2012 Cuenca Perspectives Collage

2012 Cuenca Perspectives Collage


My mission in publishing this blog is first to provide a living history of my settlement and life in Cuenca, and to provide myself and the reader with a journal account delineating my reasons for why I have chosen to settle in Cuenca. Second, the posts are my way of staying in contact with family and friends back in the states, and to provide them with an understanding of a country and culture that most North Americans have little knowledge and awareness. Third, the blog is open to one and all who wish to compare and contrast the experiences of expat bloggers living in Cuenca, so that you can determine whether or not from your perspective Cuenca is an appropriate move for you. Fourth, my blog provides another example of how expats view and interpret life in Cuenca. Ecuadorians and Cuencanos who may read this blog are especially invited to post comments that may enhance all expats understanding and appreciation of Cuneca and its people, or to correct any misinterpretations in my assumptions and perceptions of Cuencano culture. Finally, I hope I can convey the feeling of love and appreciation that grows within me each passing day for this heavenly city nestled in the Andes and its very special people.

Thursday, January 27, 2011

Health Insurance Answers

I raised the question of health insurance in my last post. I have had quite a number of emails and a post from Americans who are either in transition to moving to Ecuador, planning a move to Ecuador, or are investigating a possible move to Ecuador and expressed to me their concern about health insurance. Now, I will share with you what I learned:

First, there was absolutely no response from expats to my post for advice on health insurance, so I will share with you what I learned through my own exploration. The lack of response from expats may have been due to the following reasons: To reiterate from my previous post, I spoke to at least a dozen expat couples and singles while I was in Cuenca last summer about health insurance. I do not recall one of them saying that they carried health insurance. The rationale given was that health care is of a high quality in Cuenca and so inexpensive compared to the states that there is no real need for health care insurance.

My concern for carrying health insurance is primarily to cover for catastrophic casualties, which even can become expensive in the Ecuadorian system. Imagine the cost from a serious accident or from a debilitating stroke, plus the cost involved with rehabilitation as well. The costs soon outweigh the $9,000.00 to $12,000.00 cost of Cobra for single and family plans that are saved by a pay-as-you-go for incurred expenses. No doubt much can be saved from year to year, if one is willing to take the risk. My biggest concern, since I am not eligible yet for Medicare, is being sure that I am covered while I am visiting in the United States.

Each of us have to decide how much risk with which we are willing to live, and whether our retirement income determines whether or not we can also afford to carry a health insurance policy. People living with minimal pensions and social security may have little choice but to pay-as-you-go, and if faced with a major medical catastrophe, may choose to simply file for bankruptcy. For people who have additional assets at risk, if hit with major medicals expenses, they may have greater concern for protecting their assets.

Keep in mind also that even those who qualify for Medicare and are paying into the system, will not be covered outside the United States, unless they are volunteers. You would probably have to delve into the small print to discover what constitutes volunteers. I would assume a volunteer would be someone like a Peace Corp volunteer, not someone like me who is voluntarily relocating to Cuenca. (Sorry, no smiley faces available.) However, Medicare will cover those eligible while they are traveling and visiting in the United States. I mention this because I had one email where the spouse thought he was covered by Medicare once they relocate to Ecuador, and only his younger wife would need health care coverage.

I also mentioned in my previous post that I had read that Ecuadorian health insurance companies may not be reliable in paying on big claims. I had hoped possibly some expats who have Ecuadorian policies might offer their insights on such policies. However, it may be that they have not invested in Ecuadorian insurance policies. Also all the expats I have met or have a nodding acquaintance with from reading their blogs have also been in Cuenca three years or less. I assume the expat community in Cuenca is a relatively new phenomenon, and may still be feeling their way around about insurance. Or if they have international or Ecuadorian policies have not had time to use them to verify their effectiveness and integrity.

