Familial Health Insurance, When and Why? By Bluebox

In Ecuador, family insurance is available for both heterosexual and same-sex couples/families. I felt this was important to note since not all countries recognize the marriage of same-sex couples and this recognition was only recently made in Ecuador in 2019. Currently same-sex marriages are totally legal in our country and are protected by law.


If you are thinking about starting or adding to your family, we recommend that you get a health insurance plan as soon as possible before taking that next step. This is recommended because in the event that you or your wife becomes pregnant immediately and you contract a health plan after, this pregnancy will be considered a pre-existing condition and will not be covered by your health insurance. In order to ensure coverage, insurance must be contracted three months before you plan to conceive a baby in Ecuador. If contracted at least three months before, the mother and the unborn child will definitely have coverage before, during, and after the pregnancy. In the event of complications at birth, thermal cribs, surgeries, or immediate care for catastrophic illnesses is needed, this will also be covered by the company.

As for vaccines for newborns, these vaccines are covered by the Ecuadorian public health system. Additionally, preventive vaccines against influenza, HPV, yellow fever, and more… If you are looking for affordable health insurance for your family, IESS is also an option to consider. In order to get familial insurance, you will have to notify IESS of your familial affiliation. There is no additional charge for dependents under 18 years old and spouses will make a contribution that is less than the monthly payment. This contribution is determined at the IESS offices once you notify them of your familial status. Remember that if you join IESS, medical care will only be available to you and your family at authorized IESS offices and specialist appointments will only be made after visiting a general practitioner.


Another benefit of familial health insurance is the ease of routine exams and preventative care. Within a health plan you have access to annual exams such as pap tests, prostatic antigen tests, mammograms, ecograms, vasectomies, and others that are useful before forming your healthy and well-planned family.

In regards to transgender and gender-affirming care, unfortunately, most medical procedures and treatments are not covered. Hormonal treatments, aesthetic surgical procedures, implants, or any procedure that is related to modifications through aesthetic surgeries or hormones is not currently covered.

A health policy also includes exclusionary clauses for certain medical expenses. Any type of preventive treatment, vitamins, hormonal treatments, excess medical fees, unreported pre-existing conditions, discarded medical tests or tests not related to the diagnosis presented in the insurance are not covered. Documentation is also very important when getting reimbursed. Most health insurance will not cover invoices or reimbursement documents that are stained, altered, corrected, or made by the client and not by the doctor. Lastly, and most importantly, in Ecuador the policyholder is in charge of the reimbursement, rather than the insurance company, which is typical in most other countries. In Ecuador the private insurance regulation laws protect companies in their request that the client be the one responsible for all documentation of their reimbursement. For this reason, any clients choose to take out health insurance through a broker, which is an agent specialized in insurance that can guide you throughout the reimbursement process. If you already have a broker and they have not managed your reimbursements as you expected, you can always change brokers. If you believe your broker has harmed you or not acted with your best interest in mind you can report them to the Superintendence of Securities, Insurance and Companies, which protects the affiliate and the insurance company, in addition to regulating active brokers in Ecuador and their work licenses.

There are a few things to remember and consider if you opt for family insurance through IESS. Medical services through IESS are not always available and one of the requirements of IESS is that the member first goes to a general doctor before seeing a specialist. Getting appointments with specialists could take up to six months. Additionally, exams, ultrasounds, MRIs, and x-rays are sometimes rescheduled or pushed back due to damaged equipment, lack of resources, or lack of workers. We believe that IESS is a good option when it comes to healthy families or for pre-existing conditions that are not covered by private insurance.

Starting a new family involves considering a number of options. From the most basic options to the most complex, one has to consider the best insurance for their family, their family budget, and what is included in that insurance. Our base recommendation will always be the combination of an IESS health plan and a private insurance plan which averages the cost of $39.20 per month, per person. Another option is two private insurances with full coverage up to $500,000 for a price of less than $100 per month per person for the insured family group. The options are varied, and it is always better to get several quotes and choose the most appropriate for your family. Lastly, we always recommend that you get insurance through a broker since the price will be the same but your broker will guarantee that your claims will be reimbursed.

Av. Ordoñez Lasso 555 Edificio Monte Carlo, oficina 001

Carlos Ramirez
blueboxasesores@gmail.com
098 246 5168

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