EsSalud vs EPS: how to choose, and what stays yours even if your employer signs up for an EPS

The underlying mistake: assuming an EPS replaces EsSalud

When a company signs up for an EPS plan, workers usually assume two things that aren’t true: that management made the call alone, and that EsSalud drops out of the picture from there. Ley N.° 26790, which has governed the system since 1997, says something different on both counts.

Who actually decides whether the company signs up for an EPS

Contracting an EPS isn’t free for the employer — it’s a credit against the 9% contribution it still has to pay EsSalud either way. Article 14 sets that up:

“Las Entidades Empleadoras que otorguen coberturas de salud a sus trabajadores en actividad, mediante servicios propios o a través de planes o programas de salud contratados con Entidades Prestadoras de Salud; gozarán de un crédito respecto de las aportaciones a que se refiere el inciso a) del Artículo 6 de la presente Ley.”

But to actually get that credit through an EPS plan, article 15, subsection b), attaches a condition that’s rarely explained well:

“Las Entidades Empleadoras que, sin contar con servicios propios de salud, deseen gozar del crédito, deberán contratar el Plan y la Entidad Prestadora de Salud elegidos por mayoría absoluta de sus trabajadores mediante votación universal. En todo caso, los trabajadores que así lo deseen podrán optar individualmente por mantener su cobertura íntegramente a cargo del IPSS.”

Two things follow from that. First, the employer doesn’t pick the EPS on its own — it needs an absolute majority of workers to vote for that specific plan in a universal vote. Second — and this is what almost nobody knows — any individual worker can opt out, even if the majority voted in favor, and stay 100% with EsSalud.

What this costs the employer

The credit a company gets for covering its workers through an EPS isn’t unlimited. Article 16 sets it at 25% of the 9% contribution for covered workers, capped two ways: it can’t exceed what the company actually spent that month on health coverage, or 10% of the UIT multiplied by the number of covered workers.

What an EPS never takes away from you: serious care

This is the part that offers the most reassurance, and the one almost nobody knows precisely. Article 17 sets two protections at once: a cap on copays, and a guarantee about what EsSalud keeps covering.

“Dicha cobertura no podrá ser inferior al Plan Mínimo de Atención… y, salvo consentimiento expreso del trabajador, los copagos no podrán superar el 2% del ingreso mensual del asegurado por cada atención de carácter ambulatorio ni el 10% por cada hospitalización… Los trabajadores incluidos en la cobertura ofrecida por la Entidad Empleadora mantendrán su derecho a la cobertura de atenciones de alta complejidad, enfermedades crónicas y subsidios económicos a cargo del IPSS.”

In practice, this means an EPS typically covers what’s called “capa simple”: outpatient visits, routine tests, basic hospitalizations. But if you’re diagnosed with cancer, need a transplant, high-complexity surgery, extended ICU care, or have a chronic condition needing ongoing management, that responsibility stays with EsSalud, whether or not your employer has you on an EPS plan. The same goes for cash subsidies — paid medical leave or maternity leave — which EsSalud keeps covering.

And on the money side: if you’re charged a copay above 2% for outpatient care or 10% for hospitalization, they need your express consent for that. Without it, the legal cap governs.

Who actually pays the 9% contribution

Another point of confusion: unlike your pension fund contribution, the EsSalud contribution doesn’t come out of your paycheck. Article 6, subsection a), says that although the contribution equals 9% of your pay, it’s the employer’s responsibility to declare and pay it directly to EsSalud. If you’re a pensioner, the logic changes: article 6, subsection b), sets your contribution at 4% of your pension, and that one is on you.

Your contributions can’t be seized

One more layer of protection: the funds and contributions destined for EsSalud are untouchable. Articles 7 and 8 anchor that directly in the Constitution: “de conformidad con el Artículo 12 de la Constitución, los recursos antes indicados son intangibles. Ninguna autoridad puede disponer medidas cautelares ni de ejecución sobre ellos.” Not a judge, not a creditor can touch that fund.

How to decide in practice

• If your company is considering an EPS, insist it goes through a universal vote with an absolute majority — not a decision handed down from management (article 15, subsection b).
• If you’d rather stay 100% with EsSalud even if your coworkers vote differently, you have that individual right; exercise it formally with HR.
• Before signing on to any EPS plan, ask in writing exactly what it covers and compare it against what EsSalud still guarantees you by law: high complexity, chronic disease and subsidies (article 17).
• If you’re charged a copay above the legal cap, ask where you gave express consent for that — if you didn’t, they aren’t entitled to charge it.
• If you’re unsure how an IAFAS (your EPS or EsSalud) handled a complaint, the route to escalate it is a denuncia with SUSALUD, explained on the patient complaints to SUSALUD page.