New Cross-Border Health Insurance From Aetna

June 3, 2010 by
Categories: Healthcare, Travel Health Insurance

Travel Medical InsuranceFrom International Medical Travel Journal (IMTJ)

Major US health insurer Aetna has followed several competitors in introducing a new health plan that allows members and their families to access health care in California or in the Mexican cities of Mexicali, Tecate and Tijuana. It does so through an agreement with Mexico's Sistemas Medicos Nacionales (SIMNSA), a health management organization that operates similar deals for several other insurers. These are cross-border plans for Mexico and specific border states, not policies with medical tourism options outside Mexico. Unlike other countries, insurance in the US is regulated state by state, so insurers mostly offer individual state plans for individuals, even when they are major international insurers. These cross-border plans accept that many workers in Southern states are Mexican, or of Mexican descent, and that for many their main language is not English, so feel uncomfortable discussing healthcare in English. Some Mexicans live in Mexico but travel across the border to work in the USA, on a daily basis, or just returning home to their families at weekends.

Beth Andersen of Aetna says, "Aetna recognizes that it is important for our members to be able to receive health care in a language and cultural setting they understand and feel comfortable with. Vitalidad PlusSM offers employers an affordable health option that lets their employees receive care in whichever setting they prefer. People are more likely to get routine care and stay healthier when they have a primary care physician they can relate to. With access to Aetna's provider network in California as well as the SIMNSA network in Mexico, we believe we can help members achieve their optimal health. Members will be able to participate in Aetna's maternity management, heart health, diabetes and weight management programs, as well as other disease management and wellness programmes."

SIMNSA is a comprehensive health care service plan that was developed to provide quality healthcare for the growing U.S. workforce who prefer to receive their healthcare coverage in Mexico. SIMNSA is one of the leading Health Maintenance Organization (HMO) programs in Northern Mexico, and was the first Mexican HMO to be licensed as a health care service plan by the State of California. The network extends through the border cities of Tecate, Mexicali and Tijuana. It offers network services for treatment in Mexico on a range of its own health plans and for various US health plan providers including Cigna, Health Net and PacifiCare.

Vitalidad PlusSM California con Aetna is an HMO plan that features 100 percent coverage for qualified preventative care, including immunizations and child and adult wellness exams. Employers can select four different co-payment levels for employees. Members and their family members will select a primary care physician in California or one of the SIMNSA physicians in Mexico. Plan documents and customer service are available in both Spanish and English. In addition, members can visit Aetna's Spanish language web site to search for participating doctors and hospitals, and obtain information on a variety of Aetna health programs and products.

Sarah Horton, assistant professor of anthropology at the University of Colorado, Denver, has published extensively on immigrant health and the U.S. health care system and is currently writing a book about cross-border health care for the University of California Press.

Research a few years ago claimed that a million people traveled from the USA to Mexico for dental and healthcare, but the figures were very old and the statistical method curious. Gabriel Senior, founder of Travel for Care, a Mexican medical tourism agency sending U.S. and Canadian patients to hospitals in Tijuana and Monterrey estimates that of the 50,000 Americans who travel to another country for medical treatment every year, about 35,000 travel to Mexico. The remaining 15,000 are to destinations in Central America and Asia. Of the 35,000 people who go to Mexico, a large proportion are Hispanic who come naturally to the country on business or visiting family. SIMNSA points out that healthcare needs differ when a border is crossed as insurance may be bought by employees and their families at home in Mexico, while at the same time protecting them from emergencies on the job in the U.S. The failure to understand that people may live in Mexico but work in the USA accounts for why earlier studies overestimated medical tourism by failing to differentiate between where people work and live.