What is the deductible in a major medical insurance policy in Mexico?

Patient reviewing the medical cost of their treatment and how the deductible from their major medical insurance applies.

The deductible in a major medical insurance policy in Mexico is a key element. It is the fixed amount that the insured must pay out of pocket before the insurance company begins to cover the medical expenses covered by the policy.

In other words, if the expenses resulting from an illness or accident do not exceed the deductible, the insurer pays nothing. The insurer only begins to cover its share once the total amount of expenses exceeds the deductible.

How does it work?

• If your deductible is $15,000 MXN and the medical expenses due to an accident total $60,000 MXN, you pay the first $15,000 MXN, and the insurer covers the rest (minus the coinsurance).

• If the expenses are less than the deductible (for example, $10,000 MXN), you pay the full amount yourself.

Types of deductibles

• Per event: Applies once for each covered condition. This is the most common type of deductible.

• Annual: Applies once per policy period. This means that all medical expenses you incur during the year for covered conditions or accidents add up toward meeting this annual deductible. BUPA is an insurer that offers this type of deductible.

• Zero deductible: You can purchase additional coverage that waives the deductible in case of an accident.

Practical example

Luis, 35, suffered a leg fracture. His medical expenses amounted to $85,000 MXN.

His policy has a $20,000 MXN deductible and 10% coinsurance (with a cap of $25,000 MXN).

He paid the first $20,000 MXN (deductible), then 10% of the remaining $65,000 MXN ($6,500 MXN).

The insurer paid $58,500 MXN.

Without insurance, Luis would have had to pay the full amount.

Recommendations

• Evaluate your payment capacity: A high deductible reduces the premium but means higher out-of-pocket expenses in case of a claim. In contrast, a low deductible reduces the out-of-pocket cost when using the insurance but increases the premium.

• Verify whether the deductible applies per illness/accident or per year, as this directly affects how the insurance is used.

  
  

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