Expats win relief from Caja denial of spousal ties

The nation”s public health provider now promises that it will not discriminate against family members of foreign residents.

Expats who hold residency are required to affiliate with the provider, the Caja Costarricense de Seguro Social. Some were enraged when they found out the Caja was refusing to provide health insurance to spouses or other close family members under the same policy as the principal enrollee.

The Caja said that the spouse or other family member had to enroll individual and pay an additional fee. That extra fee was not required of Costa Ricans who were being insured under the policy of family member.

The Caja officials blamed the flap among foreigners on a misinterpretation of the regulations and said an effort would be made to find those who had been denied coverage. The Caja also said that training would be provided for workers at clinics who are the people who do most of the enrolling.

The Caja officials who issued the statement were María Eugenia Villalta, medical director, and Gustavo Picado, director of finance. Caja workers posted the new information Wednesday on the agency’s Facebook page.

The statement cited a Sala IV constitutional court case without further explanation. The case was decided this year, according to its number,  2015-0000018, and the text was not available. The files of the Poder Judicial appear to be behind due to the holidays. The case is believed to have addressed this issue.

The Caja faced a flurry of threats of constitutional court cases in which expats would claim they were entitled to the same rights as citizens.

Among the entities that were about to file appeals is the Association of Residents of Costa Rica.  Ryan Piercy, the association’s general manager, said in mid-December that an appeal was in the works. The association maintains a group policy for expats who are members.

Piercy speculated Wednesday that any expat who had paid for additional insurance probably would not get back money. That’s how the government works, he said.

However, those in the association group who were forced to pay extra will be reimbursed from association funds, he said

The amount involved for foreigners is not small change. Great Sunrise Enterprises, S.A.  said in December that expat spouses should expect to pay about half of what the principal insurer does. That firm also provides residency services for expats.

Most expat who are pensionados or rentistas sign up for insurance, and their premium is based on their estimated monthly income. Of course, permanent residents who are employed receive insurance through their workplace.

The Caja officials said that the situation of expats was considered by the board of directors in October.

They said that to receive coverage an individual must have some form of provable relationship with the principal insurer and not have a personal income.

The person to be covered needs to have lived with the insured for at least three years, the Caja said.

In its statement, the Caja reaffirmed the fact that the Costa Rican Constitution says that foreigners have the same duties and rights as Costa Ricans with the exception of limitations established by the Constitution or laws.caja011515

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