Will Ecuador’s New Mandatory Health Insurance Rules Affect You?

As of May 1st, 2018, the Human Mobility Act will replace the current immigration and naturalization law in Ecuador, imposing new rules on foreign nationals. There will be three main requirements for expats and holidaymakers in Ecuador:

– to carry travel identification or a passport while in the country;
– to register at the Ecuadorian civil register to obtain a cédula (national identity document);
– to have public or private health insurance valid for the duration of their stay.So, the simple answer is yes, these new rules will affect you. All travelers to Ecuador will have to produce proof of health insurance to the ministry of foreign affairs as an entry requirement. Without it, it will not be possible to obtain a cédula, which is required in many official situations, such as applying for a bank account, obtaining a local driver’s license and setting up services such as electricity, telephone and internet. Therefore, expats who are residents of Ecuador will need health insurance, including those who became residents before the new law came into effect. Expats already resident in Ecuador need to register their address and ensure they comply with the new health insurance rules.

There are two health insurance options available. The first is through the public Ecuadorian Social Security Institute (IESS), and the second is from a private health insurance company.

The Ecuadorian Social Security Institute, or IESS, is responsible for implementing the health insurance regulations. IESS public insurance is paid for through contributions of 17.6 percent of the individual’s income, either directly by the individual or via their employer.

A spouse or common law partner (who must also have a cédula) can also be enrolled at an additional cost. For some expats, this will be a major investment, but will give access to free medical appointments, procedures and medications at facilities that are contracted with the IESS. There is a national telephone booking system for medical appointments, which you can call for free from mobiles and landlines.

In theory, appointments will be booked at the medical centre of the individual’s choice. In an emergency situation, treatment will be given by the nearest hospital. If that hospital is unable to perform the procedure, the individual will be transferred to a private hospital at no additional cost. More information on this system can be found on the IESS website.

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Although the public health service has improved greatly in recent years, it has some ongoing problems. As investments have been made in the system, the numbers of people accessing the services have risen significantly, resulting in oversubscription for appointments and treatment. The quality of care can vary significantly in different IESS facilities, with relatively poor standards of care in some rural areas. There have been instances of IESS pharmacies not having prescribed medications, meaning that the individual had to go to a non-IESS facility to buy medicine, costs of which would be over and above contributions already made to the IESS.

For individuals who desire private health insurance, there is a choice of either local or international policies. A local policy is the cheaper option, providing cover in a limited geographical area in a designated country. This is a good option if the individual is not going to travel much.

For someone who is planning on travelling more widely, for example within their country of residence, home country and more widely, an international health insurance plan provides greater coverage.

Some international plans also provide a wider choice of hospitals and include dental and mental health care, which may not be included in some local plans. However, the costs will clearly be greater.

As a current or potential expat in Ecuador, it is important to investigate the health insurance options and ensure compliance with the new mandatory rules.

Useful websites:
IESS website
UK government advice on emigration to Ecuador
Ecuadorian Ministry of Foreign Affairs and Human Mobility


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