMOTHERAPY, RADIOTHERAPY AND COBALT THERAPY.

Ambulance transportation and hospitalization expenses due to cancer treatments and/or surgeries are covered, as long as they are supported by the corresponding test of anatomical pathology.

Cancer is understood as the illness manifested by the presence of a malign tumor, characterized by an uncontrollable growth and the proliferation of malign cells, tissue invasion, including direct expansion and metastasis, or great numbers of malign cells in the lymphatic or circulatory systems, including leukemia.

Chemotherapy, radiotherapy and cobalt therapy are understood as the service of specialized units of clinical oncology with anti-cancer drugs and ionizing radiation or linear accelerator machines, designed specifically for the treatment of localized tumors, according to internationally approved protocols.

CARDIAC SURGERY INCLUDING ANGIOPLASTY

Surgical operations of the cardiovascular apparatus -that include operations of the heart and its valves, coronary arteries and the great emerging vessels of the heart- are covered. Operations of the varicose veins or the peripheral vascular system are not covered.

B) SURGERY OF THE NERVOUS CENTRAL SYSTEM OR NEUROSURGERY

It covers surgical interventions of the central and/or peripheral nervous system, including: the brain and other intracranial structures; the spinal cord and the vertebras; peripheral nerves in all the body; and blood vessels in the brain and spinal cord.

C) TRANSPLANTS

It covers the surgical treatment of an Insured who has irreversible damages in one or more covered organs, susceptible of being replaced by the transplant of healthy organs, extracted from alive or dead donors, including medical and hospitalization expenses caused by the donor, excluding the expenses caused by tests or evaluations of possible donors, as well as the purchase of organs.

The only organs transplants, covered under this Coverage, are:

1) Kidneys
2) Heart
3) Liver
4) Lungs 5) Pancreas
6) Cornea
7) Bone marrow

D) DIALYSIS FOR KIDNEY FAILURE

It covers cases of progressive or acute deterioration of the kidney function, that require a dialysis treatment, regardless of whether it is irreversible or not.
Kidney dialysis is understood as the medical procedure made or supervised by kidney units of scientifically and technologically accredited health institutions.

E) THIRD DEGREE BURNS (GREAT BURN)

It covers cases of burns that affect and compromise a minimum of 30% of the body surface. These must be third degree burns, whose treatment requires a minimum of 10 days of hospitalization.

F) POLYTRAUMATISMS OR MAJOR TRAUMA

It covers severe trauma cases that compromise two or more organic systems and cause a critical situation of the Insured, and whose treatment requires a minimum of 10 days of hospitalization.

COVERED EXPENSES

CLAUSE 2.- This Coverage covers all ordinary, reasonable and customary expenses for the place or the country where they are made, as long as they are necessary for a surgery, illness or accident, covered by this Coverage, up to the limit of the Maximum Insured Benefit in this Coverage.
The Insured will be able to get attention in Costa Rica, Central America and other countries of the world, according to the conditions established in Clauses 9° and 11° of the General Conditions of the Policy.

a) REASONABLE COSTS COVERED WITH HOSPITALIZATION:

- Normal or bipersonal individual room.
- Operation, recovery and intensive care room.
- Medicines, oxygen, anesthetics and other necessary materials.
- Magnetic resonance, tomography, ecography, electroencephalogram, electrocardiogram, basal metabolism and any other required specialized test or study.
- Medical fees for surgical intervention, hospital treatment or visit, assistant or anesthetist.
- Dialysis
- Services and equipments that are required for organs transplants.

b) REASONABLE COSTS COVERED WITHOUT HOSPITALIZATION (AMBULATORY)

- Medical fees for treatments at home or at a physician’s office.
- Medicines, magnetic resonance, tomography, ecography or clinical tests, radiographies, electroencephalogram, electrocardiogram and any other special tests or exams that a physician considers as necessary.

Ambulatory expenses will be paid only for dialysis treatments.
Expenses made during a period of 30 days before and after surgeries or hospitalizations covered by this Coverage, will be covered also in every case indicated in Clause 1° of this Coverage.

