How does the state health insurance system work?

Chile’s healthcare system is generally good, particularly in cities such as Santiago, although less so in rural areas. You will find a wide range of medical facilities and pharmacies throughout the country. It has a two-tier form of health insurance comprised of public and private cover, and to some extent you can combine the two into a semi-privatised system.

Healthcare in Chile is regulated and organized by the National Health Services System (Sistema Nacional de Servicios de Salud / SNSS) and the Municipal System for Primary Care. Public health insurance is organized by FONASA (National Health Fund / Fondo Nacional de Salud), which is funded by the government and from national insurance contributions deducted from employees’ salaries.

If you are registered with FONASA, you will be able to use Chile’s public healthcare system, but you can also take out private provision and make a co-payment for any excess medical costs, thus combining state with private health insurance. You will find that it is relatively easy to access public healthcare, however: you can sign up with a GP of your choice and can usually see a specialist without making an appointment first.

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Who is eligible for state healthcare?

Any resident paying into the system will be covered by FONASA, which also covers the unemployed, uninsured pregnant women, people with mental or physical disabilities, and the poor.

You will be eligible as an expat only if you are working (or have a pension), have residency and are paying into the national health insurance scheme. In order to work in Chile, and therefore qualify for FONASA, you will need a work visa, which usually takes the form of a ‘subject to contract’ visa if you are working for a Chilean company, or a temporary visa if you are going to be employed by a foreign company in Chile.

The nature of your employment could affect your access to healthcare, so make sure you discuss any packages which include health cover, either with FONASA or with a private provider such as a local ISAPRE, or one of the main international insurance companies.

How do you apply to join the state health insurance system?

Your employer will need to register you with FONASA. If you are retired and wish to make contributions from your pension, you should contact FONASA directly. If you are self employed, you will need to consult FONASA about making contributions.

What is covered by the state health insurance system?

FONASA covers around 78% of the Chilean population and entitles them to:

  • primary care
  • hospitalization
  • emergency care
  • specialist consultations
  • medical tests
  • maternity care

Screening (e.g. for various forms of cancer) is set to increase as the Chilean government seeks to improve the standard of national health. There are a number of governmentally-set guarantees, known as Acceso Universal con Garantías Explícitas, or AUGE which are applicable to all Chileans, whether covered by FONASA or ISAPREs, and which cover provisions around access, quality, timeliness and financial protection.

Are retirees covered by state medical insurance?

You will only be entitled to insurance under FONASA if you are paying 7% of your pension into the system. Retired expats in Chile may prefer to take out comprehensive international health insurance rather than relying on the state. You will need to check your policy for any age limits.

There may be an age cut-off limit for the private ISAPRE programs.

Are students covered by state medical insurance?

As an international student studying in Chile, you will not be covered by FONASA and will need to take out private health insurance in your home nation.

Will your family be covered by your insurance?

FONASA will cover your dependents if you are working but you will need to make sure that they are officially registered with the national scheme. Note, however, that your spouse may not be permitted to work if they join you in Chile.

Is dental treatment covered by state health insurance?

FONASA covers basic dental treatment for adult members and also runs a program for teenagers which includes orthodontic treatment.

What are the contribution rates for state health insurance?

The contribution rates are roughly 7% of employees’ taxable income with a cap of 4,921 UF (around US$150K). This is mandatory and will be deducted from your monthly salary.

Why buy private health insurance?

If you are not paying taxes, and are not eligible to be covered by FONASA, you will need to take out either local or international health insurance on a private basis. In addition, healthcare provision can be patchy, particularly in rural areas, and even in the big cities patients often complain of long waiting times as the public system can be overstretched. The OECD reports that the country is facing a number of healthcare challenges, including an obesity epidemic, and this is taxing the national health system – which is deemed by the OECD to be of a good standard – to its limits.

Local private provision in Chile is run by ISAPRES (Instituciones de Salud Previsionales). Health insurance through an ISAPRE is differentiated by the amount of your co-payments, your premium (a higher premium will confer a wider range of benefits), and your age and state of health. Overall, customers pay around 9% of their taxable income.

The ISAPRES operate via a network of private health care providers and facilities that are either independent or contractually linked, but they have recently been criticised by Chilean customers for failing to cover certain conditions and you may prefer to opt for one of the international providers who cover Chile.

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What is covered by private health insurance?

In addition to an ISAPRE, you may be able to take out a CAEC (Cobertura Adicional para Enfermedades Catastróficas), which is a comprehensive additional policy that gives you extra cover. This has a deductible, however, so you will not be fully reimbursed.

Private insurance will give you a full range of hospital and surgical treatment, plus cosmetic treatment and any advanced dental care.

It is recommended that you take out a policy which has medical evacuation coverage. Chile is prone to natural disasters.

How much does private health insurance cost?

As so many variables have an effect on the cost of international private medical insurance it becomes very difficult to give accurate estimates without knowing the full details of the coverage required. However, as a very rough guide, using a standard profile of a 40 year old British male with no deductibles, no co-insurance, a middle tier plan/product, all modules included and worldwide coverage excluding the US, a ballpark price of around £4,000/$5,000 might be expected.

If you are able to take out an ISAPRE, then costs will vary: expats report monthly fees of around US$300 for family insurance coverage.

Which companies offer private health insurance?

Some ISAPRES are designated as covering only certain companies, such as mining organisations. The full list of ISAPRES that you are permitted to sign up to is as follows:

  • Banmédica
  • Colmena Golden Cross
  • Más Vida
  • Vida Tres
  • Cruz Blanca
  • Consalud
  • Ferrosalud

However, there are some big international providers which also cover Chile, including:

  • Allianz (its Spanish branch has some bilateral agreements with Chile)
  • Cigna
  • Pacific Prime

Glossary of health insurance terms

FONASA / Fondo Nacional de Salud - National Health Fund

ISAPRES / Instituciones de Salud Previsionales – local private insurance providers

Sistema Nacional de Servicios de Salud / SNSS - National Health Services System

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