Monday, July 15, 2024
HomeInsuranceWhat is the Senior Citizen Insurance Plan?

What is the Senior Citizen Insurance Plan?

It is a medical and hospital services insurance designed for people over 60 years of age.

The plan provides comprehensive protection against unforeseen health expenses at a low cost. It has coverage of $ 200,000.00 annually and $ 500,000.00 for life.

How Does the Insurance Work?

By enrolling in the insurance by completing the application and going through the insurability requirements, you become an insured of the Third Age plan, once the first insurance premium has been paid within a few days you will receive your insurance policy and a card with which they will be able to use the hospital services only showing the card that identifies it.

Who is Eligible to Enroll in the Senior Plan?

The applicant or policyholder must be over 60 years of age, with no age limit, and must complete the insurance application, undergo a full medical examination, and fill out a health statement.

You May Read: Top 6 Advantages of Mediclaim Insurance

What Services Does the Senior Plan Offer?

  1. At the time that the insured requires some type of medical service, he may consult with the Insurer or in the places or telephones that it designates, the conditions of the coverage according to the Table of Benefits included in the Particular Conditions of the policy and what they are the providers authorized to provide such service.
  2. The insured may attend the Hospital directly, where the availability of the required service and the coverage conditions will be indicated according to the Benefits Chart of the Contracted Plan.
  3. When the Insured is recommended a treatment that includes a service that requires prior authorization for its benefit to be recognized as covered by the plan as indicated in the Table of Benefits, it must be presented at the Company’s offices or at the places indicated by it. , or communicate by phone to the numbers indicated in the Benefits Chart to authorize and coordinate the provision of such services. The Company’s Medical Directorate may order a second medical opinion to corroborate the diagnosis and recommended treatment at no cost to the Insured.
  4. The Insured must present the authorized form to be able to access the covered services and they will be responsible for the copayment corresponding to the service provided as specified in the Table of Benefits and Particular Conditions.
  5. The Plan offers hospital and medical services, including medical consultations, surgeries, emergencies, laboratory tests, X-rays and physical therapy.
  6. Medical and hospital services are offered for almost all conditions and illnesses that appear and are treated for the first time after being approved as a Senior Plan Insured.

How Much Does It Cost to Belong to the Senior Plan?

90 or more231.60
* Premiums presented include 15% retiree discount for men and women –
* The premiums presented do not include the 5% tax –

For the payment of all premiums, except the first, a grace period of 30 days is granted, which will be counted from the first day of the month of unpaid coverage, according to the agreed payment method. During this period, the policy will remain in force and written notification will be sent to the contractor at the last address registered in the policy.

When the contractor has made the payment of the first fraction of the premium and is delayed for more than the term of the grace period stipulated in the payment of any of the subsequent premium fractions, in accordance with the established payment schedule, it will be understood that he has incurred in default of payment, which has the immediate legal effect of suspending the coverage of the policy for up to sixty (60) days.

The Premium and other conditions of this insurance are guaranteed for the term of this contract. The company may modify the Premium or Particular Conditions of this coverage on each Renewal date.

In case the Company wishes to introduce modifications, it must inform the Insured or Contracting Party of such changes 30 days prior to the renewal date. Any modification or premium adjustment must be subject to the maximum values ​​of the parameters approved by the Superintendency of Insurance.

What are the Co-Payments Necessary to Receive Medical and Hospital Services?

The co-payment amounts that correspond to the service rendered will always be in charge of the insured, according to what is specified in the Table of Benefits. It indicates the procedures and respective copayments, however, for your information we detail the most used:

General medicine5.00
Consultation with a psychiatrist20.00
Laboratory and x-ray25%
Ambulatory surgery200.00
Ambulance (metropolitan area transport only)50.00
Accidentdoes not pay
Hospitalization350.00 upon admission
(30% of all charges after the sixth day) 
(50% of all charges from the twelfth day) 

Outpatient X-rays and laboratory tests must always be ordered by an affiliated physician who has seen the insured in medical consultation.

Special procedures, hospitalizations, and outpatient surgeries require pre-authorization by the Medical Directorate of the Insurer.

The benefits to retirees, pensioners, and the elderly according to the law are contemplated in the contract and operational and administrative documents of this insurance.

What Limitations Does the Plan Have?

The Insured must wait two (2) years to receive Surgery services for some medical conditions, such as hernias and cataracts.

Services will not be provided for pre-existing conditions, however, for such conditions a 30% discount will be granted.

More from MoneyVisual

Recent Posts

Most Popular

Educational Topics