April 4, 2008 - Public Health Insurance (Caja)

We finally decided to sign up for Caja – the Costa Rican public health insurance. This covers you for any pre-existing condition, prescriptions, and emergencies. Everything we’ve heard (though I don’t have personal experience here) says it doesn’t do so well for regular health maintenance – long lines (everyone gets a 10:00 appointment), not-so-full workup (e.g., usually cholesterol is measured, but not HDL/LDL breakdown), and slow timelines for some time-critical procedures (e.g., cancer treatments can be scheduled months too late – I know, yikes!). Many people use a two-tiered method, where they have Caja *and* either private insurance or no insurance but use a private doctor. Since many doctors provide treatment under both Caja and private, you can often use the same doctor for your health – he will be able to tell you when to get something done under Caja.

So, one afternoon we went to ARCR (Association of Residents of Costa Rica) to get signed up. We are already members; this is an additional benefit provided. Normally, premiums for Caja are 13% of your income. But, since we are rentistas, we are not allowed to work. Our residency deposit isn’t really income in the same sense. But ARCR has an arrangement with the government that allows them to cover members under a corporation. So, our paperwork consisted of “getting on the payroll.” I know, this sounds suspicious, but it is legal, and has been for at least a decade. We filled out information, paid three months of premiums, and $5 to activate. Then we got a “payroll” certificate for Rick to take to the Caja office in San José. By this time, it was a bit too late to go there, so we came back to SJ the next day.

We got the Alajuela bus to San José, then caught the cementerio (yellow/orange with purple) bus to Caja (cattycorner from the National Theater). We asked the guard at the entrance where to find the “area administración de planillar,” and stood in a short line. Then we showed the payroll certificate and got a Caja number for Rick. We called ARCR and gave them the number for their records. As of now, we are both covered if we have an emergency. But there is one (only one?) more step.

Since we live in Alajuela, we need to register at the clinic in Alajuela before we can get regular treatment. This is also where we get the insurance cards. The next day, we take a taxi to the new hospital, ask the guard where to go, and he says (arg!) we need to go to the clinic, not the hospital. We take another taxi to Clínica Marcial Rodríguez (which happens to be pretty darned close to our apartment), go to the area marked “afiliación,” show copies of our electric bill and wedding certificate, and Rick gets his insurance card. However, I have a problem. I am supposed to be covered under Rick’s Caja, but the copy of our wedding certificate is not good enough – it is too old (it probably also needs more stamps and translations). Who knew? We have no other proof that we are married – our cedulas don’t indicate this. So we leave with Rick’s coverage secure, and mine a bit iffy – ARCR assures me that if I get in an accident, I will get treatment. We can provide the coverage proof afterwards if needed.

It took three days and a few headaches, but we have coverage! Since we are under 55, our cost is $61 per month. Once we (that is, Rick) reach 55, our cost drops to $43 – nice to look forward to a *drop* in cost!

I’ve since heard of someone who went in to *renew* her Caja insurance, and had a problem with her wedding certificate. Their solution was to get re-married in Costa Rica – it took a couple of hours, 2 witnesses, a lawyer, and $150. We’ve been married over 15 years, and it looks like this might be the answer for us as well. Why not? We already “got married” again in Hawaii – all that was required there was kissing in the wedding grotto…