A job usually brings the base cover

In six of the seven countries, formal employment is the door into the health system. Mexican employers register with IMSS and enrol each worker, which makes the worker and registered family members eligible for its medical care. Costa Rica asks employers to register themselves and each new employee with the CCSS, known locally as la Caja, within eight days of the job starting, foreign workers included. Peruvian employers record the worker and dependants in the T-Registro payroll register, which brings EsSalud cover.

Colombia’s system, created by Ley 100 de 1993, enrols contributing workers through a health promotion entity (EPS). Argentina makes salaried workers mandatory beneficiaries of an obra social under Ley 23.660, so employment itself is what brings cover. In Chile, every dependent worker’s health contribution must go to the public fund, Fonasa, or to a private Isapre.

Brazil is the outlier. Its public system, SUS, is open to everyone in the country at no charge, whatever their immigration status, and nobody joins it through work. A Brazilian employer’s payroll contributions fund pensions and the FGTS severance fund rather than a health premium.

Who funds the contribution

The split of the bill runs from one end to the other. In Peru, the EsSalud contribution is paid entirely by the employer, with nothing deducted from pay. Chile sits at the opposite end: the health contribution belongs to the worker and is withheld through payroll, while the employer funds work-accident and occupational-illness insurance under Ley 16.744.

Mexico, Costa Rica, Colombia and Argentina share the cost between employer and worker, and in Mexico the government contributes to the IMSS branches as well. Two details change the arithmetic. Colombia exempts income-tax-paying company employers from their share for workers earning less than ten monthly minimum wages. Argentina adds an extra worker contribution for each additional dependant placed on the obra social.

Payroll also carries work-risk cover in most of these countries, such as Argentina’s ART insurers and Costa Rica’s mandatory policy through the national insurer, INS. These sit beside health contributions rather than replacing them.

Private funds and private plans

Some countries let the mandatory contribution travel. A Chilean worker belongs to Fonasa or an Isapre, never both, and pays the difference when a chosen Isapre plan costs more than the contribution covers. In Argentina, a worker can direct contributions straight to a prepaid medicine company (prepaga) registered with the health services superintendency, with no obra social in between, under rules that took effect on 1 December 2024.

Peru offers a collective version. When an absolute majority of workers vote for it, the employer can provide cover through a private health provider entity, also abbreviated EPS, and receive a credit against its EsSalud contribution. EsSalud still handles the more complex care, and any worker may choose to stay fully with it.

On top of the base scheme, each market has a private plan that staff will recognise. Mexico has seguro de gastos médicos mayores, the major medical cover that opens private hospitals. Brazilian employers offer company plans (planos coletivos empresariais) regulated by the national supplementary health agency, ANS. Colombians add medicina prepagada or a complementary plan, both of which require EPS membership first. HR and EOR guides describe Chilean employers as commonly arranging a group complementary policy that reimburses part of what Fonasa or the Isapre leaves unpaid, and Costa Rican employers as often paying all or part of private cover.

Where enrolment is compulsory, an international plan sits on top of the social scheme and never stands in for it. In Brazil, SUS remains the public base whatever plan sits above it.

How firmly foreign insurers are kept out

The region ranges from strict to unsettled. Mexico’s insurance law (LISF) generally bars contracting personal insurance with foreign companies when the insured person is in Mexico, with exceptions granted by the regulator. Argentina’s Ley 12.988 prohibits insuring abroad any person under Argentine jurisdiction. Colombia’s financial superintendency says contracting with unauthorised foreign insurers is prohibited, and summaries of Ley 1328 exclude insurance linked to the social security system from what residents may buy abroad.

Chile and Peru draw the line at selling. Published summaries of Chile’s insurance law describe it as letting a resident buy non-mandatory cover abroad while barring foreign insurers from offering it in Chile. Peru’s banking and insurance law lets residents buy abroad, while only firms authorised by the SBS may offer insurance to the public there.

