Caja rule on foreign spouses upsets many expats

Some expats are unhappy because they feel the state health provider has thrown them a financial curve.

Foreign residents must affiliate with the Caja Costarricense de Seguro Social whether they want to use the health services or not. But in the last month, the Caja has declined to allow spouses to join as part of a family package.

Instead, spouses must apply for voluntary coverage on their own and pay based on their income.

Further infuriating expats, this rule seems only to apply to foreigners.

Great Sunrise Enterprises, S.A. noted on its Web site Nov. 10 that the Dirección General de Migración would enforce a paragraph of the 2010 immigration law as of Dec. 1.

The residency organization interpreted that to mean that all current and future adult applicants to the Caja must have his or her own policy and that spouses are no longer covered by their spouse’s policy.

In fact, Article 31(6) is far broader and says only that expats have the duty to contribute to the sustainability of the social security system.

Revised regulations adopted Oct. 8 by the Caja board of directors clearly states that social security protection extends to those persons who are related to a direct insurer and who maintains economic dependency. That is the same set of regulations that said same-sex partners could be enrolled under their companion’s policy.

The information about the changes and the impact it is having on those who seek residency was provided by Javier Zavaleta of Residency in Costa Rica, another firm that provides services for would-be expats. He suggested that the origin of the new rule was in the immigration department instead of the Caja.

The Association of Residents plans to challenge the requirement, but first, according to Ryan Piercy, there has to be a clear Caja denial of appeals that have been submitted by three or four couples. He is the association’s general manager.

He said he suspects that there will be denials and that there eventually will be a constitutional court appeal filed by the association’s lawyers.

Piercy said in one case an expat married to a Costa Rican sought to have his wife included on his Caja enrollment, but he was turned down. The woman complained and noted her citizenship, and a supervisor enrolled her and couple121714said that making a spouse pay was only for foreigners.

To Piercy that is a clear constitutional violation.

Any reply from the Caja administration is unlikely until at least January. After that a Sala IV constitutional court appeal might take four months, Piercy said. The Association of Residents has been there before with similar grievances related to expats and their residencies.

Piercy notes that the Caja is desperately in need of money, but “We are not a large enough group to save the Caja,” he said of expats here.

In addition, people are being turned away from Costa Rica by these rules, he said. He joked that pretty soon the government will be requiring tourists to enroll.

Because expats receive five to 10 foreign visitors a year, based on an association survey, Piercy said that when an expat leaves the country the impact is greater than just one or two persons.

The amount involved for foreigners is not small change. Great Sunrise said that expat spouses should expect to pay about half of what the principal insurer does.

Although some expats welcome the bargain health care provided by the Caja, others consider the fees to be just another tax because they would prefer treatment by private medical providers.

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