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Monday, October 20, 2014

Living Legal in Costa Rica - PART II

Part I of this trilogy dealt with the overdue renewal of our cédulas (mandatory ID cards if you want to linger on in Costa Rica for more than 90 days at a time). This part deals with mandatory health insurance and, if you choose, utilizing the medical and other health services provided by CAJA Costarricense de Securo Social - "CAJA" for short.

As used here, CAJA is a reference to Costa Rica's public health care system. The services include not only medical care in the classic sense as provided by medical doctors and nurses but also dental care, providing prescribed pharmaceuticals, prescribing and providing eye glasses, hearing aids, prosthetics, etc. In the case of dental care, our understanding is that the services for adults are limited.

CAJA runs in parallel with various private health care systems which operate in Costa Rica. This is in contrast to some countries, including Canada, where legislators in their supposed wisdom have decided that competition between public and private health care systems is a bad thing.

Some people rely exclusively on private health care in Costa Rica. Others rely exclusively on CAJA. Still others rely on a mixture between the public and private sectors. However, whether or not one chooses to rely on CAJA, enrolment and monthly payments to CAJA are a mandatory component of "living legal" in Costa Rica.

Until recently, we relied exclusively on the private sector. However, two factors have motivated us to try CAJA. Firstly, the amount of our monthly payments to CAJA has increased substantially from when we first started making payments in 2012 (over 70%). Secondly, Sun Life Insurance in Canada has started to deny pharmaceutical claims because receipts provided by pharmacies in Costa Rica somehow do not measure up to indecipherable regulations which Sun Life declines to explain in a clear manner.

My CAJA carné. Stapled to it is a clinic appointment card.

Enrolment in CAJA is typically evidenced by an insurance card referred to as a "carné. There are carné Aseguado Directos for principal insured persons, or direct policy holders, and carné Aseguado Familiars for related family members.

When applying to renew our cédulas through Banco de Costa Rica (see my blog post on October 11, 2014) a question arose as to whether my husband should have his own "carné" We never thought so - and not having one did not impair his cédula renewal. Neverthess, we ultimately decided that he should have his own if only as a matter of convenience.

In the meantime, someone pointed out that my carné had expired. In fact, it had expired in October 2012 just three months after it was issued.

The expiry date is in the upper right hand corner box - "Válido hasta". It's just the card that expires. We were still covered under CAJA - as long as the monthly payments were up to date.

So now it was time to renew my carné and get one for Lance.

We knew we could not do this without the services of a translator and we used Mercedes, a wonderful young lady who lives in the Atenas area and is fluently bilingual.

We first went to the Atenas EBAIS (Equipos Básicos de Atención Integral en Salud), which is the health care clinic located beside Cruz Roja (the Red Cross building). Luis Cruz is the person who issues the carnés. He sits behind a window where all the patient files are kept. There is a bench to sit on and wait your turn at the window. We had Mercedes on my cell phone and she talked to Luis and translated for us. Luis issued me a new carné (expiring in 10 days because we were waiting for our new cédulas to arrive). He gave Lance an appointment for the following Monday at the Seguro Social building around the corner and told us what we needed to bring with us.

The following Monday, we met with Mercedes at the main Social Security office in Atenas and were issued some kind of confirmation number that we then took to Luis, along with the requested documents, and Lance was issued his own carné. Coincidently, that same morning our new cédulas had arrived at the correos so I too was then given a new carné, this time with a more reasonable expiry date of February, 2016 - the same as Lance's carné.

Having Mercedes along with us was invaluable, especially because she also seemed to be a friend of Luis - more to follow.



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