On a recent Monday, I was scheduled for a 9:00AM appointment at the CAISES clinic on Calle Arcoiris in Fraccionamiento La Lejona, the one with the bright blue gates behind La Comer supermarket. (CAISES stands for Centro de Atención Integral en Servicios Esenciales de Salud, or Comprehensive Care Center in Essential Health Services).
We don’t live on that side of town any more, but it’s the last place I was seen by a doctor, and that was before Seguro Popular ended and the new public health program, INSABI, began on January 1, 2020. INSABI stands for Instituto de Salud para el Bienestar (Institute for Health & Well-Being).
Want to join IMSS instead? Here’s the info: https://www.mexperience.com/how-to-access-the-mexican-healthcare-system-imss/.
I wasn’t sure if I could still get medical care as an extranjero (foreigner), so I stopped there Saturday to ask. The receptionist at CAISES told me that yes, I would be eligible to receive free health care even though I’m an expat, and that I should see a doctor at this clinic one last time, and they will give me a referral to a clinic near our new address.
She said I should bring four documents to my appointment:
- my CURP (she meant a print-out of the certificate from this website, https://www.gob.mx/curp/, where you can get a CURP assigned if you don’t have one);
- a comprobante de domicilio (proof of residence, also called comprobante de casa, such as a lease or an invoice from CFE, Sapasma, or Telmex, even if it’s in a landlord’s name);
- a Carta de No Afiliación al IMMS (letter showing I’m not already insured by Instituto Mexicano del Seguro Social, or IMSS); and
- a Carta de No Afiliación al ISSTE (letter showing I’m not already insured by Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, or lSSTE).
I tried to generate the letters on Saturday and Sunday at the websites provided: for IMSS, https://serviciosdigitales.imss.gob.mx/gestionAsegurados-web-externo/vigencia, and for ISSTE, http://oficinavirtual.isste.gob.mx/Servicios/Acreditación-de-No-Afiliación.
Even after I double-checked the accuracy of my CURP, my NSS (Mexican social security number, available here if you don’t have one: https://www.gob.mx/tramites/ficha/asignacion-o-localizacion-del-numero-de-seguridad-social/IMSS164), and my email address, the forms to request the Carta de No Afiliación didn’t work. I figured that was because it was a weekend; strange but true: some Mexican websites don’t work outside of weekday business hours. So I tried again at 8:00AM on Monday and it still didn’t work.
The receptionist had told me on Saturday that if I couldn’t get the letters online or if I didn’t have a printer at home, I would have to visit the offices of both IMSS and ISSTE to get them printed out. But I wouldn’t have had time to do that before a 9:00AM Monday appointment at the clinic, so I decided to show up at CAISES anyway and see if they would at least give me a long-overdue physical exam, if not a referral to a clinic near my home.
For more information about public health care in Mexico, visit https://www.movehub.com/us/international-moving/mexico/healthcare-for-expats/.
When I arrived at CAISES, there were lines half a block long at both doorways, people sitting on the steps (some unmasked, none socially distanced), and more people waiting in cars. There was no place to park within two blocks.
I considered parking a few blocks away and walking over to see if my appointment time would be honored, but I didn’t want to mingle with such a dense crowd in a country where less than 23% of the population has been vaccinated to date. So I decided to skip the appointment and use the time to visit the offices of ISSTE and IMSS.
The IMSS clinic is at Calzada de La Aurora s/n (sin número, unnumbered), Colonia Aurora—just toward the Libramiento from the entrance to the Fábrica la Aurora art gallery complex. But the administrative office where you go to apply for membership isn’t at the clinic, or at least it wasn’t back then; it was a couple of blocks back into the neighborhood, and the only way I found that out was by asking at the clinic after waiting in line. If you’ve been there lately, please let me know in the comments and I’ll update this article. Better yet, send me a photo.
Anyway, I hadn’t had breakfast and wanted to get home and eat something. But in Mexico, or at least in San Miguel de Allende, there is no such thing as a quick errand. So I decided to stop only at ISSTE because it was on the way home, whereas a visit to IMSS would have taken me toward downtown.
By 9:30AM I had arrived at the office of ISSTE, not far from La Luciérnaga shopping center. There I was able to park about a block away and almost twisted my ankle while crossing the cobblestone street. (How do the elderly people with walkers and canes navigate such a perilous path on the way to their appointments?)
No one was staffing the sign-in table, so I asked a patient waiting in line if there’s an office for paperwork; she directed me inside and to the left, where I found an unmasked staffer in a ventanilla (window with an open space for passing documents). When my turn came, I asked for the Carta de No Afiliación.