MAXIMUM ANNUAL BENEFIT PER PERSON

CLAUSE 3.- The SUM of all reasonable expenses, paid annually by the “INSTITUTE” to each insured person without an age limit, can not exceed the agreed limit, in any case, as a Maximum Benefit of US $200,000 (TWO HUNDRED THOUSAND UNITED STATES DOLLARS). From the age of 70 years old, this limit will be reduced automatically to US $60,000 (SIXTY THOUSAND UNITED STATES DOLLARS) or the balance of the Maximum Benefit if it is lower by that date.

COINSURANCE

CLAUSE 4.- It is the percentage of the covered expense that is shared by the Insured in the cases indicated in Clause 9° of the General Conditions of the Policy.

NON-COVERED EXPENSES AND EXCLUSIONS

CLAUSE 5.- In addition to the conditions specified in Clauses 1° and 2° of this Coverage, this insurance does not cover expenses derived from and/or related to and/or as a consequence of:

Illnesses, injuries and/or congenital and/or birth and/or pre-existent defects at the start of this insurance; as well as any other treatment, illness, surgery or injuries that are not specified in Clause 1° of this Coverage.
Expenses paid directly by the Insured without written authorization by the “INSTITUTE”.
In addition to the general exclusions indicated in this Clause, the following transplants are also excluded:

A transplant made during the waiting period of 24 months, beginning from the start date of this Coverage.
A transplant of organs not covered by this Coverage or not approved previously by the “INSTITUTE”, as well as those considered as experimental or part of a research, or when the organ to be transplanted is considered a mechanical or artificial equipment, or an artifact designed to replace human organs. Likewise, transplants are excluded when the donor is of an animal species.
Expenses derived from the treatment of jaw problems, including the temporomandibular syndrome, disorders or other alterations related to the union between the jaw, the skull and the muscles, nerves or other tissues in this joint.
Non-surgical prosthetics, orthopedic equipment or apparatus, mechanical or electronic, in-home nursing care or experimental treatments, as well as transportation or accommodation expenses.
Treatments or expenses related to the result of any of the illnesses or treatments covered by this Insurance.

COVERAGE OF OVERSEAS EXPENSES

CLAUSE 6.- The Insured states to know that it is policy of the “INSTITUTE” to pay directly to the service provider, for which expenses generated by medical care overseas will be covered according to the following conditions:

1) Hospitalization cases, due to any of the illnesses or accidents covered by this Coverage, must be informed to the “INSTITUTE”, with 48 hours in advance if the Insured is outside Costa Rica, or within the same period to our overseas representative if he/she is outside the country.
All hospitalizations will be coordinated with the “INSTITUTE”, and/or its overseas representative, with the aim of using the most cost convenient hospital or clinic that belongs to the network of providers, as long as it provides the same guarantees and quality in medical service.

2) In case of an emergency hospitalization covered by this Coverage, the “INSTITUTE” or the Administrator of Medical Services must be given notice, within 48 hours immediately after admission.

3) The cases of ambulatory care will be paid directly to the service provider or as a reimbursement, according to the General Conditions of the Policy, as long as there was a written authorization by the “INSTITUTE” or the Administrator of Medical Services.

In case of not giving notice to the “INSTITUTE”, within the periods indicated in numerals 1 and 2 of this Clause, the “INSTITUTE” is released from any payment regarding the expenses covered directly by the Insured, hospital or clinic. Concerning the claim liquidation, the “INSTITUTE” will use the normal, reasonable and customary costs for the area or country where the treatment is taken, be it Central America or any other country in the world.
The policy of the “INSTITUTE” is to pay to physicians and hospitals directly, for the services provided in any of the countries covered by this Coverage, with the aim of benefiting the PRINCIPAL POLICY HOLDER, avoiding the payment of excessive expenses.
Our representatives abroad have the mission of providing the best attention in highly specialized hospitals that belong to our network of international providers, and guaranteeing those expenses that are covered from our part.

ADDITIONAL BENEFITS

CLAUSE 7.-
Emergency Cases
Emergency cases that take place as a consequence of ailments mentioned previously, are covered at a 100% of their costs and expenses, including room, medicines, intensive care unit, medical fees and general expenses, incurred within the first 24 hours, starting from the moment in which such emergency event occurred

All expenses made after such first 24 hours, will be treated under the benefits of hospitalization or ambulatory care, according to the case.

