Health Insurance in Colombia

Information on the Health Insurance system in Colombia, the benefits provided and how to enroll with a health insurance provider (EPS)...

All residents in Colombia must be registered with a health service provider, or Empresas Prestadoras de Salud (EPS), or with a subsided health insurance provider (Administradoras del regimen subsidiadoARS).

The different EPS providers operate in a similar way to an insurance company and are in charge of ensuring the provision of all health services included in the Compulsory Health plan (Plan Obligatorio de Salud) and also for enrolment, collection of payments and registration with the health system. Each EPS contracts the services of health providers (Instituciones Prestadoras de Servicios de Salud – IPS) such as clinics, hospitals and laboratories providing medical services to those affiliated to the system, and works with a specific group of health providers.

Self-employed people can choose the EPS that they want to subscribe to. Employed people are generally registered with the EPS that their employer is affiliated to; however, there are exceptions and an employer can request to be affiliated with another EPS if they prefer to do so.

Eligibility

  • Contributory scheme: Covers all employees or registered self-employed people. Payment is calculated as a percentage of the person’s income. The system also covers dependents (spouses, children)
  • Subsidised Scheme: Covers anyone approved by SISBEN (Sistema de Identificación de Potenciales beneficiarios de Programas Sociales), a system used to identify families on low income for social welfare benefits. This applies only to Colombian citizens

Family members and dependents can be added to the main EPS insurance contract. These include:

  • A spouse or permanent partner, as long as they can prove the union has existed for at least two years
  • Children under 18 years old
  • Children between 18 and 25 years old, if they are financially dependent on the insured
  • Parents (not affiliated pensioners)
  • Children of any age with permanent disabilities