The staffer asked for my CURP and “una hoja blanca.” I asked why she needed a blank piece of paper. “To print your letter,” she said in Spanish. I saw the printer sitting right there on the desk, loaded with paper, but whatever. Apparently ISSTE is not well stocked with office supplies, and paper isn’t free. I said I didn’t bring a blank sheet of paper. She said I could get one at the Oxxo convenience store, just to the right outside the door and two blocks up.
I said thanks and walked to the Oxxo, glad I’d worn shoes I don’t care about, as the street there is under construction and I ended up with dusty hooves.
At Oxxo I asked for a blank sheet of paper. The cashier stared at me for a moment and then said, “We don’t have any.”
“For ISSTE,” I said. The cashier continued staring and said nothing. I asked if there might be a papelería nearby. She said, in Spanish, “across the street” and turned away.
Outside, I looked around and saw a line of people outside a doorway across the street to my left. I walked over there and sure enough, there was a sign on the door saying “Se tramitan cartas de no afiliación de IMSS e ISSTE.” So I stood in line, thinking I’d get the letter done there and avoid going back to the ISSTE office. (You won’t want to make the same mistake. Just bring a blank page with you to ISSTE if you’re not able to generate the letter online.)
Though it was only 68ºF at that time of the morning, I was standing in direct sun for 15 or 20 minutes, and that’s about as long as my Nordic skin can handle. Finally I was able to enter the tiny shop, maintaining the proper Covid-19 social distancing between myself and other customers, and of course wearing my mask.
It turns out the place is mainly a computer repair shop. The guy behind the desk wore his mask below his nose, rendering it useless, and took it off to speak. I told him what I wanted, and on a desktop computer he pulled up the same online form that I had tried from home, asking for my CURP, my NSS, my código postal (ZIP code…you need to know yours as it won’t always be on the water and electric bills) and my email address.
He typed it all in and then held out a hand for my cell phone. I don’t like other people’s paw-prints all over my phone, especially during Covid, but I handed it to him, and he used it to respond to the email he’d sent me and to confirm my cell number.
Then he said it didn’t work. I would have to go back to ISSTE and have them generate the carta. So I asked for two blank sheets of paper, paid him $25 pesos for his trouble, and tromped through road construction again, back to ISSTE.
Inside the ISSTE office, a line had formed at the window, but the woman I’d spoken with earlier motioned for me to come to the front. I handed her the printout of my CURP and one blank sheet of paper, and within 30 seconds I had the Carta de No Afiliación al ISSTE in hand, proving I’m not a recipient of health care benefits for government employees.
She rubber-stamped the letter and scribbled her initials on top of the stamp, which makes me wonder if cartas printed at home are acceptable at CAISES. Would I have had to go there to get the stamp anyway, even if I’d been able to print out my own copy at home? (In Mexico they often give you incomplete information, so you’ll go through all the steps that they tell you, only to arrive with a handful of documents and find that you’re one stamp or signature or document short of qualifying for the permission you seek. Often a Mexican who grew up within this system will intuitively know what else might be needed and will arrive prepared, but we expats almost never do.)
Fortunately, I didn’t need to repeat the process at IMSS because a few days later I tried again online and was able to generate the Carta de No Afiliación al IMSS at this link: https://serviciosdigitales.imss.gob.mx/portal-ciudadano-web-externo/home.
So at this point, I’ve got the paperwork to enroll in the public health care system, and will go back to CAISES to schedule a new appointment—this time NOT on a Monday!
A word of caution: Before you enroll yourself in the INSABI health care scheme, you should know that it doesn’t cover advanced care such as cancer treatment or kidney dialysis the way Seguro Popular did. Under INSABI, expats are eligible for Level 1 (clinic visits; CAISES is a Level 1 care center) and Level 2 (some hospital visits and specialists) at no cost, but must pay our own way at Level 3 (advanced care). That’s still an amazing privilege and one for which we can be thankful, those of us who can’t afford to buy medical insurance.
Here’s a blog article from an immigration law firm in Mexico City that explains it all (in Spanish): https://www.diamsc.com/post/servicios-de-salud-para-migrantes-en-m%C3%A9xico-ante-el-covid-19. The English translation is below.
Health Services for Migrants in Mexico in the face of COVID 19
In the fourth article of our Mexican constitution, which literally says: “Everyone has the right to health protection,” supports the foundations of a new system that the current government has implemented to achieve “universality of health.”
This body is called INSABI “Institute of Health for Well-being” and its guiding principle is Article 77 of the General Health Law, which says: “All people in the country without social security have the right to receive services free of charge. public health, medicines and other associated supplies.”
