A Tijuana, Mexico-based company that specializes in offering health benefits to cross-border commuters recently became the first Mexican HMO licensed to operate in the U.S.
In February, the California Department of Corporations granted Sistemas Medicos Nacionales a license to provide employer-sponsored plans to Mexican nationals working for U.S. companies in San Diego.
"We've heard of no other foreign-based HMO that's doing business in the U.S.," says Laura Diamond, a spokeswoman for the American Association of Health Plans.
Under the plan, routine services must be provided in Mexico, though emergency care is covered worldwide. Sistemas already has 10,000 members from more than 100 U.S. employer groups, and the company expects its enrollment to double this year.
Roughly 40,000 Mexicans cross the California border each day to work legally in San Diego. Many prefer to get their healthcare in Mexico because of language and cultural differences as well as the lower costs there.
Until now, this migrant population has existed in a type of "coverage purgatory," says Sistemas founder and President Frank Carrillo. Mexico's government provides health insurance but only to employees of Mexican companies. Meanwhile, U.S. insurers have been reluctant to cover medical procedures in Mexico because of quality and fraud concerns.
Sistemas and several other Mexican HMOs had operated in California without licenses until the state Legislature last year passed a bill requiring foreign companies to be licensed. Three other Mexican HMOs have filed for state licenses.