Caja Costarricense de Seguro Social – CAJA

Joining the national healthcare system in Costa Rica

During development of the new immigration legislation, the Government stated all foreign nationals would have to join CAJA when they applied for residency, ostensibly to prevent ‘perpetual tourists’ from draining the system by presenting at emergency services. Now, technically ‘all foreign residents who have applied for or obtained residency status are required to join CAJA'(1) but lawyers appear to be giving clients differing advice on when to apply, and the law seems to be being interpreted differently around the country. At present it would appear –

• Residents, with cedulas granted before the new legislation must join up
• New applicants for residency status can apply when they have been granted approval in principle by the Immigration authority
• When new applicants visit the Immigration service for their final approval interview, when their photograph will be taken and their cedula issued, they must produce evidence that they have joined and are paying for CAJA services. The current month’s payment receipt is required
• Foreign nationals who have applied only for temporary residence are neither required nor allowed to join CAJA

Enrolment:

Although there are four levels of enrolment which cover healthcare and social security / pension services, most members of the Club will qualify under one of two levels –

• As a self-employed worker, not formally employed by another party
• As a Voluntary member – a category that covers the unemployed and retired. This status provides only the healthcare component of CAJA services
• Enrolment entitles you to use healthcare services anywhere in the country i.e. Hospital and ‘Ebais’ local clinics

How to enrol in San Isidro:

1. Go to the CAJA office – the blue and white Government building, on the left corner before the small shopping mall heading down to the farmer’s market, and before the Red Cross on the right
2. Take your cedula with photocopies of both sides of the card
3. If you do not have a cedula, the letter (Resolution) from the Immigration authority stating that your application is en tramite i.e. in process and you have approval in principle; your passport and a photocopy
4. Evidence of your address and residence e.g. a utilities bill – electricity is the most common
5. You will be asked a number of questions – name, date of birth, address etc., and for information about your income status / cost of living to determine what you will pay
6. This information will be entered in the computer system, a file prepared and a print-out prepared for your signature, which constitutes a sworn statement that the information provided is correct. You will be given a copy of this statement ‘Inscripcion Asegurado Voluntaria’
7. Take it to the general Hospital Dr Fernando Escalante Pradrilla (at the side of the soccer stadium). Enter the main entrance, turn right, pass appointment windows (and usually a long queue!) on your right, a little further on the left, see two windows for affiliation
8. This office will issue an appointment card with your details on the front, confirming your entitlement to healthcare services, dated only until your current cedula expires. Remember to renew this process when you are issued with a new cedula.

How much you will pay and how to pay:

1. Monthly rates for the Voluntary programme are calculated on a variety of factors including age and number of dependents. There is a sliding scale for % payment according to income
2. Payment should be made before the 8th of the month to be issued with a receipt for the current month. You may pay at the CAJA office, through your bank or on-line. If paying on line, it is wise to print the receipt as this is the document you will need to present if accessing hospital or clinic services in an emergency.

Note: as of December 2012, the fixed monthly rate deal previously available (to retirees with no Costa Rica based income) through membership of the Association of Residents of Costa Rica (ARC www.arcr.net) has been suspended. Hence, new applicants currently have no choice but to join at their local CAJA office.

There is also conflicting advice around about the % of income being charge for CAJA membership, hence no further detail is provided at this time. In San Isidro, membership is being denied to new applicants until they can present their ‘Resolution’ of approval in principle from the Immigration authority. The resolution will include the income an applicant stated in their application for immigration. Though applicants must prove they will have the minimum sum required by law to live in Costa Rica, if they state all their income in the belief this is required, or that it will strengthen their application, this will appear on the resolution and the % CAJA payment will be calculated accordingly. Club members should seek clear legal advice on this matter if they are about to apply for immigrant approval, or are in the process of doing so.

How to use the service:

1. After enrolling you can visit your local Ebais clinic and register with the doctor there, if you wish to. Take your paperwork with you. These primary care services frequently have long queues, aim to get there early or appointments for the day may be full. This facility will be most useful to residents with pre-existing / chronic conditions who need follow-up or periodic review, but do not require a secondary level hospital service
2. Go to the General Hospital, locate the physician / specialty you require and ask for an appointment. Be prepared however for long waiting lists in the major specialties

Emergency services:

1. It is a feature of Costa Rica’s social policy that all nationals, foreign nationals and visitors should be treated in Emergency services regardless of their status. If you do not yet have a cedula, you will not be turned away; you will be treated before questions are asked but you will be expected to pay. Be aware, emergency services frequently have long queues and triage seems to be a pretty random affair.

 

Sheelagh Richards

January 2013

Ref (1) Quote from the magazine of the Association of Residents of Costa Rica