IESS: Ecuador's Social Security
The Instituto Ecuatoriano de Seguridad Social is mandatory for all visa holders. Here's everything you need to know about enrollment, costs, benefits, and how to use the system.
IESS enrollment is mandatory for visa holders
Ecuador law requires all resident visa holders to enroll in IESS voluntary affiliation within 30 days of receiving their visa. Non-compliance can affect your visa renewal.
~$80/mo
Monthly cost (minimum base)
100%
Pre-existing covered
3 months
Waiting period (non-emergency)
17.6%
Rate (% of declared income)
Step by Step
How to Enroll in IESS
Get Your Cédula (ID Card)
You need your Ecuadorian cédula de identidad, which is issued after your visa is approved. This is your ID number for all IESS interactions.
Visit the IESS Office or Register Online
Go to your local IESS office (bring cédula, passport, and visa) or register through the IESS website at www.iess.gob.ec. The online process has improved but may still require an in-person visit.
Choose Voluntary Affiliation
As a foreign resident, you'll enroll under 'Afiliación Voluntaria' (Voluntary Affiliation). Declare your income base — the minimum is the national minimum wage (approximately $460/month in 2025).
Set Up Monthly Payments
Payments are 17.6% of your declared income base. At minimum wage, that's approximately $80/month. Payments can be set up through direct bank debit or manual payment at banks.
Wait for Activation
After enrollment, there's a 3-month waiting period for non-emergency services. Emergency care is available immediately. After 3 months, you have full access to all IESS services.
Benefits
What IESS Covers
General Healthcare
- Doctor visits and consultations
- Specialist referrals
- Surgery and hospitalization
- Laboratory tests and imaging
- Emergency care (immediate, no waiting period)
Medications
- Prescription medications at IESS pharmacies
- No additional cost for covered medications
- Generic equivalents available
- Chronic condition medications included
Maternity & Family
- Prenatal care and checkups
- Hospital delivery
- Postnatal care
- Pediatric care for children
Other Benefits
- Dental care (basic procedures)
- Disability payments
- Death benefit (~$1,000)
- Pension (after years of contribution)
- Work injury coverage
Where to Go
Major IESS Hospitals
Hospital Carlos Andrade Marín
Largest IESS hospital in Ecuador. Full-service facility with most specialties. Often crowded but well-equipped.
Hospital Teodoro Maldonado Carbo
Main IESS hospital for the coast. Large facility with emergency, surgery, and specialist departments.
Hospital José Carrasco Arteaga
Primary IESS hospital for the southern highlands. Modern facility popular with the large expat community.
IESS + Private Insurance: The Expat Strategy
Most expats use a two-tier approach: IESS for mandatory compliance, visa renewals, and pre-existing condition coverage, plus a private insurance plan for faster access to top hospitals, English-speaking doctors, and shorter wait times. This combination gives you the best of both worlds.
Use IESS For
- Visa compliance and renewals
- Pre-existing conditions (fully covered)
- Chronic medication prescriptions
- Dental care (basic procedures)
- Pension and disability benefits
Use Private Insurance For
- Faster access to specialists (no wait times)
- Top private hospitals (Hospital Metropolitano, etc.)
- English-speaking doctors
- Emergency surgery without delays
- International coverage for travel
Compare private plans to complement IESS
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