All fees, discount percentages and coverage limits below were read directly from Hospital Vivian Pellas's published Club de la Salud pages in July 2026 and are linked at the end. Discount tables shown are for the Adult plan; children's and senior schedules may differ. Prices are set in córdobas and converted at the official rate of C$36.62 = US$1. Confirm current terms with the hospital before enrolling.
For many expats moving to Nicaragua, healthcare is the deciding question. Hospital Vivian Pellas (HVP) in Managua is the country's best-known international-standard private hospital, and its Club de la Salud membership is widely recommended in expat circles. It is worth understanding precisely — because how it works is not how most summaries describe it.
The short answer. Club de la Salud is a discount membership, not insurance. Adult cover costs C$1,245/month (about $34) for Standard or C$2,380 (about $65) for Dorado. But the discounts are not fixed — they increase with how long you have been a member, and hospitalisation and ICU are not discounted at all during your first 90 days.
There are also hard ceilings. Discounts stop at C$220,000 (about $6,008) per event and C$1,099,000 (about $30,011) per year on the Standard plan. Above those limits you receive 20% off the remainder and nothing more.
The single most important thing to understand. Discount percentages depend on how long you have held the membership — 24 hours, 90 days, or 180 days — and the highest figures apply only to the Dorado tier after 180 days.
If you join today and are admitted to intensive care next month, your ICU discount is not 80%. It is nothing. ICU and hospitalisation show "N/A" in the first 24-hour band and reach only 40% at 90 days.
| Plan | Standard | Dorado |
|---|---|---|
| Children (0–16) | C$1,175 (~$32) | Not listed as a separate tier |
| Adult (17–64) | C$1,245 (~$34) | C$2,380 (~$65) |
| Senior (65+) | C$1,795 (~$49) | C$3,810 (~$104) |
This is the part most summaries get wrong. HVP publishes a tiered schedule: the longer you have been a member, the larger the discount. The columns below are the hospital's own — Standard at 24 hours, 90 days and 180 days, then Dorado at 180 days.
| Service | Standard 24 hours | Standard 90 days | Standard 180 days | Dorado 180 days |
|---|---|---|---|---|
| Emergency | ||||
| Emergency physician | 30% | 50% | 70% | 100% |
| Ambulance | 20% | 40% | 60% | 80% |
| Other emergency services | 20% | 30% | 50% | 100% |
| Hospitalisation & surgery | ||||
| ICU stay | N/A | 40% | 70% | 80% |
| Medical/surgical room | N/A | 40% | 70% | 80% |
| Operating theatre | N/A | 40% | 70% | 80% |
| Anaesthesia | N/A | 40% | 70% | 80% |
| Maternity room | N/A | 25% | 30% | 30% |
| Diagnostics | ||||
| Laboratory | 20% | 30% | 50% | 70% |
| X-ray | 20% | 40% | 60% | 70% |
| Ultrasound | 20% | 30% | 40% | 60% |
| MRI | 20% | 30% | 40% | 60% |
| CT scan | 20% | 30% | 40% | 60% |
| Mammogram | 20% | 30% | 40% | 60% |
| Bone densitometry | 30% | 50% | 70% | 80% |
| Pathology | 30% | 50% | 70% | 80% |
| Endoscopy | 20% | 30% | 40% | 60% |
| Colonoscopy | 20% | 30% | 40% | 60% |
| ECG | 15% | 20% | 25% | 30% |
| Neurophysiology studies | 5% | 10% | 15% | 25% |
| Executive check-up | 20% | 25% | 30% | 30% |
| Physiotherapy session | 20% | 30% | 50% | 60% |
| Medications | ||||
| In emergency | 5% | 10% | 15% | 30% |
| In hospitalisation | 10% | 20% | 30% | 30% |
| In ICU | 5% | 5% | 10% | 10% |
| Outpatient | 20% | 25% | 30% | 30% |
| Dental | ||||
| General assessment / basic cleaning | 20% | 40% | 60% | 60% |
| Teeth whitening | 5% | 10% | 15% | 20% |
| Other dental procedures | 10% | 15% | 20% | 30% |
Three things stand out. ICU medications are discounted at only 5–10% regardless of tier — the lowest figure in the whole schedule, in the setting where drug costs are highest. Maternity tops out at 30%. And the headline "100% emergency" figure applies to the emergency physician's fee on the Dorado plan after 180 days — not to an emergency visit as a whole.
HVP caps the total discount it will apply. These limits are published on each plan page and are easy to miss.
| Limit | Standard | Dorado |
|---|---|---|
| Per event | C$220,000 (~$6,008) | C$293,000 (~$8,001) |
| Per contract year | C$1,099,000 (~$30,011) | C$1,465,000 (~$40,005) |
Once a bill reaches the limit, the hospital applies 20% off the remainder. The annual figure is cumulative across all events in the contract year.
The children's plan lists a single set of limits — C$293,000 per event and C$1,465,000 per year.
HVP also reserves the right to adjust rates or benefits for members whose claims rate differs significantly from the usual. That clause is in the published terms.
MediMás is a separate, cheaper HVP membership aimed at routine and preventative care rather than major events. Specialist consultations start at C$275 (about $7.50), and the site advertises discounts of up to 60% on diagnostics.
We have not independently confirmed the MediMás monthly membership fee or the discount schedule beyond the consultation rate. Ask MediMás directly for current terms.
No, and it is important to be clear about that. Club de la Salud is a discount programme tied to one hospital. It reduces your bill at Hospital Vivian Pellas; it pays nothing anywhere else, and it does not travel with you.
For many expats the sensible structure is a membership for routine and local care alongside international cover for catastrophic events — particularly given the per-event ceiling of around $6,000 on the Standard plan, which a serious surgery or extended ICU stay can exceed.
Adult cover is C$1,245 a month for Standard or C$2,380 for Dorado, which is about $34 and $65 at the official rate. Seniors aged 65 and over pay C$1,795 or C$3,810, about $49 and $104. The children's plan is C$1,175, about $32. Fees are set in córdobas.
Only partially. Discounts are tiered by how long you have been a member, at 24 hours, 90 days and 180 days. Hospitalisation, ICU, operating theatre and anaesthesia show no discount at all in the first band, and reach only 40% at 90 days. The largest percentages apply to the Dorado plan after 180 days.
Not in general. The 100% figure applies to the emergency physician's fee, and only on the Dorado plan after 180 days of membership. On the Standard plan that same fee is discounted 30% in the first 24 hours, rising to 70% after 180 days. Ambulance and other emergency services are lower.
Yes. On the Standard plan discounts stop at C$220,000 per event, about $6,008, and C$1,099,000 per contract year, about $30,011. The Dorado limits are C$293,000 and C$1,465,000. Beyond those, the hospital applies 20% off the remaining balance.
No. Club de la Salud is a discount membership valid only at Hospital Vivian Pellas. It does not cover treatment at other facilities and does not travel with you. Many expats pair a membership for routine care with international insurance for catastrophic events.
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Figures read from the hospital's published pages in July 2026 and converted at C$36.62 = US$1. Hospital terms, fees and discount schedules change without notice — confirm directly with Hospital Vivian Pellas before enrolling. This is information, not medical, insurance or financial advice.
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