What is major medical insurance and how does it work?

What is major medical insurance and how does it work?


Before purchasing insurance, it is important to understand what your needs are in order to choose the plan that covers them.


4 min read

This article was translated from our Spanish edition using AI technologies. Errors may exist due to this process.


What is major medical insurance and how does it work?

If we have learned something from COVID-19 , it is that an unforeseen event can change our lives completely and it is important to be as prepared as possible. With the global health emergency that we have experienced, we can see that we are all at risk of needing medical attention at any time. That is why it is important to have health insurance.

Insurance is a financial protection plan through which people protect themselves from unexpected risks. There are different types, including major medical expenses. This covers the expenses generated by the medical attention that is necessary due to an accident or illness.

How does health insurance work?

When insurance is contracted, the client pays an amount within a period of time of his choice to an insurer. Thus, when there is an unforeseen event, you will not have to pay with your own money. Thanks to the investment you have made, the company covers it.

What is included will depend on the plan you hire , it is important to ask yourself what your needs are and choose the plan that best suits you. The basic coverages are those that any insurance usually covers without the need to pay extra, such as preventive medicine, consultations with first contact doctors (general, pediatrics and gynecology), consultations with specialty doctors and laboratory, office and imaging tests.

How to get one?

  1. If you are employed, first check what type of insurance your contract offers you and decide if you need to take out a separate one.

  2. Find out which insurer you want to go to. For more information on the options, read the BEF analysis here.

  3. Make an appointment and talk to an agent about the different offers they have: how much does it cost, what does it include, how are they paid, etc.

  4. When the plan and the quotation have already been decided, a file of the applicant will be made with the following documents:

  • Request for the plan to be contracted
  • Copy of valid official identification
  • Proof of address
  • RFC copy

In Mexico there are 32 companies where you can buy insurance for major medical expenses. There are nine that account for 90% of the market, among which are GNP, AXA, Metlife and Seguros Monterrey New York Life. In addition to researching the insurer, there are several terms that you should understand before signing a contract, you can find out about them here.

You should take into account the type of insurance you want, either with or without a copayment or reimbursement insurance. Ask about the medical chart, it informs you about the services and centers that the insurer covers you. Remember that to prevent people from taking out insurance for a specific treatment and then stop paying for it, insurers set a grace period, which is a period for which you cannot use your insurance from the moment you contract it. Check what is the gap in your insurance before hiring it. Also take into account coverage for previous illnesses and age limits as these can be important in your decision making.

Like all bureaucratic processes, it can be tedious. For this reason, you have to be as prepared and informed as possible, but if you know what you want and the steps to follow, it shouldn’t be a complicated process.



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