DM ASESORES - SPECIAL ENDORSEMENTS
Deductible: The fixed
quantity which applies to the initial expenses against the account of the
Insured until the established limit of 2 S.M.G.V.D.F. for each accident of
illness covered (Accidente y Enfermedad cubierta). Once the covered cost has
exceeded this amount, it become the responsibility of insurance company,
nevertheless it will be eliminated or reduced to $2,500.00 in the case of
surgery or admission to hospital for an emergency being attended by the agreed
doctors in the hospital level corresponding or smaller, whenever the admission
is for more than 24 hours, and in the case of the contrary, the deductible will
be the responsibility of the insured.
Co-Insurance: The amount charged to the insured as a percentage of
covered expenses, after which applies the Deductible. Said percentage is also
the maximum amount which may be charged to the insured, according to this
concept, and is indicated in the policy title page.
With the purpose of
avoiding the deducible payment and co-insurance, it is important to follow the
subsequent procedures detailed for each type of claim.
It is also
recommended, to insure smooth operation of the policy, that the claim for
either planned surgery or emergencies are accompanies by your identity card,
provided to minimize any problems that may occur on registration of a patient
in hospital.
If surgical
intervention that is not urgent is required, and this can be scheduled, it is
important to do so, thus the direct payment will be made for the authorized
surgery.
Sugeri-Cost: Limited of 36 S.M.G.M (salary, minimun, general,
monthly )
Hospital Visit: Covered as
usually charged.
Intensive Hospital
Visit: Covered.
Medical Consultation: Covered
Anesthesia Cost: 30% limit of surgeons honoraries.
Basic Standart Room: individual standard room
Caesarean: Insurable sum up to 15 S.M.G.M, without deductible
or co-insurance
Recent Birth and
Complication with Pregnancy: Protected for the
first day of birth, whenever the mother has a minimum of 10 months of coverage
from the policy.
Ambulance Terrestrial
& Aerial: Covered depending on the situation
Medical Emergencies
Abroad: $50,000.00 USD with
a deductible of $50.00 USD paid via reimbursement, whenever the claim contains
all requirements, and the emergency is covered in the policy.
Pre-existing Conditions: A condition which has been known of, however has not been realized by
medical testing before the commencement of the policy, neither has this
condition been diagnosed by a doctor. The first medical expense for this
condition must occur during the period of this policy.
Pre-existing conditions have a 2 year wait policy.
Normal Childbirth: Insurable sum up to 15 S.M.G.M, without deductible or co-insurance.
Recognition of
Antiquity: Waiting periods
eliminated.
Congenital Condition: A congenital condition can occur within the maternal
uterus or at birth.
In addition to what
has been established in the General Conditions and under the conditions of
cover, these congenital conditions will be covered for the insured born outside
the period of the policy of insurance Company.
In order to cover a
congenital condition, it will be indispensable to comply with 2 of the
following conditions:
1) For those
insured born during the duration of the policy, however with another insurance
company, whose birth has been covered by this company, and have been
registered, insurance company will cover the expenses for congenital
conditions, in addition to which the original policy covered such congenital
conditions.
2)
For those
insured who did not have coverage since birth by an insurance company, it is
required that the first manifestation of the illness presents after the insured
has reached the age of:
This endorsement modifies the exclusion of Congenital Conditions as
stipulated in the General Conditions, in the part Greater Medical Expenses Not
Covered.
It is only covered in national territory.
This endorsement forms and integral part and compliments the General
Condition of Insurance.
Agreement of Direct
Payment: In hospitals and
with doctors of agreement.
Life Renovation: Only when the policy coverage has been continuous,
without breaks.
Elimination of
Deductible and Co-insurance up to $1,000: in hospitals and with doctors of agreement, with hospital admission of
greater than 24 hours, and authorization of direct payment.