Evacuation transportation
This benefit will be provided in case of the occurrence of an emergency and the determination that it is necessary for the Insured to be evacuated and/or repatriated to the closest or specialized hospital or attention center that can treat the ailments of the Insured.

The “INSTITUTE” and/or its representatives abroad will provide a road or air ambulance, or a flight by a regular airline, through the most direct and adequate route, for these cases.

All decisions related to the medical need of evacuation and/or repatriation, the means and the time at which it happens, as well as the medical equipment and personnel to be used, and final destination, are all medical decisions that will be taken by physicians designated by the Administrator of Medical Services in consultation with a local physician on the basis of medical factors, and their decisions to determine the need for such services will be final.

REVISION OF CLAIMS

CLAUSE 8.- The “INSTITUTE” has the right to order an examination of the PRINCIPAL POLICY HOLDER and/or dependants covered by this insurance, by physicians designated by it, as many times as it is considered necessary to prove the origin of any claim. The PRINCIPAL POLICY HOLDER has the obligation to provide all tests or medical reports that are required for the best evaluation of the case and should sign the necessary authorizations to ease the delivery of additional information needed by the “INSTITUTE”. Any claim, that is simulated or fraudulent, will cause the loss of all rights or indemnification, without prejudice of initiating the corresponding legal actions against those who are responsible.

“CANCER” COVERAGE

INSURANCE COVERAGE

CLAUSE 1.- This coverage is limited to cover the illness diagnosed as CANCER, uniquely and exclusively, with the support of the corresponding test of anatomical pathology, according to the indicated conditions.
Reasonable costs of cancer treatment and surgery are covered, including chemotherapy, radiotherapy and cobalt therapy.

Cancer is understood as the illness manifested by the presence of a malign tumor, characterized by an uncontrollable growth and the proliferation of malign cells, and tissue invasion, including direct expansion and metastasis, or great numbers of malign cells in the lymphatic or circulatory systems, including leukemia.

Chemotherapy, radiotherapy and cobalt therapy are understood as the service of specialized units of clinical oncology with anti-cancer drugs and ionizing radiation or linear accelerator machines, designed specifically for the treatment of localized tumors, according to internationally approved protocols.

It is understood and agreed that this Coverage does not cover any treatment, surgery or expense in regard of or as a result of any illness that is not cancer, as it is defined in this Coverage; even if this non-covered illness or condition has been caused, aggravated, complicated or affected directly by any treatment provided in relation to a case covered by this Coverage.

COVERED EXPENSES

CLAUSE 2.- This Coverage covers all ordinary, reasonable and customary expenses for the place or the country where the treatment and surgery are made as a consequence of an oncological illness, up to the limit of the Maximum Insured Benefit in this Coverage.
The Insured will be able to get attention in Costa Rica, Central America and other countries in the world, according to the conditions established in Clauses 9° and 11° of the General Conditions of the Policy.

a) REASONABLE COSTS COVERED WITH HOSPITALIZATION:

- Room.
- Operation, recovery and intensive care room.
- Medicines, oxygen, anesthetics and other necessary materials.
- Magnetic resonance, tomography, ecography, electroencephalogram, electrocardiogram, and any other required specialized test or study.
- Medical fees for surgical intervention, hospital treatment o visit, assistant or anesthetist.
- Chemotherapy, radiotherapy and cobalt therapy.

b) REASONABLE COSTS COVERED WITHOUT HOSPITALIZATION (AMBULATORY)

- Medical fees for treatments at home or at a physician’s office.
- Medicines, magnetic resonance, tomography, ecography or clinical tests, radiographies, electroencephalogram, electrocardiogram and any other special tests or exams that a physician considers as necessary.
- Chemotherapy, radiotherapy and cobalt therapy.

ANNUAL MAXIMUM BENEFIT PER PERSON

CLAUSE 3.- The SUM of all reasonable expenses, paid annually by the “INSTITUTE” to each insured person without age limit, can not exceed the agreed limit in any case, as a Maximum Benefit of US $200,000 (TWO HUNDRED THOUSAND UNITED STATES DOLLARS). From the age of 70 years old, this limit will be reduced automatically to US $60,000 (SIXTY THOUSAND UNITED STATES DOLLARS) or the balance of the Maximum Benefit if it is lower by that date.

