What is Caja?

One of the requirements for getting your residency status and having your DIMEX card (ID card) in Costa Rica is to enroll in the national healthcare system (Caja) upon approval of your residency application.

Caja (CCSS) – Costa Rican Social Security Fund ( Caja Costarricense de Seguro Social).
You have to be a member of the Caja and pay a percentage based on the income level you declared when you applied for residency.

There are public and private healthcare systems in Costa Rica. Many foreigners and ticos use both. Private clinics are a better choice if you are in a rush for anything that isn’t too expensive. If you can stand the long wait periods in the public system for more serious concerns, then it’s better to obtain your medical care at Caja, which also has a high standard of medical care.

The Caja system consists of 2 elements:

1. Healthcare coverage – SEM (Seguro de Enfermedad y Maternidad);
2. Pension contributions – IVM (Invalidez, Vejez y Muerte), similar to SS in the USA or CPP in Canada.

Before, only the SEM payment was imposed on retired and investment residents. As for the IVM, the regulation specified that individuals could opt out of contributing to it.

As of March 16th of 2022, Costa Rican Social security rules and regulations have changed, facing a significant rise in Caja rates expenses…

According to the reform, immigrants must now have both SEM and IVM insurance, meaning both Healthcare and Pension plans. Six months after the update was published, it took effect on March 16, 2022. Residents who apply as retirees or investors will be subject to the new CAJA rates as of this date. Rentistas are also included but not explicitly mentioned in this new regulation.

Costa Rican law prohibits the adoption of new rules retroactively. As a result, people who signed up with Caja BEFORE MARCH 16, 2022, do not need to be concerned about these recent changes; they will not be affected.

Pensionado – you must provide Caja with your Proof of Pension (the same as you submitted to Immigration with your residency application earlier). Based on your pension amount, they will calculate your monthly payment.
Rentista – Caja will use the $2,500 USD monthly income out of your bank account in Costa Rica.
Investor – officially not specified yet.

1) Pensionado with $1,500 USD per month income:
(1,500 x 6.24%) + (1,500 x 7.20%) = $201.6 USD monthly Caja payment.
 Before: you had to pay 6.25% (for 1 plan, SEM)
Now: you will have to pay 13.44% ( for 2 plans, SEM + IVM)

2) Rentista with $2,500 USD per month income:
(2,500 x 8.2%) + (2,500 x 7.65%) = $396.25 USD monthly Caja payment.
Before: you had to pay 8.02% (for 1 plan, SEM)
Now, you must pay 15.67% (for 2 plans, SEM + IVM).

As you see, the Caja payments have almost doubled…

It’s uncertain if this ill-conceived system modification will continue to be the case, but only the outcome of future appeals will tell. The new administration, sworn in after the runoff election, may also assist in reversing or adjusting these rates.
It’s necessary to make a lot of noise about this issue in public forums, embassies, etc., to pressure the politicians and bureaucrats who can change it.

When compared to other countries, the Costa Rican healthcare system, despite its shortcomings and challenges, nonetheless provides greater value. Medical tourism is growing in its popularity immensely. One of the primary advantages of living in Costa Rica is the year-round availability of its unique healthy environment. Let us focus on what is still of really great value.

From our side, CRIE is working with a network of independent attorneys on preparing the appeals, which we hope will contribute to changing this regulation for a more fair solution.

-Written by Glenn Tellier (Founder of CRIE and Grupo Gap).

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Article by Glenn Tellier (Founder of CRIE and Grupo Gap)