# IMSS - Pre-Existing Medical Condition



## GnJ.in.MX (Mar 26, 2009)

My husband had what was an equivalent of a heart attack, only it occurred in his intestine while we were in Mexico. Needless to say, this really "threw a wrench in the works" with respect to our plans on moving there.
We are back in Canada right now and everything seems to be A-OK with him and we hope to go back to Mexico in January 2010.

My question is: My husband will probably have to be on the blood-thinner Coumadin for the rest of his life become of this. Will be still be eligible for coverage under IMSS using the "2-year rule"? I.E., After 2 years, will they cover him should this same medical condition flare up again?

Thanks.


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## RVGRINGO (May 16, 2007)

Only IMSS can really tell you. One doesn't have 'heart attacks in the intestine'. Did he have an aneurism? Some previous conditions can eliminate you from IMSS eligibility for any coverage.


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## GnJ.in.MX (Mar 26, 2009)

RVGRINGO said:


> Only IMSS can really tell you. One doesn't have 'heart attacks in the intestine'. Did he have an aneurism? Some previous conditions can eliminate you from IMSS eligibility for any coverage.


I didn't say he had a heart attack in his intestine. I said he had what was an equivalent of a heart attack in his intestine. At least, that's how his doctor here described it to us. 
Anyway, not an aneurism. Some arteries were blocked which was inhibiting blood flow to his intestine, killing his intestine slowly. The ambulance took a long time coming (90 minutes) so he lost about 1 metre of intestine. Lucky thing we have lots.

Have you ever read, "Mexico: The Trick is Living Here" by Julia Taylor? She doesn't have anything good to say about IMSS.

Julie


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## jlms (May 15, 2008)

GnJ.in.MX;198671
Have you ever read said:


> Hmm,
> 
> IMSS (and ISSSTE and several others) are the only thing defending many people in the Mexican population from destitution when they get gravely sick. If you just get a minor ailment then, yes, go private by all means, but for big things you want proper coverage.
> 
> ...


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## jlms (May 15, 2008)

RVGRINGO said:


> Some previous conditions can eliminate you from IMSS eligibility for any coverage.


Do you have any reference for this?

I skimmed quickly through the respective law (updated to May 2009) and could not find a reference to this.

My understanding is that IMSS will cover your no matter what as long as you are able to work.


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## RVGRINGO (May 16, 2007)

No, I don't have 'documentation' but I have heard of people being denied coverage due to pre-existing conditions. Since that information is anecdotal, one should simply apply to IMSS and see what happens. I have no further details available.


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## HolyMole (Jan 3, 2009)

*Health Care Mumbo Jumbo*



RVGRINGO said:


> No, I don't have 'documentatio' but I have heard of people being denied coverage due to pre-existing conditions. Since that information is anecdotal, one should simply apply to IMSS and see what happens. I have no further details available.


This is another instance where no one seems to know what's covered and what isn't. I'm at a loss to understand how the average guy in the street is expected to make decisons on health care insurance when there is such obvious confusion surrounding an absolutely critical issue like "does it cover pre-existing conditions?"

In my own case, I'm faced with a decision to take out-of-Canada insurance that will cost me about $2000/year in premiums.....but I can't get simple answers from the insurer as to what they cover, and, more importantly, what they do not cover.

In a relatively poor country like Mexico, it seems inconceivable that the public health care plan would exclude pre-existing conditions. That kind of nonsense is usually restricted to so-called civilized countries like the USA.


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## RVGRINGO (May 16, 2007)

It is not a 'public health care plan' and they don't have to take you with pre-existing conditions. The application form will give some clues.
If you can get coverage for $2000 Canadian per year, you should have absolutely no complaints and I wonder why you would even be interested in IMSS with that kind of inexpensive coverage available.


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## bournemouth (May 15, 2007)

HolyMole said:


> This is another instance where no one seems to know what's covered and what isn't. I'm at a loss to understand how the average guy in the street is expected to make decisons on health care insurance when there is such obvious confusion surrounding an absolutely critical issue like "does it cover pre-existing conditions?"
> 
> In my own case, I'm faced with a decision to take out-of-Canada insurance that will cost me about $2000/year in premiums.....but I can't get simple answers from the insurer as to what they cover, and, more importantly, what they do not cover.
> 
> In a relatively poor country like Mexico, it seems inconceivable that the public health care plan would exclude pre-existing conditions. That kind of nonsense is usually restricted to so-called civilized countries like the USA.


Here is a link that might answer some questions:

How to Apply for IMSS :: MedToGo International


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## HolyMole (Jan 3, 2009)

RVGRINGO said:


> It is not a 'public health care plan' and they don't have to take you with pre-existing conditions. The application form will give some clues.
> If you can get coverage for $2000 Canadian per year, you should have absolutely no complaints and I wonder why you would even be interested in IMSS with that kind of inexpensive coverage available.