COINSURANCE

CLAUSE 4.- It is the percentage of the covered expense that is shared by the Insured in the cases indicated in Clause 9° of the General Conditions of the Policy.

NON-COVERED EXPENSES AND EXCLUSIONS

CLAUSE 5.- This coverage does not cover expenses derived from and/or related to and/or as a consequence of:

a) Illnesses not diagnosed as Cancer with a diagnosis supported by the corresponding test of anatomical pathology, as well as people who had a cancer diagnosis with positive results at the start date of this insurance, and/or cancer treatment and/or surgery.
b) Plastic and/or cosmetic surgery, as well as beauty treatments that are necessary as a consequence of a treatment and/or surgery covered by this Coverage.
c) Cancer detected during the first 60 days of the start date of this Coverage, as well as expenses paid directly by the Insured without written authorization of the “INSTITUTE”.
d) Non-surgical prosthetics, orthopedic equipment or apparatus, mechanical or electronic, in-home nursing care, as well as transportation or accommodation expenses.
e) Medical checkups; psychological, psychiatric, kinesic, cosmetic and rehabilitation treatments; costs of blood or plasma; anxiolytics; vitamins and/or food supplements; and non-medicinal products.
f) Surgeries and/or treatments that are not practiced by professional physicians or that are not considered medically necessary, as well as treatments or medicines that are qualified as experimental or under a test period.
g) Nuclear pollution, as well as occupational activities or illnesses.

COVERAGE OF OVERSEAS EXPENSES

CLAUSE 6.- Expenses generated by medical care overseas will be covered according to the following conditions:

1) Hospitalization cases covered by this Coverage must be informed to the “INSTITUTE” if the Insured is in Costa Rica, with an advanced notice of 48 hours, or to our overseas representative if he/she is in Central America or any other country of the world.

All hospitalizations will be coordinated with the “INSTITUTE”, and/or the Administrator of Medical Services, with the aim of using a hospital or clinic that belongs to the network of providers, and that is the most cost convenient, as long as it provides the same guarantees and quality in medical service.

2) In case of an emergency hospitalization covered by this Coverage, the “INSTITUTE” or the Administrator of Medical Services must be given notice within 48 hours immediately after admission.

3) Cases of ambulatory care will be paid directly to the service provider or as a reimbursement, according to the Coverage conditions, as long as there is a previous written authorization by the “INSTITUTE” or the Administrator of Medical Services.

ADDITIONAL BENEFITS

CLAUSE 7.-
Emergency Cases
Emergency cases that take place as a consequence of cancer are covered at a 100% of their costs and expenses, including room, medicines, intensive care unit, medical fees and general expenses, incurred within the first 24 hours, starting from the moment in which such emergency event occurred

All expenses made after such first 24 hours, will be treated under the benefits of hospitalization or ambulatory care, according to the case.

Evacuation transportation
This benefit will be provided in case of the occurrence of an emergency and the determination that it is medically necessary for the Insured to be evacuated and/or repatriated to the closest or specialized hospital or attention center that can treat the ailments of the Insured, related to this Coverage.

In these cases, the “INSTITUTE” and/or its representatives abroad will provide a road or air ambulance, or a flight by a regular airline, through the most direct and adequate route.

All decisions related to the medical need of evacuation and/or repatriation, the means and the time at which it takes place, as well as the medical equipment and personnel to be used, and the final destination, are all medical decisions that will be taken by physicians designated by the operator of the Administrator of Medical Services in consultation with a local physician on the basis of medical factors, and their decisions to determine the need for such services will be final.

