The CCSS and the employer’s registration duty

Public health care in Costa Rica is run by the Caja Costarricense de Seguro Social (CCSS) through its sickness and maternity insurance, known as the SEM or seguro de salud. A salaried worker does not join on their own. They come into the system through the employer, who registers the business and each new hire with the CCSS.

Costa Rican legal guides put the deadline at eight days from the start of the job, and say registration can be done in person or online. Contributions are then billed through the CCSS central collection system, SICERE, so the payroll and the CCSS record have to line up month after month.

Who stands in as the employer

For a US company without a presence in Costa Rica, the first decision is who will hold that CCSS registration. A law-firm column in the Costa Rican press describes CCSS enrolment as indispensable in any formal employment relationship, foreign workers included, so the question of who holds that registration needs an answer before the start date.

If you plan to hire through an employer of record, ask how it registers the person with the CCSS and with the national insurance institute (INS), which handles work-risk cover. Paying someone as a contractor is a different route with its own classification questions; our guide to health coverage for EOR employees and contractors abroad compares the routes in general terms.

Payroll charges: health, pension and work risks

The SEM health contribution is split between the two sides of the payroll. The CCSS employer page and a payroll vendor’s 2026 guide both list 9.25% of salary for the employer and 5.50% for the worker, 14.75% in all, for 2026. Treat those percentages as a starting point and check the current figure, because the CCSS sets them.

The same payroll also carries pension insurance, invalidez, vejez y muerte (IVM), and other employer charges, so the total cost of an employee is higher than the health line alone.

On top of that sits a separate, compulsory policy. Costa Rican press coverage explains that the Labour Code (articles 193 and 201) requires every employer to insure workers against work accidents and occupational illness through the seguro de riesgos del trabajo, which the INS administers, and that the payroll reported to the INS must match the one reported to the CCSS. The same coverage says temporary disability under that policy pays 60% of the average daily wage from the previous three payrolls. A health plan is a different product and does not take its place.

Relatives covered through the worker

A worker insured directly with the CCSS can extend public health care to family members under its family protection rules. Press reports say the CCSS board approved a new family protection regulation in 2021 that changed how economic dependence is shown and removed a three-year waiting requirement.

According to a CCSS official quoted in the national press, a family beneficiary receives the same health care as the insured worker but no cash benefits, such as sick-leave pay.

Private health insurance as an extra

Employer guides published by EOR providers say Costa Rican law does not require private health insurance, and describe it as a frequent benefit that the employer pays in full or shares with the employee. In those guides, the appeal is quicker access to care and a choice of private providers.

Either way, private cover is layered over the CCSS. Enrolment stays mandatory for an employee, and the contributions are still due whether or not a private policy exists.

Where foreign insurers stand

Insurance in Costa Rica is supervised by the Superintendencia General de Seguros (SUGESE), created when the Insurance Market Regulation Law (Ley 8653) opened the market in 2008. Law-firm guidance is clear that an international plan cannot replace CCSS enrolment for an employee; at most it can top the public cover up.

The position on foreign insurers is narrow. A 2012 SUGESE legal opinion said people and companies in Costa Rica may, at their own account and risk, buy cover from foreign insurers not authorised locally, relying on freedom of contract in articles 2 and 3 of Ley 8653. That opinion dealt with property and liability insurance, not health. A 2008 law-firm article also reported that SUGESE investigated alleged illegal sales of foreign policies in the country.

So it would be wrong to read the 2012 opinion as permission for a foreign health plan to be marketed to someone living in Costa Rica. Before any foreign policy is arranged for a Costa Rica resident, check the insurance-law position, the employee’s tax treatment and the hiring structure with a local adviser or tax professional.

Asking for an introduction

If you would like to look at international cover for a team that includes Costa Rica, we can introduce you to a benefits partner that handles international and remote-team health coverage. Use the quote form on this page to give us the province your employee lives in, your headcount there and elsewhere, whether relatives would be included, and how the person is employed. We send that on, and the partner and the insurer decide eligibility, plans and pricing.

Hiring in more than one country? The international health insurance overview links every country guide, and employee benefits for small businesses covers the wider benefits section.

A few useful answers

Common questions

Can an international health plan replace CCSS enrolment in Costa Rica?

No. CCSS enrolment is mandatory for employees, and Costa Rican legal guidance says an international plan can only add to the public cover, not stand in for it.

Who pays the CCSS health contribution?

Both the employer and the worker. For 2026 the CCSS employer page and a payroll vendor’s guide list 9.25% of salary from the employer and 5.50% from the worker. The CCSS sets the rates, so confirm the figure for the current year.

Is work-accident insurance part of the CCSS?

No. It is a separate compulsory policy, the seguro de riesgos del trabajo, administered by the INS. Press coverage says the payroll reported to the INS has to match the one reported to the CCSS.

Can an employee's family use the CCSS?

Yes, through the family protection rules. A family beneficiary gets the same health care as the insured worker, but not cash benefits such as sick-leave pay.

What did the 2012 SUGESE opinion say about foreign insurers?

It said people and companies in Costa Rica may buy cover from foreign insurers not authorised locally at their own account and risk. The opinion concerned property and liability insurance, not health plans.

International Health Insurance for Remote Employees in Costa Rica