How health insurance works in Mexico
How Medical Expense Insurance Works in Mexico
Major Medical Expense Insurance helps restore your health by covering hospital expenses, medication, medical fees, and, if necessary, prostheses for illnesses and accidents.
Illnesses will be covered if the condition surpasses the waiting period and the medical costs exceed the contracted deductible.
For accidents requiring hospital care, expenses must exceed $3,300 MXN. These events will be covered as long as treatment is received immediately or within a maximum of five days after the accident. If medical attention is not sought within this period and is received later, it will be considered an illness and must exceed the deductible to be covered.
NOTE: IT IS IMPORTANT TO HAVE THE DEDUCTIBLE WAIVER FOR ACCIDENTS CLAUSE FOR THIS COVERAGE TO APPLY. If not included in your policy, it will be treated as an illness.
​
How to Differentiate Between Illnesses and Accidents
An illness can be described as an internal event in the body that affects health, whereas an accident is an external, sudden, and unexpected event that impacts the body.
It is essential to note that this type of insurance does not work the same way as public or state-provided healthcare. There are key differences to consider.
When purchasing the insurance, you must be in good health. (Analogy: "It’s like trying to buy car insurance after you’ve already crashed your car.") Any pre-existing conditions, previously diagnosed diseases, or symptoms that appeared before obtaining the insurance will not be covered.
Key Considerations for Coverage
Pre-existing Conditions and Waiting Periods
In Mexico, insurance policies can cover all illnesses, but an important requirement is to have had continuous coverage for at least two uninterrupted years. However, don't worry—only some specific conditions have this requirement. Illnesses not subject to a waiting period will be covered from day one, provided their symptoms or diagnosis occur after obtaining the insurance.
Waiting Periods for Certain Illnesses
Some illnesses require a waiting period before coverage applies. The product known as Major Medical Expense Insurance (Seguro de Gastos Médicos Mayores) starts working when:
The cost of your illness exceeds your contracted deductible.
The waiting period for certain diseases has passed.
For accidents, expenses must exceed $3,300 MXN, and the deductible waiver for accidents must be included in your policy.
Payment Methods: Direct Payment vs. Reimbursement
There are two ways your insurance company can cover your medical expenses:
Direct Payment – The insurer directly pays a network hospital.
Reimbursement – You pay upfront and then receive compensation for hospital expenses, medication, medical fees, and, if applicable, prosthetics.
We highly recommend Direct Payment whenever possible.
Important Recommendations
Check the hospital network before admission, as hospitals in the network may change. This helps avoid penalties for using a higher-tier or out-of-network hospital.
Review your policy's terms regarding prosthetics and osteosynthesis materials. Each policy has a different insured sum for these items.
If you have any questions, do not hesitate to contact us! We would love to explain your policy’s conditions and limitations in detail.
Contact us
Ponte en contacto para que podamos empezar a trabajar juntos.