CANCER

Memorial Sloan-Kattering Cancer Center, New York
University of Texas, M.D. Anderson cancer Center, Houston
Johns Hopkins Hospital, Baltimore
Mayo Clinic, Rochester, Minn.
Dana-Farber Cancer Institute, Boston
Duke University Medial Center, Durham, N.C.
Stanford University Hospital, Stanford, Calif.
University of Washington medical Center, Seattle
University of Chicago Hospitals
UCLA Medical Center, Los Angeles

CARDIOLOGY AND CARDIAC SURGERY

Cleveland Clinic
Mayo Clinic, Rochester, Minn.
Massachusetts General Hospital, Boston
Duke University Medical Center, Durham, N.C.
Texas Heart Institute-St. Luke’s Episcopal Hospital, Houston
Brigham and Women’s Hospital, Boston
Emory University Hospital, Atlanta
Johns Hopkins Hospital, Baltimore
Stanford University Hospital, Stanford, Calif.
Barnes-Jewish Hospital, St. Louis

ENDOCRINOLOGY

Mayo Clinic, Rochester, Minn.
Massachusetts General Hospital, Boston
Johns Hopkins Hospital, Baltimore
Barnes-Jewish Hospital, St. Louis
Brigham and Women’s Hospital, Boston
University of Chicago Hospitals
University of Virginia Health Sciences Center, Charlottesville
UCLA Medical Center, Los Angeles
Duke University medical Center, Durham, N.C.
Beth Israel Deaconess medical Center, Boston

GASTROENTEROLOGY

Mayo Clinic, Rochester, Minn.
Cleveland Clinic
Johns Hopkins Hospital, Baltimore
Massachusetts General Hospital, Boston
Mount Sinai Medical Center, New York
University of Chicago Hospitals
UCLA Medical Center, Los Angeles
University of California, San Francisco Medical Center
Duke University Medical Center, Durham, N.C.
Brigham and Women’s Hospital, Boston

GERIATRICS

UCLA Medical Center, Los Angeles
Mount Sinai Medical Center, New York
Duke University Medical Center, Durham, N.C.
Johns Hopkins Hospital, Baltimore
Massachusetts General Hospital, Boston
Mayo Clinic, Rochester, Minn.
University of Michigan Medical Center, Ann Arbor
Beth Israel Deaconess Medical Center, Boston
Cleveland Clinic

GYNECOLOGY

Johns Hopkins Hospital, Baltimore
Mayo Clinic, Rochester, Minn.
Massachusetts General Hospital, Boston
University of Texas, M.D. Anderson Cancer Center, Houston
Brigham and Women’s Hospital, Boston
Memorial Sloan-Kettering Cancer Center, New York
Duke University Medical Center, Durham, N.C.
UCLA Medical Center, Los Angeles
Columbia-Presbyterian Medical Center, New York
Northwestern memorial Hospital, Chicago

NEUROLOGY AND NEUROSURGERY

Mayo Clinic, Rochester, Minn.
Massachusetts General Hospital, Boston
Johns Hopkins Hospital, Baltimore
Columbia-Presbyterian Medical Center, New York
University of California, San Francisco Medical Center
Cleveland Clinic
UCLA Medical Center, Los Angeles
Duke University Medical Center, Durham, N.C.
Hospital of the University of Pennsylvania, Philadelphia
New York Hospital-Cornell Medical Center

ORTHOPEDICS

Mayo Clinic, Rochester, Minn.
Hospital for Special Surgery, New York
Massachusetts General Hospital, Boston
Johns Hopkins Hospital, Baltimore
Cleveland Clinic
Duke University Medical Center, Durham, N.C.
University of Washington Medical Center, Seattle
University of Iowa Hospitals and Clinics, Iowa City
UCLA Medical Center, Los Angeles
Brigham and Women’s Hospital, Boston

OTOLARYNGOLOGY

Johns Hopkins Hospital, Baltimore
University of Iowa Hospitals and Clinics, Iowa City
University of Michigan Medical Center, Ann Arbor
Barnes-Jewish Hospital, St. Louis
University of Pittsburgh Medical Center
UCLA Medical Center, Los Angeles
Mayo Clinic, Rochester, Minn.
University of Washington Medical Center, Seattle
University of Texas, M.D. Anderson Cancer Center, Houston
University of California, San Francisco Medical Center

