Healthcare in Ecuador: no CAK, but compulsory insurance, public through the IESS or private
Ecuador is not on the CAK's list of treaty countries, so you take no Dutch health insurance along. For the visa and for living in Ecuador you do need health insurance, public or private. With a cédula you can join the IESS, the social insurance institute, voluntarily: 17.6% of an income you declare yourself, at least on the basic wage of 482 dollars.
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Anyone moving to Ecuador takes no Dutch health insurance along. Ecuador is not on the CAK's list of treaty countries, so there is no S1 form. Health insurance is compulsory in Ecuador, though. The Cancillería's visa pages require one for the whole term of the visa, and article 52 of the Ley Orgánica de Movilidad Humana says that a resident must have public or private insurance. Public is possible through the IESS, as soon as you have a cédula.
| What | For whom | What it costs or requires |
|---|---|---|
| Dutch basic insurance | ends on emigration | |
| CAK and S1 form | only in a treaty country; Ecuador is not one | not possible |
| Insurance for the visa | jubilado, rentista, digital nomad | Ecuadorian or foreign, for the term of the visa, covering Ecuador |
| IESS, voluntary affiliation | anyone living in Ecuador with a cédula | 17.60% of the income you declare, at least on 482 dollars: 84.83 dollars a month |
| Insuring your partner with the IESS | spouse or cohabiting partner | 3.41% extra on the same base |
| Children with the IESS | children under 18 | covered |
What happens to your Dutch insurance?
Your basic insurance belongs to living in the Netherlands and ends when you emigrate; how to arrange that without a gap is explained in cancelling your health insurance. The Dutch Tax Administration writes that anyone with no Dutch income after emigrating is no longer insured under the national insurance schemes. There is then no longer any right to the Long-term Care Act either.
In Spain or Portugal the CAK fills that gap with an S1 form, at the Netherlands' expense. That is only possible in a treaty country, NederlandWereldwijd writes. The Netherlands does have a treaty with Ecuador, but it is about paying out Dutch benefits, such as the AOW, and not about healthcare. Ecuador is not on the CAK's list.
What insurance does the visa require?
For the jubilado, the rentista and the digital nomad, health insurance, Ecuadorian or foreign, that runs as long as the visa. With a foreign insurer the policy or contract must state that it covers Ecuador. The visa is valid for two years; see the residence routes.
You need the insurance before you have a cédula, and the IESS only accepts you with a cédula. For the visa application and the first months you therefore need your own policy, Ecuadorian or international. Have the insurer confirm in writing that it covers Ecuador and for how long.
How does the IESS work?
The IESS, the Instituto Ecuatoriano de Seguridad Social, is Ecuador's social insurance institute. According to the IESS, people who live in Ecuador and have income without an employment relationship, or as self-employed, can join voluntarily. A foreigner needs an Ecuadorian cédula for this and may not have arrears with the IESS. You apply online.
You choose the base yourself, the monthly income on which you pay contributions, but it is never lower than the basic wage. The contribution is 17.60%. At the basic wage of 482 dollars that is 84.83 dollars a month. Your cover starts on the first day of the month in which you apply. You pay within 15 days after each month, for example by direct debit from an Ecuadorian bank account. If nothing has been paid 30 days after a month, the IESS stops issuing bills and you have to apply again.
For that money you get, according to the IESS, among other things care in case of illness and maternity, care for your children up to 18, and a build-up towards an Ecuadorian old-age pension. You can insure your partner for 3.41% extra. The IESS mentions no waiting period on this page; ask from when care is reimbursed.
Article 51 of the same migration law says that a foreign resident is entitled to social security, and that contributions are calculated on the income you declared for your visa. Take that into account when you choose the base.
What if you go to work in Ecuador?
If you are employed, your employer registers you with the IESS. Anyone who is not affiliated when that is required risks a sanction (article 51). See working in Ecuador.
And if things go wrong before everything is arranged?
A hospital, public or private, may not refuse emergency treatment because of your nationality or residence status (article 52). That is a safety net for an emergency, not a substitute for insurance.
Bring your medicines for the first months; how that works across the border is in medicines across the border. What your healthcare costs mean alongside your AOW and pension is in AOW, pension and tax.
In Vertrekklaar this is phase 1 of 5 of the journey, step 1.2: the same steps, but for your situation — in your order, tickable, and with the deadlines watched. See the whole journey to Ecuador or go straight to step 1.2 in the open plan.
What this rests on
The facts in this article come from these official pages. Rules change. When in doubt, go by the source, not this article.
- CAK — the treaty countries for health insurance (Ecuador is not among them) — hetcak.nl
- NederlandWereldwijd — health insurance through the CAK, only in a treaty country — nederlandwereldwijd.nl
- Dutch Tax Administration — after emigration no more Wlz and no Anw — belastingdienst.nl
- Treaty with Ecuador on the export and enforcement of social security benefits, article 2 (wetten.overheid.nl) — wetten.overheid.nl
- Ley Orgánica de Movilidad Humana, articles 51 and 52 — social security and the compulsory insurance for residents — gob.ec
- Cancillería (gob.ec) — the insurance requirement for the jubilado visa — gob.ec
- IESS — voluntary affiliation for Ecuadorians and foreigners in Ecuador, with the contribution of 17.60% — iess.gob.ec
- IESS — who may join voluntarily, and the requirement of a cédula — iess.gob.ec
- Ministerio del Trabajo — the basic wage of 482 dollars a month from 1 January 2026 — trabajo.gob.ec
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