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Ecuador Now Requires Health Insurance at Visa Application: What Changed

Ecuador moved the health insurance requirement from the cedula stage to the visa application itself. Here is what is accepted, costs, and when to buy.

immigration health-insurance ecuador

The requirement moved up - and it matters.

If you applied for an Ecuador residency visa a few years ago, you may remember that health insurance was something you dealt with after your visa was approved - specifically at the cedula (national ID) stage. That is no longer the case.

Under reforms to the Ley Organica de Movilidad Humana, Ecuador now requires proof of health insurance at the time you submit your visa application. This applies to all temporary residency visa categories - retirement, investment, professional, digital nomad, and others. The change was formalized through amendments published in the Registro Oficial in 2024, and immigration offices nationwide are enforcing it.

Previously, the sequence looked like this: apply for visa, receive approval, then obtain health insurance before requesting your cedula. Now, you need a valid health insurance policy before you even file the application.

We have seen applicants turned away at the Ministry of Foreign Affairs for missing this document. Do not assume the old process still applies.

What Insurance Is Accepted

Ecuador accepts three categories of health insurance for visa purposes:

1. Private Ecuadorian Health Insurance

This is the most straightforward option for new applicants. Ecuador's insurance regulator (the Intendencia Nacional de Seguros) maintains an approved list of domestic insurers. Major accepted companies include:

  • Saludsa (Salud S.A.) - Latin America's largest health insurer, widely used by expats
  • Ecuasanitas - One of Ecuador's largest HMO-style providers
  • BMI - Popular among the expat community for English-language support
  • Panamericana de Seguros, Latina Seguros, and others on the approved list

Your policy must provide coverage in Ecuador for the full duration of the visa you are requesting. Travel insurance or short-term tourist policies will not satisfy the requirement.

2. IESS (Public Social Security)

Ecuador's public health system, the Instituto Ecuatoriano de Seguridad Social (IESS), provides comprehensive coverage with no pre-existing condition exclusions (after a 3-month waiting period). However, there is a catch for new visa applicants: you need a cedula to enroll in IESS, and you do not have a cedula until after your visa is approved and registered.

This means IESS is not an option for your initial visa application. It becomes available for renewals and for your cedula maintenance going forward. Many expats eventually switch to IESS or carry both IESS and private insurance simultaneously.

3. International Insurance with Ecuador Coverage

Some applicants hold international health insurance policies (from providers like Cigna Global, Allianz Care, or Pacific Prime) that include Ecuador in their coverage area. These may be accepted, but you should confirm in advance that:

  • The policy explicitly lists Ecuador as a covered country
  • Coverage duration matches or exceeds your visa term
  • You can produce a certificate in Spanish or with an apostilled translation

We recommend verifying acceptance with the specific immigration office where you will file, as interpretation can vary between offices.

Cost Ranges

Health insurance in Ecuador remains significantly cheaper than in the United States or Canada. Here are current typical ranges:

Private Ecuadorian Insurance

  • Basic plans: $50-$150/month depending on age, deductible, and coverage level
  • Mid-range plans: $150-$300/month - this is where most expats land. A mid-tier Saludsa policy for someone in their early 60s runs approximately $125-$175/month (Expats Ecuador)
  • Comprehensive/low-deductible plans: $300+/month

Age is the primary cost driver. A 45-year-old will pay substantially less than a 70-year-old for identical coverage. Pre-existing conditions may affect eligibility or pricing with private insurers.

IESS (Once You Have Your Cedula)

  • Individual: Approximately $83-$90/month at minimum declared income (EcuaAssist)
  • Add a spouse: Additional 3.41% of declared income (roughly $15-$20/month at minimum)
  • Premiums are calculated at 17.6% of your declared monthly income, with the minimum wage as the floor

IESS covers everything - doctor visits, hospitalization, surgery, medications, lab work - with no copays and no deductible. Pre-existing conditions are covered after a 3-month waiting period. For many retirees, the combination of IESS plus a supplemental private policy provides the most complete protection.

Timing: When to Buy Insurance

This is where planning matters. Here is the sequence we recommend:

  1. 8-12 weeks before your target application date: Begin gathering your other documents (apostilled background check, income verification, translations). Start researching insurance options.

  2. 4-6 weeks before application: Purchase your private Ecuadorian health insurance policy. You need the policy to be active and to have the certificate in hand before filing. Some insurers take 1-2 weeks to issue documentation after purchase.

  3. Application day: Submit your visa application with proof of active health insurance included in your document package.

  4. After visa approval and cedula issuance: You now have the option to enroll in IESS. Many clients maintain their private policy through the first year and then transition to IESS, keep both, or stay private - depending on their healthcare preferences.

Do not wait until the last minute to secure insurance. If your policy has a gap or the documentation is incomplete, the Ministry will reject your application and you will need to refile.

Exceptions and Edge Cases

  • Dependent visa applicants (spouses and children) must each have their own proof of insurance or be listed as covered dependents on the primary applicant's policy.
  • Visa renewals still require proof of active insurance. If you transitioned to IESS after your initial visa, your IESS affiliation certificate will satisfy the requirement.
  • Some immigration offices have historically been more flexible than others in how they interpret documentation requirements. The Quito office, for example, has at times been more lenient than regional offices like Azogues (Expats Ecuador). Do not rely on this - prepare your documentation to the strictest standard.

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Need help choosing the right health insurance for your visa application? Schedule a consultation or call 651-621-3652.