In addition, within the same law and constitution, it is stated that:1. All those who enter the country automatically acquire the rights granted by law.2. The health law says “the quantitative and qualitative extension of health services is guaranteed, with preference given to vulnerable groups.”
So ALL MIGRANTS regardless of their immigration status have the right to receive a health service, but like everything else, we must respect certain rules.
What can I do to receive free medical attention and to what extent can the services of the Mexican national health system help me if I am a migrant?
1. The general health law marks 3 levels of medical care:
– FIRST LEVEL OF CARE: Comprising outpatient care (consultations), care, prevention and health promotion. At this level we find the health centers (community clinics).
– SECOND LEVEL OF CARE: They are health services with hospitalization in basic services such as: medical clinic, pediatrics, general surgery, complementary examinations and diagnoses of basic diseases, simple surgeries, hospitalization for childbirth/ At this level we find general hospitals, some regional hospitals, and maternity hospitals.
– THIRD LEVEL OF CARE: These are the Institutions that provide care for highly specialized diseases, diseases that require high technology, ultra-modern devices, specialized hospitalization, surgery, specific surgical specialties such as: traumatology, neurosurgery, cardiovascular surgery, etc. At this level we find the 12 National Health Institutes including:
- Children’s Hospital of Mexico
- National Institute of Cardiology
- National Institute of Cancerology
- National Institute of Psychiatrics
- among many others
2. INSABI ONLY COVERS THE FIRST AND SECOND LEVEL OF CARE. This you must be very clear about—because although it is true there is universality in Mexican health, third-level care has recovery fees even for Mexicans—but we must also acknowledge the following question:
What if I don’t have money to pay for medical specialties? There is still the possibility of approaching the social work area of the tertiary hospital where you are and present your situation. They, under the criteria of exhaustive socioeconomic studies, will determine the payment or non-payment for the services rendered.
3. What requirements does INSABI ask of migrants to provide them with medical care?
A) An official identification of your country (passport, identity card, etc);
B) Your birth certificate, preferably apostilled [Anne’s note: They’re not asking for this at CAISES in San Miguel];
C) If you have any proof of your immigration status such as: valid multiple immigration form, resident card, application for regularization (the so-called NUT), CURP, refugee application, etc.
As a migrant you must have at least one of these documents. However if you have nothing and require medical attention, do not hesitate to go to your nearest health center! There the social work service will give you options.
4. What is the procedure I must follow to receive medical attention?A) All ailments must first go through first level medical care; that is, you must go to the health center closest to where you live.B) If you need Second Level medical attention, the health center will make a referral, where they will tell you in which hospital and under what concept you will be treated.C) If the hospital detects with basic tests that you have a third-level disease, you will be referred to the appropriate specialty hospital.
5. Emergencies: What do I do in an emergency? INSABI and the general health law likewise guarantee the health of patients with medical emergencies. All you have to do is go to the hospital closest to your home and request the medical attention you require.
6. For more information, call INSABI directly at (800) 767 8527 from anywhere in the Mexican Republic at no cost and ask all the questions you consider necessary. Very friendly people will attend you and are ready to help you.
7. In the event that you have symptoms or you think you have contracted COVID-19 due to having lived with a positive carrier, the first thing you should do is keep calm, call 800 00 44 800 toll free for the Epidemiological and Health Intelligence Unit. If it is not possible to do that, then look for the health center closest to your home and explain your case.
8. Above all, we must heed the information provided by the authorities. The coronavirus COVID-19 (SARS-Cov-2) is a pandemic and we must act as one humanity; borders and nationalities in this situation are secondary.
Have the patience that is required to be cared for, and I assure you that you will not be left without the attention you require.
If you want more information please watch the following video: https://www.youtube.com/watch?v=112t0uPcmPo.
Remember that DIAM S.C. It is the best immigration office in Mexico. We believe that we are all #SomosMigrantes and #NadieEsIlegal in this world. [Anne’s note: This cringeworthy statement is theirs, not mine, as is the rest of the article. Translation was done quickly using Google Translate and tweaked a bit so as to be accurate, if not eloquent.]
Call DIAM S.C. and we will gladly advise you or do the procedure for you. If you want free immigration advice, send us a message via WhatsApp at:
https://wa.me/5215519124567 José Luis Aguado
https://wa.me/5215512872985 Ernesto Rizo
Or call us and we will assist you: (521) 5519124567. Visit our website: http://www.diamsc.com or social media: FACEBOOK https://www.facebook.com/diamsc/, INSTAGRAM https://www.instagram.com/diamscmex, TWITTER https://twitter.com/diamscmx.