SIMNSA Mexico HMO

HMOs allow you to receive comprehensive coverage at set prices, called copays. Enrolling in SIMNSA should only be considered if you and your dependents meet the eligibility requirements below and have the proper documentation to easily cross back and forth across the border and are willing to do the travelling to receive services in Mexico at a SIMNSA provider, which is where you must go to receive in-network services and pick up any prescriptions.

Doctors/Other Medical Care Providers: You can only use doctors, hospitals, and pharmacies that participate in the SIMNSA HMO network in Mexico. Doctors who participate in the HMO network are called in-network providers. There is no coverage if you go to out-of-network providers, except for emergency services.

Primary care and prescription coverage is not available in the U.S. All care must be completed in the SIMNSA network in Mexico.
Only urgent care and emergency room visits are covered in the U.S.

Annual Deductible: You don’t need to pay an annual deductible before the plan begins to pay for a portion of covered medical services.

Copays: When you receive medical care, you pay a set dollar amount called a copay.

Annual Out-of-Pocket Maximum: The HMO plans include an annual out-of-pocket maximum. This is the maximum amount you could pay out of your own pocket.

Eligibility: You must meet one of the qualifications for a Mexican National. A “Mexican National” is defined as one or more of the following:

A person born in Mexico;
A person born in another country with a Mexican father or a Mexican mother, or both;
A foreign man or woman who marries a Mexican man or woman; or
A foreigner who becomes naturalized in Mexico.