Then I'm mistaken, for I was under the impression that all Mexicans are covered by some form of basic health care, which makes it a "public health care plan", doesn't it?

IMSS may be a "Tier 2" kind of coverage, subject to premiums, but if it's administered by the government, that makes IMSS a public health care plan too.

I can see how $2000/year for a health care plan might sound dirt cheap to some, but the question still remains....what do I get for my $2000?
For example, it does not cover "hospital charges"....which apparently includes the room charge and "normal hospital expenses". And it covers surgery, but "not if the physician is an employee of the hospital." Ask what that means and all I get is silence. The plan I'm considering is one made available to retired Federal public service employees, so it's not some fly-by-night outfit.....but asking for simple explanations as to what is or is not covered is like pulling teeth.

And I've been unsuccessful so far in trying to find out if the relatively inexpensive IMSS coverage would fill-in the gaps of my own coverage.


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## RVGRINGO (May 16, 2007)

As for 'filling in the gaps' or a real emergency back-up plan; that seems to be the way most expats look at IMSS. For routine medical care or even short hospital needs, most choose to use private hospitals and pay the bill themselves. Those who are under 60 may choose to purchase private health insurance in Mexico.
IMSS is basically a government social security plan for Mexican employees with options for others, including expats, to purchase membership. ISSTE is, I think, for government employees only. Both suffer from lack of funds and less than admirable facilities, yet the surgeons may be first class as they work part time to gain government pensions. If you don't speak Spanish, you will need a private interpreter with you in most IMSS hospitals or clinics.


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## Traveler123 (Feb 1, 2009)

jlms said:


> Do you have any reference for this?
> 
> I skimmed quickly through the respective law (updated to May 2009) and could not find a reference to this.
> 
> My understanding is that IMSS will cover your no matter what as long as you are able to work.


What does working have to do with IMSS eligibility? If you are a retired expat and apply for IMSS, you are obviously not working. I hadn't read that anywhere that eligibility was related to working. If that was the case, no retiree, Mexican or US or Canadian would qualify. And I have read on other forums of retired expats who were using IMSS. Do you have a source for that information? Thanks.


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## cookjmex (Aug 12, 2009)

HolyMole said:


> This is another instance where no one seems to know what's covered and what isn't. I'm at a loss to understand how the average guy in the street is expected to make decisons on health care insurance when there is such obvious confusion surrounding an absolutely critical issue like "does it cover pre-existing conditions?"
> 
> In my own case, I'm faced with a decision to take out-of-Canada insurance that will cost me about $2000/year in premiums.....but I can't get simple answers from the insurer as to what they cover, and, more importantly, what they do not cover.
> 
> In a relatively poor country like Mexico, it seems inconceivable that the public health care plan would exclude pre-existing conditions. That kind of nonsense is usually restricted to so-called civilized countries like the USA.


Mexico is actually a more civilized country than the USA (I'm an American) because they actually already have the so-called "public option" insurance (IMSS) that my compatriots up north have seen fit to have such a fight about. Here's a little reality check about Mexico, rules are constantly changing, and may vary from location to location, or even depending upon which shift of workers you are dealing with. This not only applies to health care, but to immigration, customs, traffic laws, etc. If you can't live with it, you better stay out of Mexico.


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## joco69 (Dec 27, 2007)

IMSS is one of the biggest Government run agencies in Mexico, however its funded largely by employers who have to enroll all employees by law. IMSS can be joined by everybody including foreigners living on a fm3/fm2 in Mexico on a voluntary basis. 
You will have to get used to the bureaucracy, but then Canada can be just as bureaucratic in some way.
My experience has been good, so it helps if you speak spanish. They run frequently out of medication in local Clinics but with lots of discount pharmacies around this is not a problem.
My experience in Guadalajara at the hospital has been very satisfying, good care, pleasant staff and very clean. 
Don't compare IMSS with the Canadian Healthcare System, its very different. If in hospital you are expected to have someone to be with you at all the time. The nurses will do just basic tasks, the family the rest, you have to get friendly with a mexican family who will gladly help you out. You also must be accompanied by somebody when over 60+. This of course is no problem for Mexican Citizens, they have large families and in their culture it is expected to help out the family, something we are not used to in Canada anymore.
If you can live with those conditions IMSS can be a great experience, if you can't you better go private. For more info on private insurance plans check out Tio Corp. at lakeshore.


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## moisheh (Jun 14, 2009)

Personally I would not trust the IMSS. But it does depend on where you live. In the North of Mexico the quality of care varies from bad to unbelievable! More like butchers. Some in the Chapala area do use the service and think it is fine.

Moisheh


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## RVGRINGO (May 16, 2007)

This thread is running off topic. It is about IMSS eligibility and pre-existing conditions. Quality of care in various regions is not the issue.


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## GnJ.in.MX (Mar 26, 2009)

delete


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