THE fact thatthe National InsuranceInstitute(INS) is the onlyinsurance companyin Costa Ricadoesn’t mean INSmedical insuranceis the only coverageavailable.Other sourcesinclude:The Internet.Since the popularizationof theInternet, various medical insuranceoptions have become available online. Ifyou decide to go through the Internet,make sure you deal with a recognized,reputable insurance company.Private “Non-insurance” Plans. Inrecent years, a few options have beenoffered by organizations related to majorprivate hospitals. These plans do not violateINS’s monopoly, as they are somewhatunlike insurance. Subscribers investX amount per month and build fundsupon which they may draw when theyneed medical care. If the cost of therequired care exceeds the amount accumulatedin the fund, the organizing hospitalwill advance the difference, but thesubscriber must come up with guarantees.These funds are unregulated and do notaccrue interest to the subscriber, so whatwe are really looking at is a mechanismwhereby people who are unable to savemoney and create their own funds abdicatethis burden and, in payment, theorganizer earns the accrued interest.The plans currently being offered areorganized by very reputable hospitals.However, in the past, some companiesoffering similar plans disappeared and lefttheir subscribers high and dry. In the early1980s, there was Hospital IberoAmericano; in the late 1990s, Medi-Pre.Apart from financial considerations,the main drawback of these plans is thattreatments can only be administered byand in the organizing hospitals, all ofwhich are situated in the Central Valley.Travel Policies. Sometimes peopleneed medical insurance for short periods,and often they need it right away. INS’sfull-blown medical policies all take 4-6weeks to get in place, so often the timeproblem is solved by means of travelinsurance policies, which provide somemajor emergency medical coverage andare written in 5-10 minutes.Costa Rican Social Security System(Caja). The Caja provides health caredirectly, so this is not really insurance.Some people use it as a primary careprovider, but a lot of people use Caja coverageas a supplement, in case one of thesmaller INS policies were to becomeexhausted by a large claim, or in case theinsured person were to develop an ailmentexcluded by INS.The Caja was created to provide medicalcare to Costa Rican employees andtheir dependants. All employers have theobligation to enroll their employees. Themonthly cost is borne by the employer andalso by the employee by means of a payrolldeduction. The Caja provides servicethrough a series of large, well-equipped,overstaffed and often inefficient hospitals– but, in all fairness, it must be pointed outthat Costa Rica has an enviably high lifeexpectancy, largely due to the universalbirth-to-death care provided by the Caja.Costa Ricans and legal residents canobtain Caja coverage even if they are notemployees, or if they are self-employed.Most foreigners who want this coverageobtain it through the Association ofResidents of Costa Rica (ARCR), whichhas negotiated a special rate for its members.Through the ARCR, the cost is $58per month for heads of family under 55,and $37 per month for those over 55.Contact David Garrett at 233-2455 [email protected] The opinionsand viewpoints expressed here are thoseof the writer, and do not necessarily representthe official position of the NationalInsurance Institute.