What is Seguro Popular?

What is Seguro Popular?

It is a National Health program that began in 2001 and aims to ensure the low-income population that do not have a public or private health policy. Regardless of whether or not they carry out a productive activity, whether they are salaried or self-employed.

The government policy allows people to join voluntarily and covering low or even zero fees, depending on the economic solvency of each holder, to reduce the possibilities of impoverishment of Mexican families due to diseases, it also helps to promote timely health care.

The Seguro Popular is a federal subsidy from fiscal resources from the Federal Expenditure Budget and from the contributions of the insured, which are determined according to the income level of each family, through a socioeconomic study. It currently operates in the entities of Jalisco, Oaxaca, Querétaro, Veracruz, Chihuahua, Baja California, Mexico City, Nuevo León, Morelos, Guanajuato, Chiapas, Hidalgo, Michoacán, Tlaxcala, Guerrero, Aguascalientes, Puebla, Sinaloa, Quintana Roo, Nayarit , Sonora, State of Mexico, Yucatán, Tabasco, Tamaulipas, Durango, Baja California Sur and Coahuila,

It is also a solution to the problem of lack of access to health for a large part of the Mexican population, and is that according to the Mexican Association of Insurance Institutions (AMIS) in 2019, 14.6 percent of Mexicans do not It has public or private health coverage, which increases the financial risk for families by paying sudden medical expenses with money from their own pockets, causing debt, loss of assets and impoverishment.

The institution’s statistics reveal that each year at least 560 thousand families suffer an economic loss when facing the costs of some diseaseIn addition to the fact that per year the out-of-pocket expenditure in terms of family health is an average of 1,973 pesos per year, which is why it is important to have a public or private health policy.

What diseases does Seguro Popular cover?

The members of the families affiliated with the popular insurance have access to services to attend to the basic health and emergency conditions, therefore the policy considers ambulatory medicine, pregnancy, childbirth and newborn, dentistry, rehabilitation, emergencies, hospitalization and surgical services, as well such as laboratory tests and medications. In addition, it provides universal care for the following conditions:

1. Acute lymphoblastic leukemia in children and young people under 18 years of age.
2. Cervical Uterine Cancer.
3. Antiretroviral treatment of patients with HIV / AIDS.
4. Neonatal intensive care, such as newborn respiratory distress syndrome, prematurity, and newborn bacterial sepsis.
5. Cataracts in older adults.

In total, it covers 266 medical interventions, including:

• Screenings for HIV / AIDS, colon cancer, and breast cancer and cancer.
• HIV / AIDS, colon cancer and prostate cancer screenings.
• Diagnosis and treatment of iron deficiency anemia and vitamin B12 deficiency.
• Rubella diagnosis and treatment.
• Diagnosis and treatment of measles.
• Chickenpox diagnosis and treatment.
• Diagnosis and treatment of the common cold.
• Diagnosis and treatment of classic dengue.
• Diagnosis and treatment of hepatitis A.
• Diagnosis and treatment of fibrocystic mastopathy.
• Diagnosis and treatment of asthma in children.
• Rheumatoid Arthritis Diagnosis and Treatment.
• Diagnosis and treatment of congenital hip dislocation.
• Third molar extraction.
• Stabilization in the emergency room due to hypertensive crisis.
• Hospital management of second degree burns.
• Surgical treatment of hiatal hernia.
• Leg or foot amputation due to diabetes problems.

It is worth mentioning that it also has 307 medications associated with these conditions.

What requirements are needed to enroll in Seguro Popular?

• Reside in the entities where coverage is given and not be affiliated with the IMSS or ISSSTE.
• Join voluntarily.
• Go to the Attention and Orientation Modules (MAO) of Seguro Popular, which are located in the clinics of this program.
• The registration form provided in the MAOs must be filled out.

In addition to the following documents:

• CURP of the owner or head of the family, also that of the wife and their children under 18 years of age.
• Birth certificate of the holder’s parents who are over 64 and who live in the same house as the insured.

What other health insurance options exist in Mexico?

There are two additional ways to the Seguro Popular to ensure health in Mexico, the first is through public institutions that offer free medical policies and economic fees, such as the Mexican Institute of Social Security (IMSS) or the Institute of Social Security and Social Services for State Workers (ISSSTE).

In order to join the IMSS and obtain a medical policy there are two modalities:

• Compulsory Regime: when a person works in the private sector and by having a subordinate and paid employment relationship with an employer, they obtain the right to be insured by this institution. And the coverages offered are risks of work, Illness and Maternity, Disability and Life, Retirement, Unemployment in Old Age and Old Age, and Nurseries and Social Benefits.
• Voluntary Regime: through the Institute program known as Family Health Insurance (SSFAM), people who are head of the family and workers in family industries, who independently work as professionals, such as small merchants, and other salaried workers can Obtain this policy with the payment of an annual fee, which is established according to the age of the insured. This insurance has coverage for sickness and maternity.

At ISSSTE To be entitled to the benefits of your policy, you must be a direct worker, a pensioner, a former worker with conservation of rights or voluntary continuation of a government institution, as stipulated in the ISSSTE law in art. 41. In addition to the fact that the beneficiaries can be the spouse, common-law partner, children under 18 or under 26 (if they are students) and parents, grandparents or great-grandparents of the holder. The services to which you have access through the insurance of the Institute of State Workers are: medical, surgical, pharmaceutical, hospital and maternity assistance.

The second way to obtain a medical policy is through medical insurance companies, which are private institutions that offer different policies, such as:

• Major medical expenses: It is about hospital coverage, serious illnesses and surgical emergencies. They cover a wide range of conditions but some pre-existing and degenerative diseases have restrictions.
• Personal accidents: It pays for medical expenses derived solely from an accident such as medical, specialist, nursing, analysis, hospital stay and medication fees.
• Minor Medical Expenses: It protects medical assistance for the prevention of diseases and treatment of conditions considered within the basic clinical picture of health. Such as colds, dental extractions, ophthalmological examinations, among others.

It is worth mentioning that insurers have agreements with networks of private hospitals of different levels where the beneficiary is treated.

On the other hand, to contract health insurance, those interested must meet certain requirements such as solving a Health Questionnaire and meet a certain age range, which will depend on each company.

How to find health insurance?

In Mexico there are about 101 insurance companies and in the health sector the main companies are Metlife, Monterrey New York Life, GNP, Mapfre, Allianz, Seguros Banorte and Seguros Bx +, among others. But although the offer of medical policies is very wide and varied, in the country only 8.8 percent of Mexicans have private health insurance or major medical expenses to help them face the economic consequences of an accident or illness. according to AMIS statistics.

This is due to several factors such as the low economic resources of a large part of the Mexican population, lack of information and a low culture of risk prevention. However, nowadays accessing a medical policy is easier and cheaper with the help of information technologies such as online comparators, since in a single site coverage and prices of more than three companies are contrasted, in addition to being they know the cheapest premiums and the service is free.