Zora Health / Employer guide / Americas
Compare menopause support for employees across 14 markets in the Americas.
Public cover, sick pay and workplace rules for menopause differ from one market to the next. This page puts the main points from each of Zora’s country guides side by side, so you can see where employees carry the most cost and where the rules are changing. Each country guide has the full detail and sources.
Overview
| Country | Medical cost trend, 2026 | Workplace rules covered in the guide |
|---|---|---|
| Argentina | 21.0% | Sick pay (Applies now); Ley 27.802 (labour modernisation) (From March 2026); Equal treatment (Applies now); Bill 4188-D-2025 (Proposed) |
| Brazil | 9.7% | Sick pay (Applies now); Non-discrimination (Applies now); Ministry of Health technical note (Since April 2026); Menopause care bills (In Congress) |
| Canada | 8.3% | Human rights law (Applies now); Federal medical leave (Since 1 December 2022); Hormone therapy in British Columbia (Since 1 March 2026); Parliamentary committee (Under study); No menopause leave (Leave) |
| Chile | 7.5% | Sick pay (Applies now); Ley 21.561 (40 hours) (In force, phased); Ley 21.645 (work-life balance) (Applies now); No menopause workplace rules (Guidance) |
| Colombia | 9.4% | Sick pay (Applies now); 42-hour working week (From 15 July 2026); Menopause bill (PL 377 of 2025) (Proposed) |
| Costa Rica | 10.0% | Menopause bill (Expediente 25.347) (Proposed, December 2025); Sickness benefit (Applies now); No menopause workplace rules yet (Guidance) |
| Dominican Republic | Not in Aon’s report | Sickness subsidy (Applies now); Family Health Insurance (Applies now); No menopause workplace rules (Guidance) |
| Ecuador | 11.6% | Sick pay (Applies now); Menopause bill (Proposed, March 2026); No menopause workplace rules yet (Guidance) |
| Guatemala | 13.4% | IGSS sickness pay (Applies now); No menopause workplace rules (Guidance) |
| Mexico | 14.8% | Fit menopause into NOM-035 (Meet psychosocial duties); Sickness subsidy (Applies now); Non-discrimination (Applies now); NOM-035 psychosocial risk (Since 2019); Federal menopause protocol (In draft) |
| Panama | 10.0% | CSS sickness benefit (Applies now); No menopause workplace rules (Guidance) |
| Peru | 7.2% | Sick pay (Applies now); No menopause workplace rules (Guidance) |
| United States | 9.5% | Americans with Disabilities Act (Applies now); Family and Medical Leave Act (Applies now); Pregnant Workers Fairness Act (Unsettled); Rhode Island (Since June 2025); Federal menopause care bill (Introduced May 2026) |
| Uruguay | 10.0% | Sickness subsidy (Applies now); Menopause on the agenda (Public health); No menopause workplace rules (Guidance) |
Public cover and costs by country
Each card shows what public cover or mandatory insurance pays for and what the employee still carries, as set out in that country’s guide.
Americas
Argentina
- Hormone therapy under the PMO. Estradiol, estriol, conjugated oestrogens, medroxyprogesterone and progesterone covered at 40% of a reference price. Employee still carries: about 60% of the reference price.
- Medicines for chronic conditions. Covered at 70% of a reference price. Employee still carries: about 30%.
- Time off for appointments. Employer pays full salary during sick leave: 3 months with up to 5 years’ service, 6 months with more, longer with dependents. Employee still carries: no menopause leave.
Americas
Brazil
- Primary care in the SUS. Free; the April 2026 technical note makes primary care the coordinator of menopause care. Employee still carries: about 1.4 million primary care appointments for menopause in 2025, roughly 4% of the estimated population.
- Hormone therapy in the SUS. Topical vaginal estriol is listed; systemic hormone therapy is not on the national medicines list. Employee still carries: systemic therapy is usually bought privately or through a health plan.
- Private gynaecology consultation. No public subsidy. Employee still carries: R$130 to R$600 for a first consultation in listed clinics in the São Paulo metropolitan area.
- Time off for appointments. Employer pays the first 15 days of sick leave; INSS pays 91% of the benefit base from day 16. Employee still carries: no menopause leave.
Americas
Canada
- Family doctor or specialist visit. Covered by provincial health insurance, for example OHIP in Ontario. Employee still carries: finding a clinician with menopause expertise can take time.
- Hormone therapy in British Columbia. Listed menopausal hormone therapy covered in full under Plan NP since 1 March 2026, for residents enrolled in MSP. Employee still carries: unlisted products are paid by the employee or a private plan.
- Hormone therapy in other provinces. Depends on provincial drug programmes; OHIP does not cover most prescription drugs outside hospital. Employee still carries: paid through an employer drug plan or out of pocket.
- Private virtual menopause care. No public subsidy. Employee still carries: from C$99 for a first visit and C$40 for follow-ups at one online provider, plus medication.
- Time off for appointments. Federally regulated employees get up to 10 paid medical leave days a year. Employee still carries: provincial employees depend on provincial standards and employer policy.
Americas
Chile
- Public primary care (FONASA). MINSAL has technical guidance for climacteric care in primary care, and the public medicines basket includes some hormone therapy. Employee still carries: limited choice of hormone therapy; private treatment costs.
- Explicit health guarantees (GES). 0% co-payment for FONASA groups A and B, 10% for group C, 20% for group D and ISAPRE members. Employee still carries: we could not confirm that menopause is a GES condition.
- Time off for appointments. Medical leave of 11 days or more is paid from day 1; shorter leave from day 4. Employee still carries: the first 3 days of short leave.
