The claims system seems designed to make it hard to use the insurance for trivial, inexpensive ailments - you have to do an awful lot of paperwork to get your money back! The policies work fine if you use the network of providers. And if you have an important, expensive treatment and you obtain a "preauthorization" they work best of all, with a minimum outlay of funds and paperwork.

IF YOU NEED AMBULATORY CARE IN COSTA RICA, go to the doctor, hospital or clinic of your choice, and at the end of the visit ask the attending doctor to prepare and sign a SOLICITUD DE BENEFICIOS which is an insurance claim form. Pay the entire bill. Fill out and sign the front of the SOLICITUD DE BENEFICIOS form: one form per ailment - not per doctor's visit - but if you see more than one doctor, you'll need one claim form from each. Attach all original receipts for tests and medication, and copies of the prescriptions. Make sure that all "facturas" are originals, fulfilling fiscal requirements. To recover your money you must present a claim, either directly to INS or through your insurance agent. INS pays claims based on "usual and customary" prices, and claim processing normally takes 2-3 weeks. Documentation can be given to your insurance agent, who will push the paperwork through with INS, but direct processing with INS is usually quicker.

If your doctor asks for tests or tells you to take medication, make sure he gives you prescriptions. If the lab asks you to surrender the prescriptions, ask for copies.

Lately, CIMA and Clínica Bíblica have been giving interesting discounts (aren't ALL discounts interesting?) if a patient shows his/her INS insurance card when paying at the pharmacies, labs - and sometimes even for doctor's visits. These discounts are given unilaterally by those hospitals (I think they are trying to compete with each other) and you will find no mention of the discounts in your insurance policy.

It's advisable, anyway, to have your insurance card in you wallet or purse, in case you have an accident or sudden ailment.

IF YOU NEED TO BE HOSPITALIZED OR REQUIRE SPECIALIZED TREATMENT OR TESTS IN COSTA RICA, (such as neurophysiological and cardiovascular tests, MRIs, ultrasounds, angiograms, nuclear medicine, etc.) five working days before the procedure ask your doctor, hospital or clinic to get a "preauthorization" from INS. (This means they will negotiate a price.) When you enter hospital, present your insurance card at Admissions. When you are checked out, they will return your card, and instead of paying the entire bill, you will be asked to pay the deductible.

IF YOU HAVE AN ACCIDENT IN COSTA RICA, AND NEED TO BE HOSPITALIZED, tell the hospital that you have insurance, and ask them to contact INS for a preauthorization.

IF YOU ARE ABROAD AND NEED MEDICAL CARE and you are within the area of coverage of your "INS MEDICAL" policy, call collect (305) 994 7989 or Email info@imcscostarica.com and you will be given a list of providers for your location, and instructions on how to proceed in order to receive the care you require.

SPLIT OF COVERAGE. With Plan 16 policies, the yearly insured amount is split: 90% for hospitalization and 10% for outpatient care. The "INS MEDICAL" policies do not have such a split.

DEDUCTIBLES. With Plan 16 policies, INS classifies providers in A, B, and C. With "A" providers deductible is 20% of the usual or customary prices. With "B" providers, it is 25%. With "C" providers (those not classified by INS) deductible is 30%. The only "A" providers are CIMA, Hospital Clínica Bíblica, Hospital Clínica Santa Catalina, and Hospital Clínica Santa Catalina Jacó. The main "B" providers are Hospital La Católica, Hospitel Clínica Santa Rita, and Hospitel Cristiano Jerusalén. To see the complete ratings, go to the INS web site at http://portal.ins-cr.com/Personas/SegurosPa/SegGastosMedicos.

CHECKUPS. Routine checkups, including Pap tests, mammograms, prostate tests, etc., are not paid for unless an ailment comes to light. However, for holders of "INS MEDICAL" Regional and International plans, INS will pay $150 toward a yearly physical, as of the second year. To arrange for your checkup, contact your insurance agent.

PREEXISTING CONDITIONS AND MORATORIUMS. INS will not cover conditions or sicknesses which you had before you bought insurance - read your policy and you will see if any ailments have been excluded. (Some conditions, e.g. hernias, pregnancy, ear, nose and throat ailments, and problems with women's reproductive systems have a 12 month moratorium before the coverage of a new policy comes into effect.) If you suffer the recurrence of an excluded ailment, or if within the first 12 months (after you bought the policy) you have an ailment which is subject to a moratorium, you are "on your own" and any related claim will be rejected outright.

DENTAL CARE, EYEGLASSES, COSMETIC SURGERY. These are paid if needed because of an accident within the insured period.

DEPOSITS FOR HOSPITALIZATION. Hospitals' Admission desks ask for a deposit, and will not accept your INS card for this purpose you must deposit cash or sign a blank credit card stub - much like when you hire a car. When checking out, if you previously got a "preauthorization", the hospital will accept your INS card for most of the bill: they will take the deductible from your deposit and return the rest of the money.

AMBULANCES are paid for if prescribed by a doctor. Payment is based on mileage.

AIR AMBULANCES. If you have an accident - for example, at a remote beach - ask the doctor giving first aid to contact INS, which will organise and pay for an air ambulance to San José. The doctor must RECOMMEND such transportation.

CARDS. INS does not provide a new medical insurance card every year: it's not like with credit cards! If you lose your INS card, contact your agent. INS charges ¢1,000 to replace cards, and replacements take about three weeks.

POLICY PAYMENT AND RENEWAL. Plan 16 policies expire on December 31. Regional and International plans expire on their anniversary. After expiration date, INS grants 20 working-days grace for renewal payment of yearly policies, 10 for semiannual policies, and 5 for quarterly. Within the grace period and until you renew, you cannot use your INS card. Until the renewal premium has been paid, you would have to pay for your medical treatments, and then present a claim after the renewal.

POLICY MODIFICATIONS. When a policy is within its grace period, INS will not allow any changes. (For example, some people decide that they would like to change from yearly payments, to semiannual.) So when the policy renewal date is coming up, try to foresee any changes and tell your agent beforehand - otherwise you may find yourself locked into an uncomfortable arrangement.

The writer's purpose is to give you a better understanding of insurance in Costa Rica. The opinions and viewpoints are his, and do not necessarily represent the official position of the National Insurance Institute (INS). For further information see www.InsuranceCostaRica.info, call David Garrett at 2233 2455, or write david@InsuranceCostaRica.info .