Chiriqui Hospital Health Care Plan - This is their New Brochure verbatim

[Jeff Simon]

MS CHIRIQUI, S.A. HEALTH CARE PLAN

[e-mail]  [phone]   www.chiriqui.com

***THIS IS TAKEN DIRECTLY FROM THE NEW BROCHURE ON THE ABOVE PLAN***

EMERGENCY SERVICES  -  Immediate eligibility

• Outpatient emergency accident you are covered a 100% up to $500.00.  After $500.00 we will cover 70% and member pay 30%.
• Disease emergency covered 70%.
• Ambulance is cover to 70% up to $75.00 – Only in Chiriqui area.

 

SPECIALIZED MEDICAL APPOINTMENT  -  Immediate eligibility

• Member is entitled to 12 coupons for medical visits per year, co pay of $12.00.

 

FUNERAL SERVICES  -  Immediate eligibility

• Funeral expenses are covered 100% up to mazimum of $750.00.

 

LABORATORY  -  Eligible after 30 days of enrollment

• 70% reimbursement of eligible expenses.

 

XRAY EXAM  - Eligible after 60 days of enrollment

• 70% reimbursement of eligible expenses

 

SPECIAL PROCEDURES  -  Eligible after 180 days of enrollment

• Covered 50%.  Must be requested by a physician provider and with written authorization by the Medical Committee.  One per month.

 

OUTPATIENT SURGERIES – Eligible after 1 year of enrollment

• The member must deposit $100.00.  After this amount we will cover 70% of eligible expenses and the affiliate a 30% as co-pay.  It requires pre-authorization of the Medical Committee.

 

ELECTIVE SURGERIES  -  Eligible after 1 year of enrollment

• The member must deposit $300.00.  After this amount we will cover 70% on eligible expenses and the affiliate a 30% as co-pay.  It requires pre-authorization of the Medical Committee.

 

MATERNITY  -  Eligible after 1 year of enrollment

• Normal Delivery covered 70% up to $1,400.00 total.  Cesarean Delivery covered 70% up to $2,000.00 total.

 

PREVENTIVE CARE  - Eligible after 1 year of enrollment

• Yearly physical, Well Visit, Annual Mammograms, Pap smear, Vaccinations, Exploratory Exams/ Test, Colonoscopies, etc.

 

PRE-EXISTING CONDITIONS  - Eligible after 2 years of enrollment

• Covered 50%

 

EYE SURGERIES – Eligible after 3 years of enrollment

• Covered 70% up to $1,350.00 total.

 

HIP AND KNEE REPLACEMENT  - Eligible after 3 years of enrollment

• The Member must deposit $300.00.  After this amount we will cover 70% on eligible expenses and the affiliate a 30% as co-pay.  It requires pre-authorization of the Medical Committee.

 

BENEFITS  $18,000.00  coverage per year

 

ADVANTAGES:

• 24/7 Service
• Immediate use
• Low co-payments
• Easy installments
• All ages eligible with no cancellation
• No pre-existing conditions exclusions
• Comprehensive Medical Services

 

SUPPLEMENTAL HEALTH AVAILABLE:

• Cancer
• Individual $63.00 Annually
• Family $100.80 Annually

 

ENROLLMENT REQUIREMENT

• Fill out application
• Pay registration fee $10.00
• First payment in advance
• 2   I.D. size photos
• Copy of your passport (personal ID)
• Applicants 50+ must have lab test and physical exam

 

INDIVIDUAL PREMIUM

AGE                MONTHLY

30-39               $32.00

40-49                 42.00

50-59                 48.00

60-69                 62.00

70-79                 72.00

80 +                 112.00

 

FAMILY PREMIUM

Added to premium above

 

Spouse     19-49      $25.00

Spouse     50-79        45.00

Child        0.2-18        18.00

 

PREMIUM INSTALLMENTS

Three payment options:

• Monthly   (only by credit card auto-billing)
• Quarterly (cash in advance, 6% discount)
• Annually  (cash in advance, 8% discount)

[Mark Perillo]

Is this pricing still current?

[Jeff Simon]

The $18,000 mentioned is the annual limit on "Covered Expenses" per person. If the condition is not "pre-existing" then the plan will cover 70% of "Covered Expenses". Keep in mind that not all expenses are covered (true for any U.S. plan as well). e.g. the plan does not cover any "devices" such as a stent for your heart, or a pin or screw in a broken bone or a hip replacement or pacemaker.  These are all "devices" and it is my understanding they are not covered.   If the condition is "pre-existing" then you will have no coverage during your first two years in the plan. After two years, the condition will be covered but the plan will only pay for 50% of "Covered Expenses".   Another important point:  All plans have what are known as "Inside Limits".  This means that the plan covers up to a certain amount for each procedure, surgery, etcetera.  So if a given operation has a limit of $3,000 and the actual charges exceed that amount, you will only be reimbursed a given percentage of the $3,000 limit.   So don't think that you will ever be reimbursed $18,000 for a given stay at MS Chiriqui under their plan. That will never happen.  You will be reimbursed either 50%, 70% or 0% of COVERED EXPENSES, and up to the limits they set for each procedure or operation.  If you have pre-existing conditions and are in the plan for less than two years, you may have no reimbursement if your health problem is due to your pre-existing condition.   Remember, 70% of $18,000 is only $12,600.  If your annual premium is around $1,200 - then your premium is about 10% of the very most you could be reimbursed in a given year.  

[Lee Zeltzer]

The MS Chiriqui plan is not insurance, it is a prepaid partial indemnification plan.  You do get some discount vouchers for doctors visits also. They cover a portion of the little stuff and are pretty good on accident coverage, not much more.

They are almost worthless for a major issue that will exhaust their $18,000 or as you described $9000 on a preexisting claim after two years of payment. The rub is they are the only option for pre-existing conditions in Chiriqui,  so for many something makes you feel more secure than nothing. If you pay $62 a month as I do,  in two years that is $1488 toward a $9000 maximum on a pre-existing condition claim. That is for services at Hospital Chiriqui. For anything serious you want to get to Panama City ASAP not linger in David.

[Finley Hatch]

Jeff, I'm confused.  Not so long ago, you posted that any post using your name and photo after that date would have been posted by an impostor if it appeared on this site.  Now here you just posted again.  Here comes the tough question:  are you an impostor, THE impostor, the real Jeff Simon (whoever that may be), a new impostor, Roberto Saldana, or someone who doesn't remember what they last posted?  Or, perhaps, none of the above?  If you posted this, did you also post the (allegedly) bogus posts of Roberto Saldana?  Is this, as they say in show biz, a comeback tour?  Plus, how do we know if any response to this is by..........  And if you are the real Jeff Simon, have we missed you - or not?  Any attempt to clarify your identity, the hog farm issue, and what you are doing now, would be appreciated welcome.

[Finley Hatch]

Permalink Reply by Jeff Simon on April 8, 2011 at 3:31pm

Thank you for clearing that up Lee.

 

Now if we could find out who did this.....who created the Roberto Saldana persona.....the hog farm hoax, etc.

 

If anyone sees a post on Boquete.ning.com please know that it is not originated by me.

 

 

[Bill]

Thanks Jeff.  Good to have you back.