Brazil and Costa Rica are less clear. A 2021 Brazilian court ruling treated an international policy from a foreign insurer as an international contract rather than a regulated local plan, and the question has been raised with ANS. Costa Rica’s 2012 regulator opinion on buying from foreign insurers concerned property and liability, not health. In every case, whether a plan can cover someone living there is for the insurer to confirm.

Staffing limits and the EOR question

Several countries restrict how long, or for what work, a third party can employ someone on your behalf. Mexico’s 2021 labour reform bans general subcontracting of personnel and leaves only specialised services, from providers registered in REPSE, outside the client’s core business. Colombia’s temporary services companies may place the same worker with a client for at most one year. Chile’s equivalent firms work only for listed reasons and for limited periods, generally 90 days, or 180 days where the work is a new project or the company has just started. Peru limits labour intermediation to temporary, complementary or specialised services, and courts treat misuse as direct employment.

Brazil and Argentina have their own risk: a worker paid as a contractor can be reclassified as an employee, with back contributions due in Brazil and fines in Argentina. Before choosing an entity, an employer of record or a contract for any of these countries, check the structure with a local adviser or tax professional.

Family members on the record

Family cover is written into most of these schemes. Argentina’s primary family group includes a spouse, unmarried children up to 21 (25 in some study cases) and children with a disability at any age. Colombia covers a spouse or permanent partner, financially dependent children up to 25 and, where there is no spouse or child, dependent parents without a pension. Mexico reaches parents who depend on the worker and live with them. Peru covers a spouse or common-law partner, minor children and adult children unable to work.

Costa Rica gives family beneficiaries the same health care as the worker, though no cash benefits. In Chile, Fonasa covers a member’s legal dependants, while adding one to an Isapre contract can raise its price. A private benefit that extends to dependants should start from that existing cover.

Country guides for Latin America

For the details of one country, open its guide:

Mexico: IMSS enrolment, gastos médicos mayores and the 2021 outsourcing reform
Brazil: SUS, ANS-regulated company plans and contractor risk
Argentina: obras sociales, prepagas and insuring abroad
Colombia: EPS membership, prepaid medicine and temporary staffing limits
Chile: Fonasa or an Isapre, GES guarantees and work-accident insurance
Costa Rica: CCSS registration and private cover as an extra
Peru: EsSalud, the EPS option and labour intermediation

Canada and other regions are covered from the international health insurance overview.

Getting an introduction to a benefits partner

Tell us through the quote form on this page which Latin American countries your team works from, how many people are in each, and whether they are hired through your own entity, an employer of record or a contract. We pass it to a benefits partner that handles international and remote-team health coverage, and any decision on who qualifies, which plans fit and what they cost is made by that partner together with the insurer.

For the US commercial policies a distributed team can affect, such as workers’ compensation and employment practices liability, we request cover from insurers and the insurer decides terms. See insurance changes for remote teams, or the employee benefits hub for every benefits guide.

A few useful answers

Common questions

Can one international plan replace the social health schemes across Latin America?

Not where enrolment comes with the job. In Mexico, Costa Rica, Peru, Colombia, Argentina and Chile, enrolment or contributions follow employment, so a private plan adds to the scheme rather than standing in for it. In Brazil, SUS stays open to everyone. Whether a plan can cover someone in a given country is for the insurer to confirm.

Which country puts the whole health contribution on the employer?

Peru. The EsSalud contribution is paid entirely by the employer, with nothing deducted from the worker’s pay. Chile is the reverse: the health contribution is the worker’s, withheld through payroll.

Can an employee in Chile or Argentina send contributions to a private fund?

Yes, within each country’s system. A Chilean worker chooses Fonasa or an Isapre. An Argentine worker can direct contributions to a registered prepaga and pays any difference when the plan costs more.

Why do staffing rules matter for health cover?

Whoever is the legal employer registers the worker with the local scheme. Mexico, Colombia, Chile and Peru limit how a third party may employ someone for another business, so the hiring setup decides who carries the health duties.

International Health Insurance for Remote Employees in Latin America