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General Guidelines for Health Insurance Dominican Republic

Do not compare the health insurance here in the DR, with the ones in Industrial Countries. In these Countries you pay a high price for a Health Plan that provides very expensive care. Here the Premiums are less because the Health Insurance Plans work on different principles! Because of the different working mentality in this country, you can’t expect Clinics or Superintendence, to have the same performance as in industrialized Countries experience.
Also clients with 100% Health Insurance Plans will find themselves sometimes in a disadvantaged position. A Person that has a monetary contribution may have that advantage. That is because Doctors have their own rules and cash has a motivating effect.
Nevertheless Health Plans are absolutely necessary, this ensure that the Doctors are bound to a Labor Contract. Otherwise they can charge you whatever they like.
It is important to know if a patient is not able to pay, then, the Clinic does not have to treat the patient.
Self-responsibility is a major factor in this country. The following tips should help to simplify processes and avoiding problems.

1. ) Always have your insurance card at hand, and show it before the consultation, to ensure coverage and the amount of Insurance coverage!
2. ) Only use Clinics or Doctors which are contracted by your insurance company.
3. ) In case of emergency, if you have to use another Clinic or Doctor. Be sure you get a detailed receipt of the treatment and issued in your name. Be aware that the application for a refund can take up to 6 month, and will have as foundation, the Labor Contract, not the money spent.
4. ) Every surgery has to be approved by the Insurance Company. To get the approval, they offer a special consultation in Puerto Plata with a contracted Doctor. Check the waiting periods and inform yourself about blood reserves. If possible plan your surgery and may be do a self blood donation.
5. ) All side costs like the bed of a companying person, a Minibar or similar non-illness related costs, are not included, and will not be reimbursed by the Insurance Company.
6. ) Be careful if they want to persuade you to take a suite. Check first if this is in your price range. The Clinics not only bill you for the difference of the room, they also do so for the Doctors highest labor cost. Contracted Clinics have a very good basic standard. They are clean, and most offer a TV and a refrigerator.
7. ) If you will be released on a weekend, make sure you get your bill not later than 12:00 noon on Saturday. There are Clinics that will just wait until no one is reachable in the main Insurance office, and then they will charge a higher private bill. That, if paid, will not be reimbursed by the Insurance Company.
8. ) Doctors may have different fees according to their specialties and experience. Be sure to ask the Doctor(s) if they accept the insurance of your choice. There are Doctors who do not accept the rules of the Labor Contracts. Ask for an alternative Doctor or visit another Clinic.
9. ) If you have to visit a Dentist or plan a surgery, we recommend getting fist an estimate. If you are not sure lock for a second opinion. With the estimate we figure out the cover of your insurance and if the price is real. That way false pricing can be kept at an minimum.
10. ) Be sure that you pay your premium before the 10th of the current month. The first action the Insurance Company will take is to suspend your policy. From that moment on there is no coverage. After fife more days, the policy will automatically be canceled! In the case of groups, the coverage is still in force until the end of the month, because the deposit is used to make the last payment. Insurance premiums are legally a debt to be discharged at creditor's domicile. In every case, it is necessary to contact us as Intermediary!
11. ) If problems with coverage occurred please contact us immediately. Then we can help you, and do the necessary telephone calls to the Insurance Company. The offices open at 09:00 am and close at 5:00 pm weekdays, and the weekend starts Saturday 12:00 noon! Be aware that in this country lunch hour is between 12:00 noons until 03:00 pm.

If you follow the guidelines, you will be satisfied with our service. We are looking forward to serving, using all the possibilities available in this country. Act with responsibility and communicate with us to share good and bad experience for the best of our community.