Medical Consultation Reimbursement
- Submit the claim form completed by the insured and the treating physician indicating the diagnosis.
- Attach proof of payment generated by the Fiscal Machine (if a Legal Entity).
- Manual payment receipt issued by the provider (if Natural Person) where it contemplates signature, seal and name of the doctor, specialty, Registration #, name of the clinic or hospital, address, telephone numbers, RUC-DV. It must also specify in legible letters the total amount paid for the consultation.
- The receipt generated by the Fiscal Machine, must be the original, however in some cases the information is easily erased, so we recommend attaching a legible copy.
Prescription Drug Reimbursement
- Present the claim form attaching the original prescription or a true copy of the original issued by the treating physician indicating the diagnosis, as well as the proof of payment generated by the Fiscal Machine. For the presentation of claims for long term medication, attach a copy of the medical order each time you present your claim. (Medical Order valid for 6 months).
- The proof generated by the Fiscal Machine, must be the original, however in some cases the information is easily erased, so we recommend attaching a legible copy.
- Present the purchase of medicines in detail and with the description of each medicine purchased.
Reimbursement for Special Exams, Labs and X-Rays
The treating physician should indicate the tests that are clinically necessary and related to the diagnosis. When submitting the claim, verify that the medical order contemplates the diagnosis. Submit the claim form attaching the medical order issued by the treating physician indicating the diagnosis, as well as the proof of payment generated by the Tax Machine. The receipt generated by the Fiscal Machine must be the original, however in some cases the information is easily erased, so we recommend attaching a legible copy. Those exams with a unit cost over $100.00 require Pre-authorization
Accident or Illness Emergency
In case of an Emergency due to Illness, it will be subject to the conditions detailed in the Critical Illness Listing and will be covered according to the benefits of your policy. If hospital confinement is necessary, the Insurance Company's Coordination of Benefits Department must be notified within the first 48 hours of the occurrence of the emergency care.
Physical Therapies
Physical and rehabilitation therapies are required to be Pre-Authorized. Requirements for filing a claim for payment of therapy:
- Submit the claim form, attaching the medical order issued by the treating physician indicating the diagnosis, as well as the proof of payment generated by the Tax Machine.
- The receipt generated by the Fiscal Machine must be the original, however in some cases the information is easily erased, so we recommend attaching a legible copy.
