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AUTOGESTION HEALTH PLAN AND FORECAST FOR THE YEAR 2010 MPPE
January 24th, 2010 by thesuper

The purpose of the Plan is to compensate for reasonable expenses (or provide the service which through its network of suppliers), incurred by the affiliate owner or their beneficiaries duly registered in PASP-2010, under: 1) hospitalization, surgery and maternity: Hospitalization in a medical institution legally registered for treatment or surgery, resulting from an illness or accident. Affiliate Holder for the maximum amount is up to twenty thousand Bolivars (Bs 20,000.00), while for its beneficiaries duly registered on the PASP-2010 the maximum amount is up to fifteen thousand Bolivars (Bs 15,000.00). In case of Motherhood, the maximum amount for the Affiliated Women will be up to TEN Holder thousand Bolivars (Bs 10,000.00), while for the Spouse will be up to seven thousand Bolivars (Bs 7.000,00).These amounts represent the maximum benefit per case-year term of PASP-2010 for each affiliate. 2) Primary Care (PA’s): Through this benefit the Affiliate holder or beneficiary will receive Primary Care through Medical Institutions designated for such purpose (AP’s) under: External Consultation, Triage, laboratory tests and medical treatment not requiring hospitalization, up to the coverage limit stipulated in paragraph 1. 3) PROFIT OF FUNERAL SERVICE COSTS: Through this benefit, if death Holder Affiliate or any of its beneficiaries, are required as follows: Transfer of site of death to the site of the wake (nationally). Superior metal chest (Manara, Madrid, Fiorentina, Buen Pastor, Monumental). service or funeral home chapel. Bed rest for family members. Coffee service learning. Service thanatology (normal). Assistance in legal proceedings. Two (2) Vehicles for transporting coffin and family. Crafts religious shrine. Cremation Services or plot. Failure to use the service through affiliated funeral homes will only be refunded the cost of it, according to the invoice, not exceed ten thousand Bolivars (Bs 10,000.00), upon notification to the Ministry, within one hundred twenty (120) calendar days after the date of death have occurred 4) PAYMENT OF DEATH BENEFIT FOR ANY CAUSE: It guarantees the payment of ten thousand Bolivars (Bs 10.000,00) when the death occurred Affiliate Consultant. Such payment shall be made at (the) heir (s) of the same laws. 5) PAYMENT OF DEATH BENEFIT DISABILITY BY ACCIDENT: It guarantees the payment of ten thousand Bolivars (Bs 10.000,00) when the death occurred Holder Affiliate accidental causes. Such payment shall be made at (the) heir (s) of the same laws. In case of accidental Disability pay rate established in the special conditions, which varies depending on the degree of injury, this amount will be paid to Affiliated Contractor with a maximum of TEN THOUSAND BOLIVARES (Bs 10.000,00). 6) PROFIT OF DENTISTRY AND OPHTHALMOLOGY: Through this benefit, through the provider network ensures that: Extensive Plus Dental Cover: Oral Medicine: Medical history (diagnosis, prognosis and treatment plan). Periodontics: Tartrectom a simple and dental prophylaxis. Prevention: Pit and fissure sealants, topical fluoride application. Functioning: amalgam in posterior teeth, resin curing anterior and posterior glass ionomer in the neck of the teeth. Endodontics: Endodontics monoradicular birradiculares, multiradiculares, pulpotomy, pulpotomy, formocresol and Capiel cures. Surgery: Extraction of simple and permanent teeth, extraction of third molars (wisdom teeth). Radiology: Periapical radiographs and / or coronal taken at clinics affiliated. Emergencies: Endodontic, periodontal and prosthetic. Specialties: If the patient requires treatment not covered, they may be billed directly by the treating dentist with a discount from 20 and up to 50 , the member must pay for them. Ophthalmology Coverage Through this benefit, through the provider network ensures that: Medical Records Study of Visual Acuity Balance of Eye Movements Color Discrimination Intraocular pressure Making Biomicroscopy Gonioscopy Fundus Pre and Post-cycloplegic refraction Frames and Lenses: A maximum amount per person Bs


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