PULMONARY DISEASE

National Jewish Center, Denver
Mayo Clinic, Rochester, Minn.
Barnes-Jewish Hospital, St. Louis
Johns Hopkins Hospital, Baltimore
Massachusetts General Hospital, Boston
University of California, San Francisco Medical Center
University Hospital, Denver
Duke University Medical Center, Durham, N.C.
Cleveland Clinic
UCLA Medical Center, Los Angeles

RHEUMATOLOGY

Mayo Clinic, Rochester, Minn.
Johns Hopkins Hospital, Baltimore
Hospital for Special Surgery, New York
Brigham and Women’s Hospital, Boston
University of Alabama Hospital at Birmingham
UCLA Medical Center, Los Angeles
Massachusetts General Hospital, Boston
Cleveland Clinic
University of Michigan Medical Center, Ann Arbor
Duke University Medical Center, Durham, N.C.

UROLOGY

Johns Hopkins Hospital, Baltimore
Mayo Clinic, Rochester, Minn.
UCLA Medical Center, Los Angeles
Cleveland Clinic
Duke University Medical Center, Durham, N.C.
Massachusetts General Hospital, Boston
Stanford University Hospital, Stanford, Calif.
Barnes-Jewish Hospital, St. Louis
Memorial Sloan-Kettering Cancer Center, New York
University of Texas, M.D. Anderson Cancer Center, Houston

OPHTHALMOLOGY

University of Miami (Bascon Palmer Eye Institute)
Johns Hopkins Hospital (Wilmer Eye Institute), Baltimore
Wills Eye Hospital, Philadelphia
Massachusetts Eye and Ear Infirmary, Boston
UCLA Medical Center (Jules Stein Eye Institute), Los Angeles
University of Iowa Hospitals and Clinics, Iowa City
University of California, San Francisco Medical Center
Los Angeles County-USC Medical Center (Doheny Eye Institute)
Duke University Medical Center, Durham, N.C.
Mayo Clinic, Rochester, Minn.

PEDIATRICS

Children’s Hospital, Boston
Children’s Hospital of Philadelphia
Johns Hopkins Hospital, Baltimore
Children’s Hospital, Los Angeles
Children’s National Medical Center, Washington, D.C.
Children’s Hospital of Pittsburgh
Children’s Memorial Hospital, Chicago
Children’s Hospital Medical Center, Cincinnati
Columbia-Presbyterian Medical Center, New York
Univ. Hospitals of Cleveland (Rainbow Babies & Children’s Hosp.)

PSYCHIATRY

Massachusetts General Hospital, Boston
C.F. Menninger Memorial Hospital, Topeka, Kan.
McLean Hospital, Belmont, Mass.
Johns Hopkins Hospital, Baltimore
New York Hospital-Cornell Medical Center
Mayo Clinic, Rochester, Minn.
UCLA Neuropsychiatric Hospital, Los Angeles
Columbia-Presbyterian Medical Center, New York
Sheppard and Enoch Pratt hospital, Baltimore
Yale-New Haven Hospital, New Haven, Conn.

REHABILITATION

Rehabilitation Institute of Chicago
University of Washington Medical Center, Seattle
Tirr (The Texas Institute for Rehabilitation and Research), Houston
Kessler Institute for Rehabilitation, West Orange, N.J.
Craig Hospital, Englewood, Colo.
Mayo Clinic, Rochester, Minn.
New York University Medical Center (Rusk Institute)
Ohio State University Medical Center, Columbus
Los Angeles County-Rancho Los Amigos Med. Ctr., Downey, Calif.
Thomas Jefferson University Hospital, Philadelphia

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5 Responses to “Sample Private Health Insurance Policy”

  1. Steve Linder says:

    Even without insurance, health care in Costa Rica is inexpensive compared to the US or Canada. Background: Costa Rica has a nationalized health care system that is nearly free for all residents. Quality of care ranks #36 worldwide by the World Heath Organization (the US is #37) and yet the cost per capita of healthcare in Costa Rica is less than 1/10th the cost of comparable care in the US. Many procedures cost even less, in fact many procedures cost as little as a tenth the cost of comparable care in the US.

    What is their secret? With cost of living expenses in Costa Rica significantly lower than the US, the cost of doing business is less. Average per capita income in the country averages less than $12,000 per year, so labor costs are significantly lower than many other countries. Furthermore, Costa Rica has basically eliminated malpractice expenses, a primary reason why health care costs are so expensive in the US.

