If you’ve been diagnosed with a spine condition in Chile, someone probably mentioned the words “GES” or “AUGE” without explaining what they actually mean or what they guarantee you. Knowing whether your condition is covered, what the law actually secures for you, and how to activate the benefit can save you weeks of uncertainty and a substantial amount of money in unforeseen expenses. This guide helps you understand the basic concepts of GES/AUGE applied to spine conditions, how to access the benefit, and what you should know before your next medical visit.
Why you need to know about GES/AUGE
The Chilean healthcare system combines three distinct logics that coexist for every patient: mandatory legal coverage (GES/AUGE), the plan from your insurer (FONASA or ISAPRE), and the private market for medical services. Most people use the system without realizing they have explicit legal rights over certain conditions, and end up paying for consultations, exams, or surgeries that GES would have covered.
Spine conditions are one of the areas where most confusion exists. Lumbar Herniated Nucleus Pulposus (HNP) and Scoliosis in patients under 25 are the two spine conditions directly covered by GES, but the clinical criteria for entering the benefit are specific. Knowing them allows you to ask better questions, save money, and reduce waiting times.
What is GES/AUGE?
GES stands for “Garantías Explícitas en Salud” (Explicit Health Guarantees). It is also known as the AUGE Plan (“Acceso Universal con Garantías Explícitas,” or Universal Access with Explicit Guarantees), the program’s original name when it launched in 2005. Today, the two acronyms are used interchangeably: GES and AUGE refer to the same coverage regime.
GES was created by Law 19.966 of 2004, which mandated that a selected group of health problems must be treated by every health insurer in the country (FONASA and ISAPRE) under four minimum guarantees. The underlying idea is that certain serious, frequent, or high-cost conditions should not depend on network availability, the patient’s resources, or individual negotiations with the insurer.
The list of covered health problems is not fixed: it is updated by ministerial decree on a regular basis, based on clinical and economic evidence. Since its launch in 2005 with 25 problems, the list has grown to 90 guaranteed conditions under Supreme Decree N°29, in force since December 1, 2025. Each problem enters the list with a specific Clinical Guideline that describes the criteria for becoming a beneficiary, the covered services, the maximum timelines, and the copayments according to the health system you belong to.
The 4 explicit guarantees
GES/AUGE is not just “a list of covered conditions.” What sets GES apart from any other benefit is that it defines four minimum guarantees, all legally enforceable, for every health problem included:
1. Access. If you meet the criteria defined in the Clinical Guideline for your condition, your insurer (FONASA or ISAPRE) is required to provide the covered services. They cannot deny you the benefit or condition it on additional copayments not contemplated in the guideline.
2. Quality. Care must be delivered in accredited facilities by professionals with the required qualifications. The list of accredited providers is public and available through the Health Superintendence website.
3. Timeliness. Each service has a maximum timeline defined by decree, counted from the clinical event that indicates it. For example, a surgery runs from the surgical indication; the post-surgery specialist follow-up runs from hospital discharge. If the insurer fails to meet the timeline, you can be referred to a different provider or file a complaint with SUPERSALUD.
4. Financial protection. The maximum copayment is capped by law. For FONASA users in any bracket (A, B, C, or D), GES spine services are free ($0), according to the official information published by the Health Superintendence. For ISAPRE users, the copayment is 20% of the reference fee for the procedure, regardless of the plan. Additionally, the sum of copayments for a single GES event has a maximum cap of UF 122 per individual beneficiary (or UF 181 if more than one beneficiary in the family group requires GES services in the year), according to the information published by the ISAPREs and current regulations at the time of this publication. The exact amounts and the way the cap is applied may vary by plan; check the details with your insurer before starting the process. Beyond that cap, the ISAPRE covers the remaining cost. This mechanism is independent from CAEC (Additional Coverage for Catastrophic Diseases), which applies to other non-GES medical expenses.
That combination — legal obligation, maximum timelines, and financial cap — is what makes GES different. It is not an additional insurance product or a contractual promise: it is an enforceable right.
How a condition enters GES
Not every condition is on the list. The selection is based on technical criteria defined by the Ministry of Health and the Health Superintendence:
- Disease burden. How common and how serious the condition is in the Chilean population.
- Cost-effectiveness of treatment. How well the available intervention works, in terms of health gained per peso invested.
