A Broker's Guide to Pre-Existing Conditions: Your Expat Health Insurance Strategy in Ecuador

As an expat insurance broker based in Cuenca, the most critical—and often most stressful—conversations I have with new arrivals revolve around pre-existing medical conditions. Securing comprehensive health insurance is not just a visa requirement; it's the bedrock of your financial and physical well-being in a new country. For those with chronic illnesses or a complex medical history, the standard insurance application process can feel like a minefield.

This guide cuts through the generic advice. It provides the specific, actionable strategies you need to navigate the Ecuadorian insurance market, based on years of hands-on experience helping expats get the coverage they deserve.

The Two Paths: Understanding Ecuador's Health Insurance Landscape

For expats, there are fundamentally two routes for health coverage: the public system (IESS) and private insurance. Each treats pre-existing conditions very differently.

1. The Public Option: IESS (Instituto Ecuatoriano de Seguridad Social)

The national social security system is a viable option for many expats who become residents. You can join through a work contract or via afiliación voluntaria (voluntary affiliation).

• Hyper-Specific Detail #1: The IESS Advantage & Cost. The single biggest advantage of IESS is that it does not exclude pre-existing conditions. Once you are affiliated, your conditions are covered. However, there are crucial waiting periods (períodos de carencia) for specific services, such as a 60-day wait for general surgery. As of 2024, the minimum voluntary monthly contribution is 20.6% of the declared income, which cannot be less than the national basic salary ($460). This puts the minimum monthly payment at approximately $94.76. While affordable, be prepared for potential wait times for appointments and bureaucracy within the public system.

2. The Private Market: Tailored but Selective

Most expats prefer the speed, comfort, and choice offered by private insurers. This is where pre-existing conditions become the central focus of the application. Insurers here are assessing risk, and a known condition represents a higher probability of claims. Their responses typically include:

• Permanent Exclusion (Exclusión Definitiva): The most common outcome for significant conditions. The policy will explicitly state that it will not cover any costs related to the condition, its symptoms, or its complications.
• Premium Surcharge (Recargo): The insurer agrees to cover the condition but increases your monthly premium to offset their risk. This is more likely for well-managed, stable conditions like controlled hypertension.
• Extended Waiting Periods (Períodos de Carencia): A policy may cover a condition, but only after a waiting period of 12 or 24 months, during which you must remain treatment-free for that specific issue.
• Outright Denial: For severe, complex, or unstable conditions, an insurer may refuse to offer a policy at all.

Strategic Moves to Secure the Best Possible Coverage

A proactive, transparent approach is non-negotiable. Here’s how to position yourself for success.

1. Full, Honest Disclosure is Your Only Option

The Declaración de Salud (Health Declaration) you sign is a legally binding document. Failing to disclose a past surgery, a chronic medication, or a diagnosed condition is considered insurance fraud.

• Broker Expertise: Insurers are not naive. Upon receiving a large claim, it is standard practice for them to request your complete medical file (historia clínica) from the treating hospital or clinic. If they discover evidence of an undisclosed pre-existing condition, they have the right to deny the claim and even cancel your policy retroactively, leaving you responsible for the entire bill. Be exhaustive in your disclosure.

2. Choose Your Insurer Wisely: Local vs. International

Not all insurers are created equal, especially for expats. Your choice depends entirely on your needs and medical history.

• Hyper-Specific Detail #2: Key Players and Their Profiles.
  • Local Prepaid Medicine (e.g., Saludsa, Confiamed): These are Ecuador’s giants. They offer excellent in-country coverage with vast networks of doctors and clinics. Their plans are often more affordable for day-to-day care. However, their underwriting for significant pre-existing conditions can be very strict, often leading to permanent exclusions.
  • International Insurers (e.g., VUMI, Best Doctors): These providers specialize in the expat market. While their premiums are higher, their underwriting can be more sophisticated and sometimes more accommodating of well-managed chronic conditions. Their key advantage is global portability and often includes coverage in the U.S., which can be a lifeline for complex treatments not available in Ecuador.

3. Arm Yourself with Documentation

Don't just state that your condition is "stable." Prove it. Before you apply, gather the following from your doctors back home:

• A concise letter detailing your diagnosis, treatment history, and current stability.
• Recent lab results or imaging reports.
• A complete list of your medications and dosages.

Presenting a well-organized medical file to an underwriter demonstrates that you are a responsible patient and that your condition is a manageable risk, not an unknown liability.

⚠️ Broker's Warning: Avoid This Critical Coverage Gap

The most devastating mistake an expat with a pre-existing condition can make is choosing a local-only plan when they might need international care. A local plan from Saludsa, for example, is fantastic for seeing a GP in Cuenca or getting a procedure in Quito. But if your chronic condition takes a serious turn and requires a specialist or facility only available in the United States or Europe, that local plan will provide zero coverage. You will be paying 100% out-of-pocket for an international medical evacuation and treatment.

If your condition has any possibility of requiring advanced international care, an IPMI (International Private Medical Insurance) plan from a provider like VUMI is not a luxury—it is an essential risk management tool.

The Financial Reality: What to Expect in Costs

• Hyper-Specific Detail #3: Real-World Premiums & Deductibles. Costs vary widely based on age, health, and coverage level. As a benchmark, a relatively healthy 65-year-old expat should budget between $250 and $550 per month for a robust private plan. Deductibles typically range from $1,000 to $5,000 annually. A plan that agrees to cover a pre-existing condition will almost certainly come with a premium surcharge of 25-50% or more.

• Hyper-Specific Detail #4: Understanding Enfermedades Catastróficas. This is a key Ecuadorian insurance term. The government defines a specific list of "catastrophic illnesses" (e.g., cancer, stroke, major organ failure). Most private policies have a separate, much higher coverage limit for these listed conditions. It's crucial to review this list in any policy you consider, as it represents the insurer’s maximum liability for the most expensive medical events.

Your Action Plan for Success

1. Don't Wait: Begin the insurance application process before your move or as soon as you arrive. Underwriting can take weeks.
2. Gather Your Records: Compile a complete medical file with letters from your current physicians.
3. Be Radically Honest: Disclose everything on your application. The short-term convenience of hiding something is not worth the long-term risk of financial ruin.
4. Work with a Specialist: An independent broker who understands both the local and international expat markets can advocate on your behalf. We know which underwriters are more flexible and how to present your case in the most favorable light.

Navigating this process alone can be daunting. But with the right strategy and expert guidance, you can secure a policy that provides genuine peace of mind, allowing you to fully embrace your new life in Ecuador.

Ready to build a smart insurance strategy tailored to your specific health needs? Schedule a free, no-obligation policy review and consultation with me today.