Health care has been foremost in many people’s minds over the past year for obvious reasons. The COVID-19 pandemic still rages on in various parts of the world raising our consciousness about the importance of staying safe and healthy. “If you don’t have your health,” as the saying goes, “you don’t have anything.” With that in mind, it would be timely to answer some of the frequently asked questions that people have about health care in Costa Rica.

Before we delve in, it’s important to know what the CAJA is as it will be referred to throughout this article. The Caja Costarricense de Seguro Social is often abbreviated in writing as the CCSS or simply referred to as the CAJA. Simply put, the CAJA is similar to Social Security in the United States while also being combined with the socialized health care system here. In short, it provides both a basic pension savings plan as well as health care to the country. Now that we know the very basics of what the CAJA is, let’s dive into the questions.

 

1. How do I enroll in the CAJA?

The most common way to enroll in the CAJA is to enroll through one’s job. Unless you are hired as an independent contractor, all companies must provide CAJA insurance for their employees.

For foreigners who are legally working in the country, the company would obtain a passport number or DIMEX number (if you’re a resident), provide that information to the CAJA and ask for an ID number for the CAJA in return. The CAJA provides this number and it gets registered with payroll. The company then needs to pay the pension/health care payment in the first six days of each month.

When enrolled, the insured person will get a monthly receipt called the Orden Patronal which serves as proof of enrollment in the CAJA system. Users can sign up to get this electronically through their email which is highly recommended. You will often be asked to provide this Orden Patronal for various other types of government services so it’s a good idea to make sure you are properly enrolled and getting this document on a monthly basis.

On the other hand, if you have Residency as a Pensionado, Rentista, Investor, etc. you register into CAJA as a volunteer, not through an employer. You would, consequently, be able to register in CAJA only after your Residency is approved. CAJA registration for the principal applicant and all of their dependents is the second to last step of the Residency process.

 

2. How much does the CAJA charge per month?

If you are a worker, the CAJA charges the company that you work for 26.5% of your monthly salary each month both to cover you medically and pay into the pension system. The company also deducts 10.5% of your monthly salary to contribute to the payment.

If you are a Resident with one of the categories such as Pensionado, Rentista, Investor, the process is different for you. The CAJA monthly fee a family pays as Rentista is different than the fee they pay as a Pensionado or as Investors. CAJA determines the monthly fee a family pays on the principal applicant’s income. Income for a Rentista is automatically assumed as $2,500 so Rentistas end up paying around $200 into CAJA a month. Income for Pensionados is equal to the principal applicant’s pension. Investors must declare their income to CAJA and CAJA will use that number to come up with the monthly fee. We have our investors work with a Certified Public Accountant so that they can declare income, expenses, etc. and come up with a final number. The document the CPA prepares is what we take to CAJA. To read more on the formula CAJA uses, you can read further on the matter here.

 

3. What if I don’t have a job in Costa Rica? Can I enroll individually?

Yes! If you are either an independent contractor or simply moving to live in Costa Rica and want access to the CAJA health care system, you can enroll as an “independent worker” or a volunteer as Rentistas, Pensionados and Investors do. In this case, you need to go to the CAJA offices directly in order to enroll (if you don’t speak Spanish, you may want to go with someone who does) and, as discussed, you will be able to achieve this only after your Residency has been approved.

 

4. Does the CAJA cover pre-existing conditions?

Yes, this is one of the greatest benefits of the CAJA. You won’t be rejected because of any current health conditions you might have. As long as you are up-to-date on your payments, you will have access to doctors and medication for “free” (i.e. outside of the fee you are paying per month). No one is denied access to treatment because of pre-existing conditions.

 

5. What is the EBAIS and how do I register there?

   Your local EBAIS is basically your local health clinic where you would go to see your doctor or for urgent care (for emergencies and for specialized care, you would go to the closest hospital).

The process of registering at your local EBAIS can vary a bit as they each tend to have slightly different requirements so it’s a good idea to check with them ahead of time. However, you’ll generally need your Orden Patronal if you are a worker (see above), your ID (passport or DIMEX), a utility bill (electrical, water, cable/internet, etc.), and a copy of your lease. In some cases, in lieu of a copy of your lease you might present a declaración jurada, which is a sworn statement made to a lawyer that says that you live where you say you live.

Once you provide all this information, you will generally be enrolled in the EBAIS within a few days.

Bear in mind that when Outlier Legal assists with Residency, they register the clients at the corresponding CAJA office or EBAIS clinic, as required so that would be taken care for you.

Important note: the EBAIS is where most COVID vaccinations will be happening so if you aren’t getting yours in your country of origin and are planning on getting vaccinated here, you’ll definitely want to enroll.

 

6. How do I get an appointment at my local EBAIS/clinic?

You generally need to go to the clinic very early (6 am or even before) and ask for an appointment. There is usually a line and, once you reach your turn, they will give you an appointment time for later that same day.

In some cases, though, you can make your appointment online . CAJA also offers an app call EDUS that allows you to book appointments too.

Important note: Unfortunately, at the moment it is difficult to get appointments due to COVID-19. COVID-19 patients along with other urgent cases take priority so you can often be low on the list  if you have a cold or minor flu.

 

7. What private insurance options are there in Costa Rica?

If you are not obliged to register into CAJA or you are enrolled but the CAJA doesn’t seem like your cup of tea and you would prefer to go the private insurance route, there are definitely options. There are many different providers including the INS, Pan-American Insurance, and more. For a list of private providers, please follow this link. Obviously, each company has different packages and prices. Most won’t cover pre-existing conditions and they will often ask you to take a physical before deciding whether or not they will cover you at all.

 

8. What are the main private hospitals in the country?

Most of the private hospitals in the country are located in the Central Valley region though there are a few in other locations. The main private hospitals are Hospital CIMA, Hospital Metropolitano, Hospital Clinica Biblica, and Hospital La Catolica.

 

9. What other health care options are there?

There are some medical discount plans in Costa Rica that are quite good. One of them is called MEDISMART. For a relatively low fee (approximately 8,000 colones per month), you can have access to private doctors, vets, dentists, and pharmacies enrolled in the MEDISMART system and you can get very substantial discounts for services. It’s not infrequent to get 20-30% off of services, medication, etc.

 

MEDISMART is primarily linked to the Hospital Metropolitano, but other private hospitals may have their own discount plans so it might be beneficial to ask around.

 

10. What recommendations do you have for medical coverage in Costa Rica?

It goes without saying that everyone has their own medical history to consider, their own budgets, and own preferences, but it is strongly recommended to enroll in the CAJA because it covers catastrophic cases, organ transplants, heart attacks, and chronic illnesses like diabetes. If you are younger and planning on living and/or legally working in Costa Rica for some time, it also provides you with some pension coverage.

 

However, the CAJA can be frustrating at times in terms of getting non-emergency care. For voluntary procedures or visits, getting private insurance or a discount service can be a great way to avoid long wait times for a doctor’s appointment and receive more personalized care.