- Service availability. Whether the healthcare system has the actual capacity to meet the timeliness guarantees without collapsing.
- Equity in access. Whether the lack of coverage creates a clear inequality between those who can afford care and those who cannot.
The list is reviewed periodically. The final decision is made by the Ministry of Health by decree, with technical support from evaluation commissions. Conditions that are not currently covered may be incorporated in future revisions if the evidence and resources allow it.
Spine conditions included in GES/AUGE
Within the 90 currently guaranteed GES conditions, the ones that directly affect spine patients are two, both with literal clinical criteria defined in their MINSAL Clinical Guidelines:
Lumbar Herniated Nucleus Pulposus (HNP)
Covered only in adult patients whose case meets the criteria defined in the 2013-2014 MINSAL Clinical Guideline. The literal criteria are:
- Surgical indication (Recommendation Grade B): “radicular pain that does not respond to medical treatment after a 6-week period or that presents progressive neurological involvement”.
- Cauda Equina Syndrome (medical emergency with immediate referral, no 6-week wait required): severe acute or progressive motor neurological deficit (M3), urinary retention, fecal incontinence, decreased sphincter tone, saddle anesthesia.
- Associated red flags (suggesting severe or complicated HNP): age over 65, history of cancer, severe night pain that does not subside, recent trauma, prolonged corticosteroid use, persistent fever, unexplained weight loss.
The MINSAL guideline explicitly excludes from GES the management of non-specific low back pain (without radiculopathy) and cases with a favorable response to initial medical treatment. Open surgery (microdiscectomy) is the surgical technique of choice according to the guideline.
Official guaranteed timelines (per the Health Superintendence):
- Surgery: within 45 days from surgical indication.
- Specialist follow-up: 30 days from hospital discharge.
If your case meets the GES HNP criteria, the formal steps to activate your coverage, the legal deadlines and the key decisions (which provider to choose, what happens if you decline the GES network, how to claim the copay voucher) are explained in detail in our dedicated guide: Lumbar Herniated Disc and GES — step-by-step process.
Scoliosis in Persons Under 25 years
Covered in patients under 25 years old with scoliosis (idiopathic or non-idiopathic) who meet the criteria defined in the 2010 MINSAL Clinical Guideline:
- Scoliosis diagnosis: “Any curve over 10°, measured by the Cobb method on standing spine radiographs, is considered pathological and must be monitored until the end of puberty”.
- Surgical indication in adolescent idiopathic scoliosis (literal):
- Curves >40° in pre-menarchal immature girls and post-menarchal skeletally immature patients, with curve progression despite brace use.
- Curves >30° associated with severe dorsal lordosis and decreased thoracic volume.
- Curves >50° in skeletally mature patients.
- Curves >40° in male patients under 16 years.
- Curves between 40-50° in skeletally mature patients with severe trunk deformity.
- Indication in young adults (20-25 years): Curves >50° showing progression.
- Orthopedic treatment (brace): indicated in adolescent idiopathic scoliosis with skeletal immaturity and curve <30°.
Official guaranteed timelines (per the Health Superintendence):
- Surgery: within 270 days from diagnostic confirmation.
- First post-discharge follow-up: 10 days after hospital discharge.
Important: the criteria above are the literal text of the current MINSAL Clinical Guidelines. If your case is non-specific low back pain without an identified herniation, a spondylolisthesis without surgical criteria, adult scoliosis over 25, or a mild vertebral sprain, you are not covered by spine GES and must manage it through your regular FONASA or ISAPRE plan. To better understand these conditions, you can read our guide on what a herniated disc is and the full guide on low back pain.
How to activate the benefit (step by step)
The process for making the GES guarantees effective follows a defined order:
1. Diagnostic confirmation. A physician must confirm that you meet the criteria of the Clinical Guideline for your condition. For spine, this typically requires a physical examination, imaging (MRI, X-ray, or CT scan as applicable), and sometimes electromyography when there is radicular involvement.
2. Notification to the insurer. The treating physician or the healthcare center issues the GES notification form, declaring that you meet the clinical requirements. This form is sent to your insurer (FONASA or ISAPRE).
3. Coverage activation. Once the notification is received, the insurer must assign you an accredited provider and deliver the covered services within the legal timelines corresponding to each service.
