USA/Canada vs. Mexican Insurance Market
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- Marsha Alexander
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1 USA/Canada vs. Mexican Insurance Market Differences in Products, Policies, Claims & Legal Aspects MGI Agente de Seguros, S.A. de C.V. C License Class September,
2 CONTENTS 1. General Statistics 2. Mexican Insurance Market 3. Legal codes 4. Non admitted Insurance in Mexico 5. Mandatory Insurance in Mexico 6. Health Insurance in Mexico 2
3 1. General Statistics USA MEXICO CANADA - Insurance Companies 3, Insurance Agents 325,000 31,970 6,250 In Mexico 6,600 agents have a temporary insurance license. Only 25,370 have a permanent license Sources: Insurance Information Institute, Candafaq, AMIS 3
4 2. Mexican Insurance Market - MAJOR AUTHORITY: Secretaria de Hacienda Comision Nacional de Seguros y Fianzas (CNSF) - AMIS: Mexican Insurance Companies Association - All insurance companies are regulated on a Federal (not state) Basis - Margin of Solvency regulated by Secretaria de Hacienda. - CONDUSEF: Financial Services Protection Bureau. - Total Insurance Companies registered in Mexico: 84 Health Insurance Companies: 31 4
5 2. Mexican Insurance Market - Major Worldwide Insurance Groups with representation in Mexico: PAN AMERICAN, BUPA, AXA, AIG, CHUBB/ACE, MAPFRE, METLIFE, RSA, QBE, TOKIO MARINE and ZURICH among others. 5
6 2. Mexican Insurance Market - Insurance Agents in Mexico: 31,970 Type A B C Insurance Lines Life, Auto and Homeowners, Individual Health.and Commercial Lines up to US$50 millions value.. and any Big Risk & Reinsurance Negotiations. Only 84 Brokers in Mexico with C class. Agents must renew their license every 3 years. Agents must carry their E&O Policy. Agents average age in Mexico: 51 years. 6
7 3. LEGAL CODE MEXICO Napoleonic Code - Guilty until proven innocent Mexico adjusters go to the scene of the accident Detained if there is no resolution Your adjuster will post the bail bond. If legal action is needed a lawyer is included and hired by the insurance company. Always inform insurance company of a claim before you leave the country Perito Person in charge of investigating the scene of the accident Insure the vehicle not the driver USA Common Law - British Code: Innocent until proven guilty Insures the driver and the vehicle CANADA Common Law - British Code: Innocent until proven guilty Insurance regulations per province Insures the driver and the vehicle 7
8 3. LEGAL CODE Based on the Mexican Civil Code: - Any person in the Mexican Territory has the right to be indemnified for any injury to his person and /or damage to their property. - Any person that has made damages to another person is obligated to indemnify him. First party: Insured person or company Second Party: People with contractual obligation or part of the family. Third Party: Anybody else 8
9 4. Non Admitted Insurance in Mexico Article 3 of the Mexican General Insurance Law Ley General de Seguro - Any foreigner that seeks Insurance Coverage for risks in the Mexican Territory is bound to comply with the Mexican laws and regulations. - This article prohibits insurance transactions for risks in Mexico with foreign (non-admitted) Insurance Companies. THERE ARE EXCEPTIONS TO THIS LAW IF THE PRODUCT IS NOT AVILABLE IN MEXICO - Penalties for violations: The Article 141 of the General Insurance Law, under fraction II, establishes the penalties and fines for violations of Article 3: For Sellers and Buyers: Imprisonment for a term from 3 to 10 years: and A fine between 200 and 2,000 Daily Salaries in Mexico City Daily Salary in Mexico City: $73.04 pesos 9
10 5. Mandatory Insurance in Mexico Some of the most common are: Auto Liability: Jalisco, Nuevo Leon, Mexico City. Aircraft Liability: To land in any Mexican airport. Boat Liability: In Mexican waters Passenger Transportation: Auto, Bus, Boat, Airplanes. Hazardous Materials Transportation Liability. Pollution Liability Workers Compensation: IMSS There are no clear penalties in some of them by the authorities 10
11 Health Insurance in Mexico 11
