Big changes lie ahead for private health insurance as the National Assembly debates additional regulations, broader coverage

Jul 27, 2016 | 23 comments

Under legislation being debated in Ecuador’s National Assembly, private health insurance policies and prepaid health plans will be required to provide new services that some say will make health care coverage more expensive.

Assemblyman Carlos Velasco pushes case for more health coverage.

Assemblyman Carlos Velasco pushes for more health coverage.

According to Assemblyman Carlos Velasco, it is time to make private health coverage as comprehensive as the public health care offered by the Social Security and public health systems. “Ecuador is now has one of the best health care systems in Latin America but private providers are lagging behind the coverage offered by the state,” he says. “We need to upgrade private services.”

Among new requirement being proposed are elimination of restrictions on pre-exisiting medical conditions and age. Currently, many policies exclude coverage of pre-existing and chronic conditions and limit new policies to clients under 60 or 65 years of age.

In addition, insurers would be required to provide more coverage for medicine costs, cover ongoing treatments such as kidney dialysis, offer natural and holistic options for cancer treatment, cover costs for organ transplants, and offer dental care coverage. It would also increase out-patient services for a large range of diseases and chronic conditions and provide greater coverage for pregnant women.

The legislation, which is supported by the ruling Alianza Pais coalition and is expected to pass, is being opposed by some assemblymen for being too expensive. “These requirements could force some insurers out of business and would require all of them to increase their charges,” says Andres Paez. “The intentions are good but they place a heavy burden on companies that have been offering good services for years,” he adds.

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Velasco says that a key element of the legislation is to make sure the elderly are fairly covered by private plans. “Today, some companies end services or impose additional costs for those over 65, and most companies refuse to sell new policies to the elderly at all. This practice will end,” he says.

Another requirement of the legislation is that private health insurers maintain a minimum capital reserve of $1 million, although some legislators say the amount should be more.

About one million Ecuadorians are insured by private insurers.

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