4. Access to services. Once the timeliness guarantee kicks in, you receive care (consultations, exams, surgery if applicable, physical therapy, follow-ups) at the assigned provider, with the maximum copayment defined for your bracket or plan.
5. Filing a complaint if timelines are not met. If the insurer does not meet the guaranteed timelines, you can file a complaint with SUPERSALUD, which has the authority to oversee compliance with the guarantees and impose sanctions when warranted.
Differences between FONASA and ISAPRE in using GES
Although both modalities cover the same conditions and have the same four guarantees, there are practical differences in how the benefit is exercised:
FONASA
- The GES provider network is the Institutional Care Modality (MAI), generally hospitals and public health centers.
- $0 copayment in any bracket (A, B, C, or D) for lumbar HNP and Scoliosis under 25, according to the official Health Superintendence information.
- Specialist referral usually goes through primary care.
ISAPRE
- The GES network is defined by each ISAPRE: typically private clinics under contract with the insurer.
- Copayment: 20% of the reference fee for the procedure, with an aggregate cap per event of UF 122 individual (or UF 181 if more than one beneficiary in the family group), according to the information published by the ISAPREs and current regulations. Beyond the cap, the ISAPRE covers the remaining cost. Check the details with your insurer for your specific plan.
- Referral starts directly from the treating physician within the GES network of the ISAPRE.
If your ISAPRE offers care outside the GES network, that care moves to the regular plan regime, with different coverages. This often causes confusion, because many patients use their regular plan without knowing they could activate GES and pay significantly less for the same condition.
What GES/AUGE does NOT cover
GES has explicit rules, but it also has clear limits worth knowing:
- Care outside the accredited network. If you choose to be treated by a non-assigned provider, you lose the financial guarantee and the timeliness guarantee for that specific care.
- Services not included in the Clinical Guideline. Experimental procedures, complementary therapies, or very new technologies are usually outside until the Guideline formally incorporates them.
- Conditions not on the list. For example: chronic non-specific low back pain, vertebral sprains, certain spondylolisthesis without surgical criteria, mild sports injuries.
- Voluntary second medical opinions. GES guarantees treatment within the assigned network. Asking for a second opinion with a specialist of your choice, outside that network, is a personal decision not covered by GES.
- Accessory private services. Telemedicine, structured patient education outside the institutional framework, or premium services are outside the benefit.
How to use this knowledge in your next visit
Having the GES concepts clear allows you to ask specific questions instead of accepting the first thing offered:
- Is my diagnosis within GES? Do I meet the Clinical Guideline criteria?
- If it is, what services do I have covered, and what timelines do they have?
- Has the insurer received the GES notification yet? Where can I be treated?
- What copayment will I have based on my FONASA bracket or my ISAPRE plan?
- If timelines are not met, how do I file a complaint with SUPERSALUD?
These questions are not aggressive: they are the ones the law itself invites you to ask. Having clarity on these points typically speeds up the process, prevents unforeseen costs, and reduces the feeling of being trapped in bureaucracy.
Myths and realities
| Myth | Reality |
|---|---|
| “If I have ISAPRE, GES doesn’t cover me.” | False. GES is mandatory for both FONASA and ISAPRE since Law 19.966. The difference is in the assigned network and the copayments, not in the right itself. |
| “GES covers any back pain.” | False. It only covers conditions explicitly included and only if you meet the clinical criteria defined in the corresponding MINSAL Clinical Guideline. |
| “Activating GES is slow, better to pay privately.” | It depends. GES has maximum timelines by law. If your condition is covered and you follow the process, it is usually faster and significantly cheaper. |
| “Once GES is activated, I can’t choose anything else.” | False. You can keep GES active and, in parallel, decide whether to seek a second opinion or complementary private services. They are independent decisions. |
| “GES pays for the full surgery, I shouldn’t pay anything.” | For FONASA, that’s correct: $0 copayment in any bracket (A, B, C, or D) according to the official Health Superintendence information. For ISAPRE, the copayment is 20% of the reference fee, with an aggregate cap of UF 122 per event (UF 181 if family-group), according to information published by the ISAPREs. Beyond the cap, ISAPRE covers the remaining cost. Check the details with your insurer. |
| “If I’m not in GES, I have no right to care.” | False. If your condition is not on the list, you still have coverage through your regular FONASA or ISAPRE plan; you simply don’t get the four additional explicit guarantees. |
Bottom line
GES/AUGE is not a minor benefit: it is a legal tool that gives you the right to timely care, in an accredited network, with a capped copayment, for specific conditions. Knowing it well allows you to ask better questions of your insurer, file complaints when warranted, and significantly reduce the costs associated with a serious spine condition.
