Caja Insurance Cost For Dependents

[costaricabill]

My wife and I just completed renewing our Temporary Residency (pensionado) for the first time, and for the very first time in my attempt to deal with anything relating to securing a government approval or license or whatever, it actually went pretty smooth and we got it all done in one day.

Now comes the problem, or question – –

At our recent FIRST FRIDAY event in Samara I was explaining to others how smoothly it went – all we had to do was collect and make copies of the documents on the list, get an updated Social Security Benefits Letter (5 minutes on line, amazing!) , get a letter from BNCR recapping all of our monetary exchanges (had all of my cambio receipts plus a list of my online payments that were paid in colones (like utility bills)), etc., and then make sure the CAJA payments for BOTH my wife and I were up to date.

[b]That is where the question came up.[/b] I had 5 or 6 fellow pensionados tell me that I should only be paying ONE Caja payment because my wife was approved for residency as my dependent, and dependents do not have to pay. I asked a lot of questions and they all are paying only for the “qualifying” pensionado and the “dependent spouse” pays nothing, zero, zilch, nada.

So I have been trying to find out if I have been paying double, and if so, how do I get it corrected – for the future, because I know there is absolutely no chance of getting what I have paid for her monthly coverage refunded or credited.

To that end, I googled [b]“CAJA insurance for dependents”[/b] and found the following explanations on various websites: (please note, I have [b]bolded[/b] certain parts of the articles for emphasis)

[b]Costa Rica Mandatory Registration with Social Security For Residency[/b]
on [b]www.costaricalaw.com[/b] states

“…..applying for residency under the Pensionado (Retirement) or Rentista (Income Based) Immigration categories you will generally have to apply under the “Self Insured” (Asegurado Voluntario) guidelines of the social security insurance. The self insured program is a classification for individuals and their dependents that legally reside in Costa Rica but do not generate income from local Costa Rica sources……The final approval of your social security insurance application must be done at any of the regional offices of the CCSS. The approval generally requires a personal interview with a social security administration officer who will evaluate your information, income, age and then set the percentage that you must pay according to the sliding scale indicated above. The primary applicant will be the person that was the primary applicant on the immigration application. [b]Their spouse will be included as a dependent on the health insurance portion as well”.[/b]

And, a [b]TicoTimes[/b] article:

[b]Caja Registration Required for Residents
BY HENRY LANG APRIL 23, 2010[/b]
“As readers may know, a new immigration law has been in force in Costa Rica since March 1. This new law has created significant changes in several residency categories and procedures, to which the immigration authorities, in many cases, are still adjusting.
The one new requirement that imminently and substantially affects all residents in the country is that every person applying for or renewing their residency must be covered by the Costa Rican Social Security (Caja) medical insurance system. This requirement is obligatory and enforced even for persons with private, non-Caja local or international medical insurance coverage.
…….In general terms, if you are not a local employee, you would need to apply either as a trabajador independiente (independent worker) or as [b]anasegurado voluntario (voluntarily insured worker)[/b].
Independent worker status applies to individuals who are self-employed and declare income in the country. [b]The voluntary worker classification is used for anyone who lives in Costa Rica and does not generate and declare income locally.[/b]
In either of these cases, you need to meet with a Caja inspector who will determine your employment status and income in order to set a monthly fee. The meeting will take place at the Caja office with jurisdiction over the address indicated on your electric bill, which you must have with you for the meeting. The electric bill does not need to bear the applicant’s name; its sole purpose in this case is identifying the applicant’s place of domicile. No other type of bill is accepted.
[b]…….The monthly insurance payment for voluntarily insured workers is usually set according to the amount indicated to the inspector during the interview as an applicant’s average monthly expenses, or on the funds the applicant has available for living costs.
The dependents (minor children and spouse) of the applicant can be included in their Caja insurance coverage at no additional cost.”[/b]

And on the
[b]Garrett Insurance Group Home Page:
“The cost of Caja coverage is either a percentage of an employee’s wage or, in the case of non wage-earners, it is a fixed amount, regardless of the number of dependents…….”[/b]

So now, as our CAJA cards expire next month and we have to go renew them (presumably by meeting with a Caja inspector who will determine your employment status and income in order to set a monthly fee”) my question becomes “IF” I want to raise this issue what is the best way to do it? DO I take a “representative” with me to argue my case. To be honest, right now the 2 payments we make add up to what the “sliding scale” for CAJA payments indicate my payment alone should be (about 7.25% of my pension. (see http://www.costaricalaw.com/Immigration-and-Residency/costa-rica-mandatory-registration-with-social-security-for-residency.html for the scale)

But if we go to the meeting and our rate goes up a significant amount, then that would exceed the “statutory rate” detailed in the scale, so I feel that I have a right to ask for relief, or a re-calculation.

Any suggestions, ideas or similar experience??

[jreeves]

All I can tell you is that we’re a family of 6, all permanent residents. We didn’t have to sign up for CAJA while were we temporary residents as it wasn’t a requirement for our residency back then. We’ve been members of CAJA for going on 2-1/2 years and we make one payment to CAJA that covers all 6 of us. Husband is the primary, we’re all his dependents. We’re under age 55 so our premium includes payment into a pension for husband.

I really don’t know what I’d do in your situation. Any chance you can bring a Tico friend in with you ahead of time to just feel out the situation for you?

Something that disturbs me about the CAJA requirement for residents is this total uncertainty over what your premium will be. People can talk until they are blue in the face about how it is X% of the pension because that is what the regulations say, but I know a lot of residents & no one seems to pay any type of consistent % of income, pension, whatever. It’s all over the place.

Jessica

[costaricafinca]

Yes, since your wife is your dependent, you should only be paying a single premium. [b]If[/b][i][/i] she had applied with her own pension, she would not be covered under your premium.
And I totally agree with the above poster, [b]jreeves[/b], that the CAJA/CCSS does not treat applicants equably…and it really seems to be decided by a [i]flip of a coin.[/i]
I read today Oct 6th. on a ‘letter to the editor’ on [url=http://www.amcostarica.com/morenews.htm]AMCOSTARICA pg 2.[/url] [b]”The time has come for Solís to act”[/b] where the author stated, [b]”…and all pensioners are exempted to pay for their medicare”.[/b][i][/i] [b]So if this is true,[/b] where does the [i]Pensionado[/i] come into this? I know that if one applies for citizenship you can opt out of CAJA… but why would you, if you are are no longer obligated to pay the mandatory premium and be provided coverage?

[Author]

Posts