What does the sum insured mean in a major medical insurance policy in Mexico?

Woman reviewing information about the sum insured of her major medical insurance at a clinic.

The sum insured is the maximum amount of money an insurance company will pay for covered medical expenses during the policy period (usually one year).

This limit can apply per illness or accident, or per policy year, depending on the insurer and the product. Having an adequate sum insured in a major medical expenses insurance policy in Mexico is essential to avoid having to cover a significant portion of medical expenses yourself in the event of a serious illness.

Types of Sum Insured in a Major Medical Policy in Mexico

• Per event sum insured: Applies the contracted sum insured for each illness or accident covered by the policy.

• Per policy year sum insured: Applies the contracted sum insured for all covered illnesses and accidents during each annual period. It is reinstated when the policy is renewed.

The most common option is the per event sum insured, which typically ranges from MX$1 million to unlimited amounts.

Practical Example

Ana, 48, was diagnosed with cancer and required multiple hospital treatments throughout the year.

Her total medical expenses reached $3.5 million MXN.

Her policy had a sum insured of $4 million MXN, so the insurer covered everything except the deductible and coinsurance.

If her sum insured had been only $2 million MXN, she would have had to pay $1.5 million MXN out of pocket.

Recommendations

• Assess the cost of common medical treatments in Mexico to determine whether you need a medium or high sum insured.

• If you have a family history of serious illnesses, consider a higher or even unlimited sum insured.

• Don’t confuse the sum insured with the actual amount the insurance company will reimburse or cover: the deductible, coinsurance, medical fee schedule, and sum insured sublimits still apply.

• Carefully check if there are sublimits by illness or type of treatment.

At Sáas, we have a team of consultants who can guide you through the process of contracting and using your policy.