Now, to get to what I have learned. I explored two international insurance companies, Bupa and Health Care International Global. Both are large international insurance companies that have been in existence for thirty or more years, and both deal with tens of millions of insured clients world-wide. Both companies are located in Great Britain. Bupa is the older company. Health Care International Global is not publicly-traded, which they claim leads to their profits being reinvested into the company.

Below you will find a comparison of a single policy between the two companies. If I go with either, I will choose Health Care International Global. It provides better coverage at less cost with a much lower deductible. My cost quote is based upon my age and a single cover policy. The company allowed for only a $2,000.00 deduction, and I chose for premium quote purposes a 10% co-pay. Both policies provide me with coverage when I am visiting in the United States. The premium with Health Care International can be canceled in writing fourteen days before it goes into effect. After that, it can’t be canceled or modified until the end of its first year.

Bupa offers more deduction choices without a co-pay, and is about $300.00 cheaper than Health Care International, but that is at a deduction rate of $8,500.00. Also Bupa appears to be more physician and hospital restricted. Health Care will cover any physician, hospital, or clinic that is licensed or accredited by the country in which you are residing or traveling at the time of medical attention. Bupa also disappointed me, because it failed to call me in a follow-up when I responded to an email, and also when I set up a time for appointment on their web page. (Keep in mine, that Great Britain is five hours ahead of us.) Also, when I found the page that was to list the providers in Ecuador, the page was blank except for the Bupa name and company logo. (The International site also directs you to Bupa, Latin America web page, but that site did not provide me with a medical providers list either.) I tried on three different occasions over two days, and always got the same result--no hospitals, clinics, or physicians listed.

Once I am eligible for Medicare, I can drop the international coverage. I can then procure catastrophic coverage for $900.00 to $1,200.00 that covers me regionally or just while I am in Ecuador. There are also short-term inexpensive traveling insurances, which requires greater investigation.

Procuring health insurance is a very personal decision; both companies offer other more expansive plans as well. I cannot sign up for Health Care International until thirty days before I want the policy to go into effect, so I have a little more than two weeks to make a final decision. There are many companies out there dealing with international insurance. Ultimately, each of us will have to do our own research, based upon our needs. I do hope, however, that today’s post provides a starting point for exploration and comparison. If you think you have found better insurance coverage for the dollar in the next two weeks; I’d appreciate it, if you would share with me whatever you have learned.

Health Care International Global
Your quotation for Individual Private Medical Insurance

Thank you for enquiring about cover under the Emergency + Worldwide Including USA, incorporating a claim deductible of US $2,000 with a 10% Co-Payment starting 14 March, 2011. We can confirm that the following premiums will apply for you and your family based on 1 adult aged between 61-65 years:

Plan Type Emergency + Worldwide Including USA Annual Premium US $2,582.51
Claim Deductible US $2,000 Semi Annual Premium N/A
Co-Payment 10% Quarterly Premium N/A
Dental Cover 1 members Monthly Premium N/A
PA Additional Cover US $50,000, 1 members at US $85 each

* The premium may differ slightly, depending on the exchange rates applicable at the time or if you are paying in a different currency to the plan's currency.
HealthCare International Medical Insurance Plans offer some of the most innovative and user friendly plan benefits currently available. By working closely with our underwriters, we have been able to include many benefits as standard that are often excluded by other international programs.

• In-Patient Hospital Treatment Accommodation
• Life-saving Organ Transplants
• Hospital Cash Benefit
• Daycare Surgery Treatment
• Road Ambulance Transportation
• Dread Chronic Diseases
• Emergency Medical Evacuation Medical Repatriation
• Repatriation of Mortal Remains
• Personal Accident Cover

Accidents do happen, so it's important to insure yourself and your family against any eventuality and with our Personal Accident programme, we will provide a cash payment which is yours to use in any way you like. You are automatically covered for US $25,000 as part of the benefits to all the medical plans (benefit not available for those under 18 years of age) with a maximum limit of up to US $125,000 per person.

