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.

Medical / Dental Costs in Mexico

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.

• University Hospital of the University Iberoamericana (Tel: 2297-2242 Fax: 2236-0426, E-mail: admisiones@unibe.ac.cr), located in San Jose's suburb of Tibás, is the country's newest private hospital. It is a full-service university hospital specialists treat all Where 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:

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: .

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 $20 per doctor’s visit, plus 20 percent of otherprescribed expenses. How much does it cost? You can choose from three levels of insurance. Premiums depend on the level, and on age and sex of applicants (costs shown in U.S. dollars). Some averages of yearly premiums: Adults Age Men Women 0-18 US$ 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

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: .

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”.

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.