Unfortunately, the answer to this question is more nuanced than it really should be. This has led to some confusion amongst expats, and even lawyers and facilitators.
What is clear is that you need health insurance before you can apply for your cédula. This is universally accepted. But, whether you need health insurance as part of your permanent or temporary residency visa applications depends on the migration office you apply through.
There was a slew of visa changes in February 2021. But, the Azogues office has decided to interpret these rules differently from other migracion offices. Effectively creating two sets of rules. One for Azogues, another for the rest of Ecuador.
We help a lot of people obtain their temporary and permanent residency visas for Ecuador. Our strong preference is to always avoid the Azogues office because they have their own set of rules, the processing time is generally longer and they are just more difficult to work with.
We've had considerably greater success working through the Quito migracion office. If possible, this is the office we generally choose to work through.
Within the past two weeks, we've helped obtain temporary & permanent residency visas through the Quito office. All without the need for health insurance with the visa application. This is 1st hand information that comes directly from the source.
As for Azogues, I personally visited the office immediately prior to writing this article and they confirmed they do need health insurance as part of the visa application.
The other main rule that Azogues interprets unfavorably is the time allowed outside of Ecuador during temporary residency and still be eligible for permanent residency.
Azogues has taken a very strict interpretation whereby spending just one day outside of Ecuador during your temporary residency will automatically prohibit you from obtaining permanent residency. They'll request that you renew your temporary residency instead.
Again, Quito immigration does not share this interpretation. So, it is certainly possible to spend time outside of Ecuador and still obtain your permanent residency.
For many applicants, the difference is negligible as you'll most likely want health insurance here anyway. The only difference for Azogues-based applicants is that you'll need to purchase your insurance earlier in the process.
But, there are also those that only want to meet the minimum insurance requirements in order to obtain the cedula (or visa - if appropriate). There can be many reasons for this. They may already have medical coverage via their travel insurance or are planning on obtaining IESS rather than private health insurance.
So, if you're really trying to minimize your health insurance expenses, you may be able to reduce the time you're paying for insurance by around 1 month (ie time between applying for visa and cedula) by applying via Quito as opposed to Azogues.
I really wish I knew. For many outsiders (myself included), it seems rather absurd to have multiple sets of interpretations for something that seems so basic. There is clearly little national oversight to ensure consistency amongst the different migration offices.
On a personal level, it would be so much more convenient for us to use Azogues as our 1st choice because it's a 10-minute drive from our house - we live in between Cuenca and Azogues. Operating predominantly out of the Quito office requires more coordination (and slightly more expense), but we believe the better visa outcomes for our clients are worth it.
The end result of all of this confusion is that we find many people turning to us for visa assistance. And yes, we are able to help you obtain your visas in both Quito and Azogues.
Obviously, we have a current preference towards Quito, but if you really have a strong preference for Azogues, we can assist here too. Just reach out to us via our contact us form and leave your details. We respond within 24 hours (normally a lot sooner).