Americas
Colombia
- EPS visits (cuota moderadora), 2026. Covered by the EPS. Employee still carries: COP 5,000 under 2 minimum wages; COP 20,100 for 2 to 5; COP 52,800 above 5.
- Other services (copago), 2026. Covered by the EPS. Employee still carries: 11.5%, 17.3% or 23.0% depending on income, with annual caps from COP 748,882 to COP 5,990,696.
- Time off for appointments. Employer pays days 1 and 2; the EPS pays from day 3 at two thirds of salary for the first 90 days. Employee still carries: no menopause leave.
Americas
Costa Rica
- CCSS medical care. Care, medicines and hospital stays provided directly by the CCSS. Employee still carries: employee contribution of 5.5% of earnings (2019 rates).
- Private specialist care. Through employer medical insurance, where offered. Employee still carries: fees not covered by the plan.
- Time off for appointments. CCSS sickness benefit of 60% of earnings after a three-day waiting period. Employee still carries: the first three days and the gap to full pay.
Americas
Dominican Republic
- SFS health insurance. In-kind care through the Health Services Plan; the employer pays the larger share of the contribution. Employee still carries: employee pays 3.04% of salary.
- Choice of ARS. Each worker chooses an ARS and tells the employer within 10 days. Employee still carries: care outside the plan.
- Time off for appointments. Sickness subsidy of 60% of average salary for outpatient treatment (40% in hospital), from at least 4 days of incapacity, for up to 26 weeks. Employee still carries: the gap to full pay.
Americas
Ecuador
- IESS medical care. Provided directly at IESS facilities, with refunds for some external care. Employee still carries: private fees for faster care.
- Time off for appointments. Employer pays 50% of earnings for the first 3 days; IESS then pays 75% for up to 70 days, then 66%. Employee still carries: the gap to full pay.
Americas
Guatemala
- IGSS illness cover. General and specialist medicine, tests, medicines, reproductive health and family planning. Employee still carries: worker contribution of 4.83% across IGSS programmes.
- Private specialist care. Through employer medical insurance, where offered. Employee still carries: fees not covered by the plan.
- Time off for appointments. IGSS pays two thirds of daily base salary from day 4, for up to 26 weeks; the employer pays day 1. Employee still carries: days 2 and 3, and the gap to full pay.
Americas
Mexico
- IMSS care for affiliated workers. Menopause care at all three levels, with hormonal and non-hormonal treatment. Employee still carries: waiting times and access vary by clinic.
- Private gynaecology consultation. No public subsidy. Employee still carries: MX$950 to MX$3,000 for a first visit in listed Mexico City clinics.
- Gynaecological tests. No public subsidy privately. Employee still carries: pelvic ultrasound MX$215 to MX$1,509 and mammogram MX$295 to MX$1,309 in Mexico City, according to PROFECO.
- Time off for appointments. IMSS sickness subsidy of 60% of the contribution base from day 4. Employee still carries: no menopause leave.
Americas
Panama
- CSS medical care. Employer pays 8% of payroll for medical benefits; dependants get the same cover. Employee still carries: employee pays 0.5% of earnings for cash sickness benefits (2019 rates).
- Private specialist care. Through employer health insurance, where offered. Employee still carries: fees not covered by the plan.
- Time off for appointments. CSS pays 70% of average daily earnings from day 4, up to 26 weeks. Employee still carries: the first 3 days and the gap to full pay.
Americas
Peru
- EsSalud care. Covers insured employees. Employee still carries: waiting times, or private fees for faster specialist care.
- Private specialist care. Through an EPS or private plan, where offered. Employee still carries: fees not covered by the plan.
- Time off for appointments. Employer pays salary for the first 20 days of incapacity; EsSalud pays a subsidy from day 21. Employee still carries: no menopause leave.
Americas
United States
- Primary care or gynaecology visit. Covered under most employer health plans, subject to deductibles and copays; we found no federal law requiring specific menopause cover. Employee still carries: costs vary widely by plan design and network.
- Menopause hormone therapy. Cover depends on the plan formulary. Employee still carries: average out-of-pocket cost of US$14.33 per 30-day prescription; some brands cost over US$100.
- Specialist menopause care. Depends on the plan network. Employee still carries: clinicians certified in menopause care are not available in every network.
- Time off for appointments. No federal menopause leave; FMLA gives up to 12 weeks of unpaid, job-protected leave for a serious health condition, for eligible employees. Employee still carries: paid sick leave depends on state law and employer policy.
Americas
Uruguay
- FONASA contribution. Employer pays 5%. Employee still carries: employee pays 3% to 8% of earnings, depending on income and dependants.
- Care under the SNIS. Covered through FONASA. Employee still carries: any co-payments set by the provider.
- Time off for appointments. BPS sickness subsidy of 70% of taxable earnings from day 4, capped at UYU 67,754 (January 2026). Employee still carries: the first 3 days and the gap to full pay.
Related guides
Menopause benefits compared: Asia PacificPublic cover and workplace rules by countryMenopause benefits compared: Middle East and AfricaPublic cover and workplace rules by countryMenopause benefits compared: EuropePublic cover and workplace rules by countryEmployer guides by countryFertility and menopause guides for 85 marketsMenopause corporate benefits guideOptions for designing a menopause benefit
Sources
- Aon, The Global Medical Trend Rates Report 2026
- Aon, APAC employee medical plan costs to stabilise in 2026 (October 2025)
- Public cover, costs and workplace rules: the sources listed on each country guide linked above
Plan menopause support across the Americas
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