With the consequences of being ill, particularly in unfamiliar surroundings, often proving to be a distressing experience, each of our plan's have been purposely designed to provide against not only for the financial worries you may often have to face but to meet those experiences associated with specialist treatments often excluded by other international plans.


Bupa Critical Care

Bupa Critical Care is specifically designed to cover major illnesses and injuries, with access to thousands of quality doctors.

Key Benefits

Bupa Critical Care only covers the following illnesses and medical needs (subject to the coverage limits detailed below):
Neurological illnesses, including cerebral vascular accidents $150,000
Cardiac surgery and angioplasty $150,000
Cancer treatment, including chemotherapy, radiotherapy and reconstructive surgery $200,000
Severe trauma (polytrauma) including rehabilitation $150,000
Chronic renal insufficiency (dialysis) $100,000
Severe burns, including reconstructive surgery $300,000
Severe infectious disorders (septicemia) $150,000

Organ Transplant (per insured, per lifetime):
Transplant procedures (per diagnosis, per lifetime) $300,000
Heart $300,000
Heart/Lung $300,000
Lung $250,000
Pancreas $250,000
Pancreas/Kidney $300,000
Kidney $200,000
Liver $200,000
Bone marrow $250,000
Air ambulance (per insured, per year) $25,000

Plans & Premiums for cover starting on 14-Mar-2011

Product name James
Worldwide Medical Insurance
(USD 8,500.00 Deductible) USD 2,231.01
Worldwide Medical Plus
(USD 170.00 Deductible) No Cover
Worldwide Medicines and Equipment
(USD 80.00 Deductible) No Cover
Worldwide Wellbeing
(USD 0.00 Deductible) No Cover
Worldwide Evacuation
(USD 0.00 Deductible) USD 289.00

Annual Total USD 2,520.01

Annual Grand Total : USD 2,520.01

Bupa Plans & Premiums for cover starting on 14-Mar-2011

Product name James
Worldwide Medical Insurance
(USD 8,500.00 Deductible) USD 2,231.01
Worldwide Medical Plus
(USD 170.00 Deductible) No Cover
Worldwide Medicines and Equipment
(USD 80.00 Deductible) No Cover
Worldwide Wellbeing
(USD 0.00 Deductible) No Cover
Worldwide Evacuation
(USD 0.00 Deductible) USD 289.00

Annual Total USD 2,520.01

Annual Grand Total : USD 2,520.01


Friday, January 21, 2011

Questions About Health Insurance???

When I was in Cuenca many expats that I spoke to did not carry any health insurance. The reasoning was that medical care costs are so low in Ecuador compared with the United States, that expats chose to pay out of their pockets for any expenses. Out-of-pocket expenses were viewed as more desirable than spending $9,000.00 to $12,000.00 annually for single or family plans in the U.S.A. I know from my conversations with expats in Cuenca that there have been surgeries which have cost $4,000.00 to $5,000.00--a fraction of what the expense would have been in the the United States. Yet, what if someone has a really serious accident or is diagnosed with cancer, where either incident might involve long-term care or rehabilitation? I would think that a $100,000 claim in the United States, for example, could still run $20,000.00 to $30,000.00 in Ecuador--not exactly a small piece of change.

Therefore, I am seeking a policy with a high deductible which not only covers me while in Ecuador, but also when I visit the United States until I am eligible for medicare. It is my understanding that when I am eligible for Medicare, that Medicare will not cover expenses outside the United States, unless one is a volunteer(however that is defined)in another country. However, Medicare would cover me while I am visiting in the states.

Connie Pombo recently had a post where she procured health insurance through Humana, but she mainly spoke of the insurance in its use for prescription drugs. Otherwise little detail was provided. Connie, if you are reading this, I would appreciate more information as your health insurance relates to hospitalization, out-patient, pre-existing conditions, etc. I attempted to email you, but then your email disappeared on me, and I couldn't find it again on wherever I initially saw it. When I tried to contact you by Facebook, your name would snap off every time I typed it into the message form. (Sorry Connie, I truly believe that somewhere out there among the constellations is a negative vibe between me and technology.) I also googled Humana in Ecuador, (which was the company mentioned by Connie). Currently I am waiting for some price estimates from some international insurance companies. I will share what I learn as I procure this information.