    It’s an attitude. Costa Rica operates their health care system with the acceptance that health care providers do occasionally make mistakes. The difference in their system is that if a mistake occurs by a doctor, nurse or other party involved in providing health care services, legal claims are limited by the injured party to the actual cost of the procedure and nothing more. By taking out the cost of malpractice insurance, huge awards, litigation and compensation to these unfortunate few, their health care system is not supporting huge expenses paid through litigation. This eliminates a number of costs that we incur in the US, attorney fees, malpractice insurance costs, awards paid to injured parties for pain, lost wages and survivor benefits, etc. It also discourages the need to over test; over administer drugs and remedies, i.e. testing to find every possible malady, again out of fear of malpractice in the event some rare issue gets missed. Doctors in the US are so afraid of malpractice that they test for everything, exposing patients to unneeded surgeries, potentially lethal drugs and unnecessary expenses. This cost is passed on throughout our health care system by the hospitals, the staff, the increased use of equipment, over prescription of potentially lethal medications and the hectic pace that this over testing and fear based system requires.
    How safe is their health care? The truth of the matter is that Costa Ricans have a life expectancy of longer than the US yet they pay roughly one tenth the cost per capita of health care services. Let me repeat that. They pay a tenth of what we do yet they are expected to live longer than us. How can that be? As a result of the huge cost of healthcare in the US, many of us are uninsured or underinsured. Many of us don’t get the routine care we should be getting and skip recommended procedures designed to find issues in early stages. This results in undetected issues that if treated early are typically not costly to deal with. Instead we wait until these issues are a true emergency and often with life threatening results. Those of us who are insured bear the cost of those who are not. In reality we all pay for the uninsured since everyone is entitled to some free care in emergency situations.

    Now with nationalized health care on the horizon from the Obama Administration, these costs will be mandated and spread among tax payers in the US. However until the system is fixed and doctors continue to base their care on potential malpractice exposure rather than sound health practice, them cost of healthcare in the US will still be unnecessarily out of balance.

    My recent experience: Two days after our tour in July ended, I went to the Clinica Biblica in San Jose, a large private hospital in Costa Rica for an “Executive Check Up”. I arrived at 7:30 am and was checked in. Within a few minutes after arrival I was already being seen. My day started at the lab giving blood for analysis as well as urine, followed by a general physical exam. Minutes later I was having a chest plate X-Ray as well as a bone density scan. The equipment used was all the same as we’d use in the states, Ultrasound equipment by Siemens, X-Ray machines by GE, everything I was used to. Many of the doctors and lab assistants spoke multiple languages and I was escorted throughout the day by a translator for the few instances when the doctor did not speak English. Next I had a number of ultrasounds done to view all my vital organs, then off to the Endoscopy clinic. I opted for full anesthesia for both the Endoscopy and Colonoscopy. Next they fed me a great chicken dinner and then I was off to a sound proof room for the most extensive hearing test I’ve ever had in my life, followed by a complete eye exam. Next I met with a nutritionist, who by then had the results of my blood work and urine, as well as a complete medical record with my chest X-Ray, bone density results, a complete set of color photos of the inside of my colon, stomach, esophagus, photos of nearly all of my organs. He reviewed the results of all and reviewed my diet and exercise routine, with suggestions on where I could improve. I then visited with the chief resident doctor of the program who again reviewed my completed results. I learned that I suffer from osteoporosis as well as small ulcers in my upper GI tract from acid reflux. He prescribed medications as well as suggestions on how to treat these issues holistically. I walked out of the hospital before 3:00 pm on the same day with all results in hand, a medical history summary, all lab results, X-Rays and full color images. In summary: My experience was incredible. I did not wait more than 5 minutes between each test or procedure. My experience with doctors in the US is that we are treated by them as an enemy who they must guard themselves against due to the risk of malpractice and litigation. On the contrary however on this day in Costa Rica the doctors all explained to me what they were doing and why. They talked to me like a friend, were very thorough and I did not feel rushed. What I realized most was how broken our health care system really is in the United States. See more about health care on our blog at http://www.PacificLots.com

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