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In 2013, the National public health system of Ecuador was in the top 20 in the world. All this was achieved with the inauguration of 13 new hospitals over the last decade and 18 more currently under construction. They also upgraded 11 of the principal existing hospitals in the main cities in Ecuador. From 2008 to 2015, 34,000 doctors were hired by the government to work in the public health system, and in 2016 there were over 39 million medical appointments made across the country. This may be one the reasons the demand has increased, although primary health care in case of emergency still remains free on the National Public Hospitals under the MInistry of Health of Ecuador. The health system in Ecuador is made up of the General Public Health System, Instituto Ecuatoriano de Seguridad Social (IESS) and private Clinics and private Hospitals.

At IESS (Instituto Ecuatoriano de Seguridad Social) the number of people officially registered has decreased. In 2014, the number of people enrolled was 2'394.000, in 2015 it lowered to 2'315.000, and in 2016 the amount decreased to 2'207.000, according to official IESS information. All this indicates that in the last 3 years, more than 187 thousand people have left the IESS public health insurance system.

Here is a brief summary of what the Human Mobility Act and the Social Security regulation of Ecuador says, based on the latest information and public knowledge about whether to get public or private health insurance in Ecuador once a foreigner obtains a residency visa.

How is the governemnt going to determine if you have health insurance or not? Having health insurance is a must under the current Ecuadorian immigration laws, if a person will be applying for a visa transfer, a new cédula order, when you renew your Certificate of Deposit for your investor visa, or in customs at the airport, authorities will be allowed by law to request proof of compliance with the law.

Below you will find the translation of the main articles related to immigrants in Ecuador and benefits, duties, and rights under the public social security system (IESS) of Ecuador; in another article we will be explaining the pros and cons of going with private health insurance.

Human Mobility Act.-

Article 51.- Right to work and to Social Security:

Foreigners residing in Ecuador have the right to work and to have access to the social security system. Their monthly payments will be calculated based on the real income declared at the time of obtaining their residency.

When the resident works for an employer their monthly payments (to IESS) will be calculated based on their salary.

Article 53.7- Duties for foreigners: Have public or private health insurance while they are staying in Ecuador, except for those people who are on need of international protection program.

Article 61.- final paragraph.- Once the temporary residency visa is granted, the foreigner must be enrolled in the social security system or have private health insurance.

Article 64.- penultimate final paragraph.- Once the temporary residency visa is granted, the foreigner must be enrolled in the social security system or have private health insurance.

Regulations for insurance, collecting and assets management for IESS ACT.

Article 95.- Can be eligible to get this enrollment (Voluntary IESS Enrollment), all persons, of legal age, living in Ecuador, and not any person listed in article 2 of the Social Security Act (employee-employer relationship, Self-employed, Self-employed professional, Business owner, Self-employed underage, Unpaid person working at home), and to declare their willingness to enrolled to this system (Social Security)." Download the law here.

Article 96.- Requeriments for foreigners

to enroll in the IESS Social Security public system​

1.- Cedula

2.- at least 18 years old

3.- Have a residency Visa

4.- Not have debts with the IESS

5.- For retired foreigners, submitting the Social Security letter of benefits certificate that shows their monthly income or by making an online declaration through the IESS web site.

Article 97.-

The amount to be paid for the voluntary IESS enrollment in Ecuador will be the monthly income that a person will state on their application, which will not be lower that the minimum wage.

For retired foreigners, the monthly payment to IESS ​will be calculated based on their monthly social security income or ​the declaration made to the IESS, but can not be lower that the minimum wage in Ecuador.

How much does IESS cost? A person who voluntarily registers for IESS must pay 17.6% of the monthly income they declared at the time of enrollment (this amount must be higher than the Ecuadorian minimum wage). For an additional 3.41% the spouse, by marriage or common law, can be added as long as they have a cédula number for registration.

If you have any specific questions regarding this or any other immigration topic, you can email us at

The EcuaAssist Team

Important: The information provided on this website does not, and is not intended to, constitute legal advice; instead, all information, content, and materials available on this site are for general informational purposes only. Information on this website may not constitute the most up-to-date legal or other information

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