For those of you who are expats, I find the question of health insurance is rarely addressed in the blogs. I have received post comments and emails seeking information over this topic, so I know there is a great deal of interest out there over health insurance coverage in Ecuador. If anyone has a policy with a company you believe is trustworthy, we sure would appreciate some feedback either on your blog posts or via email to me. I have read accounts that Ecuadorian health insurance companies often will not pay on large claims. I have no idea how accurate that claim is. However, it is one reason of concern why I am looking at international insurance companies.

Thursday, January 20, 2011

Looking To The Future

Last Friday was my last day of teaching as the semester and my current career have come to a close. It was a good week. I appreciated the cake, cards, and congratulations from both students and colleagues. It was nice to end my career with a fine group of students. I wish my seniors well in their future endeavors. The fact that I taught many of them as freshman made the goodbyes more poignant. A number of them have matured over the four years, and its not often a teacher has the chance to witness his students' social and academic growth so directly. I hope in the process of my interaction with them, I instilled within my students a sense of curiosity beyond their own experiences, and a desire to travel and see the world. One thing is for sure, they all know where Ecuador and Cuenca is on a map. In fact, my retirement to Ecuador became quite a topic of conversation among staff and students, a number of teachers told me they had their students look up Ecuador and Cuenca in their map atlases. Not bad, considering I don't recall myself ever hearing of Cuenca until a year ago last Christmas season.

Meanwhile, I am now focused on the future. I have taken action to get all my paper work in order for my legal residency in Ecuador. I am working with Gabriela Espinosa, the attorney in Quito, who has come highly recommended by many expats. Although personnel in the Ecuadorian consulate in Washington tell me that visas are not yet being processed, I am told that the delay should not affect my time-table for returning to Ecuador. I tentatively intend to arrive in Quito on Monday, March 14th. I will spend a few days in Quito to finalize my residency requirements, and then arrive in Cuenca later in the week.

Well, on one hand, I am overwhelmingly excited about returning to Cuenca; on the other hand, I hope I have sufficient time to get everything accomplished. I am finding that the little things which don't show up in concrete form, like unloading my personal belongings, are very time consuming. Seeking out health insurance, dealing with the governmental offices, determining what will and will not be downloaded from my P.C. to my laptop, how to handle my finances and investments, notifying all the proper sources of address changes and cancellation of services, or scanning thousands of slides; these are only scratching the surface of things that need to be done, but don't process like an accomplishment the way an eventual empty apartment does.

For those of you who comment on problems and delays with Ecuadorian government and business bureaucracy, the Ecuadorians may have learned it from the United States. I was delayed for two weeks getting my social security information to the Ecuadorian Consulate, because of misinformation that was given to me twice from social security representatives, as I needed to procure my monthly income statement for authorization by the Ecuadorian consulate personnel. I have a friend who is 65, but is still working and has never applied for Medicare. Yet Medicare has been trying to collect hundreds of dollars in back payments for insurance for which my friend has never applied or used. It has been months of back and forth phone calls and letters between my friend and Medicare. The problem still has not been fully resolved. Medicare personnel tell him one thing and then do another. One would think with our government's advanced computer operations that such delays would be less likely than in a country like Ecuador where the computer operations are less sophisticated. At any rate, bureaucratic snafus and delays just seem to be a part of everyday modern life no matter where one lives.

I look forward to reconnecting with old friends and acquaintances, and making new friends and acquaintances as well. I read that you are having beautiful weather in Cuenca, I hope it will still be as nice in March. If anybody has any advice for me in my move, I am open to any suggestions.