Expat insurance and health insurance in Ecuador

Ecuador’s healthcare system mainly rests on the IESS (Instituto Ecuatoriano de Seguridad Social), founded in 1928 and responsible for the Seguro General Obligatorio (SGO). This scheme covers sickness and maternity within the broader framework of social protection that also includes workplace accidents, old age/disability/survivors’ benefits and unemployment. Affiliation is mandatory and irrevocable for any employee on a local employment contract in either the private or public sector: neither the employee nor the employer can opt out. The total contribution comes to around 20.6% of pay, split between an employer share of around 11.15% and an employee share of around 9.45%, deducted automatically by the employer.

The private sector is particularly well developed in Quito, Guayaquil and, to a lesser extent, Cuenca — the three cities France Diplomatie identifies as having good-quality hospital infrastructure, allowing thorough examinations and urgent procedures. The Hospital Metropolitano de Quito is the only Ecuadorian facility accredited by Joint Commission International according to the sources consulted. Outside these urban areas, particularly in the Ecuadorian Amazon and rural Andean areas, access to care of a comparable standard becomes considerably harder.

France Diplomatie highlights the very high cost of private hospital procedures and serious, recurring problems with medical care, with a deposit systematically required before any admission. A tourist or resident not affiliated with the IESS gets no public cover and should expect to pay for the entirety of their care in the private sector.

• Tourist stay (mainland, under 90 days): no health insurance legally required on entry. A requirement introduced in 2018 for all foreign tourists (Organic Law on Human Mobility) was lifted as early as August 2018 by the Ministry of Tourism for the mainland, to preserve the country’s tourism competitiveness. France Diplomatie nonetheless considers it essential in practice.
• Galápagos Islands: the 2018 repeal explicitly excluded the archipelago, where insurance was then still said to be required. The recent sources consulted on the current status of this requirement are contradictory — some mention a minimum cover (around 40,000 USD) still requested on entry, others an absence of any formal requirement following a decision of the Governing Council of the Galápagos special regime. This point must be checked directly with the Parque Nacional Galápagos or the Ecuadorian consulate before any trip to the archipelago; insurance broadly covering medical evacuation (helicopter transfer to the mainland) remains strongly recommended in any case, as such evacuations can cost several thousand dollars.
• Working Holiday Visa (Visa de Vacaciones y Trabajo): bilateral France-Ecuador agreement, open to those aged 18 up to and including 30, annual quota of 300 places (never reached), maximum stay of 12 months, multiple-entry visa. Application to be filed online with the Ecuadorian authorities, with mandatory insurance covering sickness, hospitalisation, disability, maternity and repatriation for the whole stay, a medical certificate of good health, a criminal record check less than 3 months old, translated and apostilled, and proof of minimum savings of €2,500. Visa fees of about 50 USD on filing then 40 USD on collection.
• Seconded employees and residents on a local contract: mandatory, automatic IESS affiliation as soon as formally hired, regardless of nationality, with a total contribution of around 20.6% of salary.

No official set fine has been identified for simply lacking cover outside the working holiday visa and, potentially, the Galápagos; the documented risk is being billed in full for care in the private sector, with a deposit required on admission.

No bilateral social security agreement between France and Ecuador has been identified: the CLEISS does not publish a dedicated country factsheet for Ecuador, and the country does not appear in the list of country factsheets consulted, unlike several South American neighbours for which agreements exist. Based on the sources consulted, Ecuador must therefore be considered a country with no social security agreement with France.

• An expat worker in Ecuador is entirely subject to Ecuadorian law for their health cover (IESS affiliation), with no totalisation of insurance periods or coordination with French social security.
• No secondment form (A1, SE 401 Q...) applies: an employee sent to Ecuador with no agreement in place remains, barring a specific contractual arrangement, subject to the Ecuadorian scheme as soon as they work there under a local contract.
• This lack of agreement should be checked with the CLEISS before any departure, as a change to the treaty situation can never be ruled out.

With no bilateral coordination, voluntary membership of the Caisse des Français de l’étranger (CFE) or international private insurance are the most commonly cited solutions to keep a link with the French system, alongside or instead of local IESS affiliation.

• Before departure: take out insurance covering medical expenses, hospitalisation and medical repatriation, whatever the planned length of stay.
• For a trip including the Galápagos: check beforehand with the Parque Nacional Galápagos the exact status of the insurance requirement and the expected coverage amount, as this point is contradictory depending on the source.
• For a working holiday visa: put together the online application with insurance valid for the whole stay (sickness, hospitalisation, disability, maternity, repatriation), a medical certificate, an apostilled criminal record check and proof of minimum savings of €2,500, before filing the application.
• For a stay longer than 90 days: start the residence visa process with the Ecuadorian authorities before the visa-free period expires, or pay for the additional 90-day extension (about 400 USD).
• As soon as hired on a local contract: check with the employer that automatic IESS (Seguro General Obligatorio) affiliation is in place.
• Within 6 months of arrival: register with the roll of French nationals living abroad at the French embassy in Quito (free, valid for 5 years, recommended).
• With no France-Ecuador agreement in place: consider voluntary CFE membership or international private insurance as soon as you settle.