Knowing whether your case meets the literal GES criteria, what to do when timeframes aren’t respected, or how to evaluate a surgical indication are questions best resolved by reviewing the details with a specialist. If you need guidance about your specific situation, you can schedule a teleconsult with Dr. Yoshiro Sato. The consultation is via video call, lasts 30 minutes, and includes review of your imaging.
To go deeper into specific conditions: read our guide on what a herniated disc is and the full guide on low back pain, the two most frequent conditions that fall within the GES benefit.
This content is for educational purposes and does not replace evaluation by an orthopedic spine specialist. If you have persistent symptoms or red flags, consult a physician.
Frequently asked questions
Does GES/AUGE cover me if I'm with an ISAPRE?
Yes. GES is mandatory for both FONASA and ISAPRE since Law 19.966. What changes between the two systems is the assigned provider network and the copayment, not the right to coverage itself.
Is any back pain covered by GES?
No. Only the conditions explicitly included in the current list, and only if you meet the clinical criteria defined in the corresponding MINSAL Clinical Guideline. Non-specific low back pain, for example, is not within GES.
How much do I pay if I activate GES for a spine condition?
If you are a FONASA user in any bracket (A, B, C, or D), the copayment is $0 according to the official information published by the Health Superintendence. If you are an ISAPRE user, the copayment is 20% of the reference fee for the procedure, with an aggregate cap per event of UF 122 (individual) or UF 181 (if more than one beneficiary in the family group requires GES services), according to the information published by the ISAPREs and current regulations. The exact amounts and the way the cap is applied may vary by plan; check the details with your insurer before starting the process. Beyond that cap, the ISAPRE covers the remaining cost.
Can I choose my treating physician within GES?
GES guarantees care within an accredited network assigned by your insurer. Choosing a specific provider is limited. If you want a second opinion with a specialist outside that network, that’s a separate service, not covered by GES.
What do I do if GES doesn't meet the timelines I'm entitled to?
You can file a complaint with the Health Superintendence (SUPERSALUD), which has powers to oversee compliance with the explicit guarantees. Timeliness is one of the four guarantees: if it’s breached, the insurer must respond.
Is a herniated disc always covered by GES?
Not always. Lumbar Herniated Nucleus Pulposus (HNP) is included in GES, but only in adult patients with radicular pain that does not respond to medical treatment after 6 weeks, or with progressive neurological involvement, according to the literal criteria of the 2013-2014 MINSAL Clinical Guideline. Cauda equina syndrome (urinary retention, saddle anesthesia, severe motor deficit) is always an emergency and warrants immediate referral.
Scientific references
This article cites the following peer-reviewed sources and official clinical guidelines:
- (2004). Law 19.966 — Establishes a Health Guarantees Regime. Ministry of Health, Republic of Chile.
- (2014). AUGE Clinical Guideline — Lumbar Herniated Nucleus Pulposus. MINSAL Clinical Guidelines Series, 2013-2014 (DIPRECE).
- (2024). Surgical Treatment of Lumbar Herniated Nucleus Pulposus — GES Guarantees. SUPERSALUD — Health Orientation.
- (2010). Clinical Guideline — Surgical Treatment of Scoliosis in Persons Under 25 years. MINSAL Clinical Guidelines Series, 2010 (DIPRECE).
- (2024). Surgical Treatment of Scoliosis in Persons Under 25 years — GES Guarantees. SUPERSALUD — Health Orientation.
- (2024). Explicit Health Guarantees (GES) — List of Health Problems. MINSAL — official site.
- (2025). Supreme Decree N°29 — Approves Explicit Health Guarantees of the General Health Guarantees Regime. Official Gazette of the Republic of Chile, 28 Nov 2025 (in force since 1 Dec 2025).
- (2010). After Chile's health reform: increase in coverage and access, decline in hospitalization and death rates. Health Affairs, 29(12):2161-2170.
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