12 6. Health Insurance in Mexico GOVERNMENT ISSSTE: Government employees - Federal and by State Own Hospital Network and Doctors MILITARY: Mexican Military Forces Federal - Own Hospital Network and Doctors SEGURO POPULAR: Lowest income people Public General Hospitals and Clinics - Any person in Mexico with proof of income is accepted for free. IMSS SEGURO SOCIAL: Workers, self employed and Residents of Mexico - Own Hospital Network and Doctors - No age limit - Preexisting restrictions - Medical exam mandatory - Need proof or residence 30 Day waiting period 12
13 6. Health Insurance in Mexico PRIVATE : INSURANCE COMPANIES: - HMO & PPO - Medical services of participating private hospitals and clinics and physicians - Nationwide Coverage & Worldwide Coverage - Major Medical Insurance 31 Underwriters - Minor Medical Insurance 7 Companies: Mexico-Monterrey-Guadalajara 13
14 6. Health Insurance in Mexico 14
15 6. Health Insurance in Mexico Applications : Must be signed in Spanish. Some insurance brokers create their own courtesy translation for a better understanding when applicants fill it out Age of acceptance: major 64, some 75 Deductibles: Applies per illness or event. Only 3 companies (World-Class) have it per year Sum Insured: Applies per illness or event. Only 3 companies (World-Class) have it per year Coinsurance: Normally is 10% with maximum of US$2,500. Only 3 companies (World- Class) don t have coinsurance Preexisting Conditions: All companies request your medical history when you declare preexisting conditions, and evaluation will result in 5 options: 1) apply an extra deductible, 2) coverage restrictions, 3) deny coverage for such preexisting condition, 4) deny offer of coverage for the applicant, 5) accept the applicant at no restriction at all Continuity of Insurance: Most only accept Mexican Insurance Companies A few like Pan American Mexico, Bupa and WEA accept policies from other countries 15
16 6. Health Insurance in Mexico Age limit of coverage: Insurance companies don t cancel the policy when the client turns a certain age Hospital Levels: All companies offer different levels that impact the premium. Only 3 companies offer full nationwide coverage at a standard price. Waiting Periods: Varies between companies. They go from 1 to 4 years. Only Pan American Mexico and Bupa have a 60 day waiting period, 10 months for maternity and 2 years for AIDS. Coverage Abroad: Most companies offer a limited coverage via reimbursement. Pan American Mexico and Bupa offer a Worldwide Coverage on a normal basis. Medical Services: Currently some offer a combination of Major and Minor medical coverage and Services. Dental & Vision: Only when is medically necessary due to an accident, illness, or sudden unexpected pain. Denied: Combination of heart problems, high blood pressure with diabetes, brain diseases, HIV/AIDS. Some companies deny coverage if a client had cancer in the last 5 or 10 years. 16
17 6. Health Insurance in Mexico WORLD-CLASS INSURANCE COMPANIES SPECIALIZED IN HEALTH INSURANCE: - Pan American Mexico & Bupa Benefits: - Multilingual assistance 24/7 - Coverage throughout the world, including full coverage in the U.S., Canada & Europe - From 30 to 60% lower costs than similar policies in the U.S., Canada & Europe - Zero deductible for accidents regardless of the deductible contracted - Only one deductible per person per year, of two per family group regardless of the number of people on a policy - Special premiums for children under the age of 24 - Direct payment benefit throughout the world - If the client pays out of pocket, the reimbursement is made within the firs 7 business days after all documentation is provided - The lowest waiting periods in Mexico: 60 days for all illnesses and 2 years for HIV/AIDS - Up to 2 years of free coverage to all dependents should the holder die 17
18 6. Health Insurance in Mexico OUR HEALTH INSURANCE BUSINESS PARTNERS 18
19 6. Health Insurance in Mexico MINOR MEDICAL INSURANCE -GASTOS MEDICOS MENORES Mainly Employees using a Payroll Deduction Discount and medical services with participating Hospitals, Clinics, Labs and Doctors No age limit No prescriptions 7 Companies offer this product mainly in the cities of Mexico, Monterrey and Guadalajara 19
20 THANK YOU MGI Agente de Seguros, S.A. de C.V. USA/Canada: Mexico: (984) / info@novamar.net - San Diego - Seattle - Sarasota - Puerto Vallarta - Cancun 20
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