Two Parallel Systems: Visa Insurance vs. EPS
One of the most frequent confusions among foreigners in Colombia is equating the medical insurance required for the visa with EPS affiliation (Colombia's national health system for formal workers). They are two distinct legal instruments with partially different purposes and different legal bases.
Medical assistance plan for the visa (Resolution 5477)
This is the immigration requirement imposed by the Cancillería. Its purpose is to guarantee that the foreigner has medical coverage during their stay in Colombia without depending on the public health system. CoVisas plans are examples of this instrument. The 7 mandatory coverage categories: accidents, illness, hospitalization, maternity, sanitary repatriation, and death. Full analysis: the 7 mandatory coverage categories.
EPS (SGSSS affiliation)
Colombia's Sistema General de Seguridad Social en Salud (SGSSS) is the health insurance mechanism for formal workers. Affiliation is mandatory for any worker — Colombian or foreign — who has a formal employment relationship in Colombia. The employer pays employer contributions; the worker pays employee contributions, in percentages established by Law 100 of 1993.
When Is a Foreigner Required to Affiliate with the SGSSS?
Foreign worker with a formal employment contract in Colombia
If the foreigner has a formal labor relationship with a Colombian or foreign employer operating in Colombia, SGSSS affiliation is mandatory for both parties. The employer must enroll the worker with an EPS, a pension fund, and an ARL (occupational risk insurer). The current contribution rates: health — 12.5% of base income (employer 8.5%, worker 4%); pension — 16% (employer 12%, worker 4%); ARL — employer only, rate varies by risk level.
Self-employed foreigner with economic activity in Colombia
If the foreigner conducts independent economic activities in Colombia (consulting, professional services, property rentals) and their income exceeds one minimum monthly wage, they must also contribute to the SGSSS as an independent worker. Monthly contributions to the health system are required.
Foreigner without labor activity in Colombia
A foreigner in Colombia as a visitor, tourist, student, or retiree without labor activity is not required to affiliate with the SGSSS. In these cases, the immigration requirement is met exclusively through the medical assistance plan for the visa (like CoVisas).
UGPP: Active Oversight of Foreign Workers' Contributions
The Unidad de Gestión Pensional y Parafiscales (UGPP) has authority to audit social security contribution compliance. When it detects that a worker — Colombian or foreign — with economic activity in Colombia has not contributed correctly, it can demand back contributions plus interest and penalties. Foreigners with Colombian income are not immune to this oversight.
Comparison: Visa Plan vs. EPS
| Aspect | Medical Assistance Plan (Visa) | EPS (SGSSS) |
|---|---|---|
| Required by | Cancillería — Res. 5477 | Law 100 / Ministry of Health |
| When mandatory | Always when holding Colombian visa | Only with formal work or independent activity with income |
| Who pays | Visa holder | Employer + worker (proportional) |
| International coverage | Yes (except country of origin) | No |
| Repatriation | Yes (mandatory coverage) | Not applicable |
| Continuity without employment | Yes — directly with CoVisas | Only as voluntary contributor |