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Group Health Plan: Large Groups

Group Medical Plan for Large Groups

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Coverages

Products offered by MAPFRE LIFE INSURANCE COMPANY OF PUERTO RICO are designed to meet the highest industry standards and provide peace of mind to our members by having a comprehensive health plan. Our Large Group health plans in Puerto Rico known as Flexichoice, Excel, Choice, and Administration Service Only (ASO) adapt to group needs and budget. In addition, the employer can set copays and coinsurance that best adjust to employee needs. For the US Virgin Island territory we have the VIE policy.

Among the benefits that these products offer, are the following:

Medical expenses: free selection plans with a wide variety of benefits and an extensive network of providers.

Benefits and advantages

MAPFRE’S health insurance for companies, include a series of optional benefits and added values through their coverage’s.

MAPFRE’s Flexichoice, Excel, Choice, Administration Service Only (ASO) group medical plans may include additional benefits and coverage’s.

Additional benefits:

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Pharmacy

Coverage for the cost of prescribed medication.

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Dental insurance

Offers members preventive and restorative services for the maintenance and restoration of oral health thru an ample network close to 1,500 dentists, Endodontists, Periodontists and other health specialties related to oral health care.

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Vision insurance

Helps to cover costs related to products and services offered by a qualified Optometrist or Ophthalmologist.

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Group Life Insurance

MAPFRE offers as part of each quote coverage up to $10,000 for death due to natural causes or up to $20,000 for accidental death & dismemberment.

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MedAssist service

24 hour International Medical Assistance and other services when traveling outside Puerto Rico.

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EAP (Employee Assistance Program)

Provides the employee and family members unlimited access to professional psychologists with $0 copay.

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MAPFRE FIT

Health and wellness portal with information, programs and tools to help members improve their health.

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Organ transplant

Helps to cover expenses directly related to transplant procedures.

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TeleMedik

Health counseling by phone, available 24/7.

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ASO platform works with different risk variants such as

Administrative Expenses, Aggregate Stop Loss and Specific Stop Loss.

Added values:

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Living well with Diabetes and MAPFRE

When registering members benefit by having an economical and fixed copay for supplies, discounts and promotions. Call and have your supplies delivered to your home or office.

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MAPFRE Puerto Rico mobile app

Is an application focused on customer service. You can access the Provider Network, your plan ID card, and more. Smart Phones (Androids and IPhones).

MAPFRE offers policyholders, employers and providers, as well as people interested in learning more about MAPFRE’s Flexichoice, Excel, Choice and Administration Service Only (ASO) group medical plans, the service of a 24/7 Call Center where they will be attended by tele-operators specialized in the benefits of Health services.

Through our avant-garde digital transformation, we also provide a Health Portal that allows direct access to specialized personnel to meet needs and provide guidance to both providers and employers and policyholders. The versatility of this tool also allows you to obtain valuable data such as: copays, coinsurance, deductibles, types of coverage, view your claims, explanation of benefits, view invoices, and view the image of the medical plan card, among others. Its functions are effectively expanded towards the ability to perform cover certifications, print instantly and carry out movements in the
population, such as: adding dependents, among others

General Conditions

MAPFRE’s medical plans Flexichoice, Excel, Choice, Administration Service Only (ASO) and VIE allow peace of mind by offering a comprehensive policy that provides coverage to the employee and family, according to the established general terms, conditions and limitations in the policy.

The general terms, conditions and limitations of MAPFRE’s health services informed users which coverage’s they may access, the benefits and additional advantages, as well as the requirements and restrictions established by the Company.

Requirements and Restrictions

MAPFRE’s health insurance includes a series of requirements and restrictions that users must be aware of in order to know what coverage’s may be accessed according to the general terms and conditions established in the agreement. Some are:

Excluded are losses resulting from an insurrection or war, declared or not, any incidental act of said insurrection or war, or participation in any disturbance or civil disobedience.
Excluded are losses due to cosmetic surgery, unless reconstructive surgery to restore damaged tissue due to sickness, including the reconstruction of mama after a mastectomy, or corporal accident, lesion or surgery to correct a sickness or congenital anomalies, including oral defect of a newborn.
Excluded are those services that exceed the policy limits established in the general conditions and limitations.

Recommendations for use

MAPFRE recommends that all interested in participating in the Flexichoice, Excel, Choice, Administration Service Only (ASO) group and VIE health insurance coverage pay special attention to the policy’s general terms, conditions and limitations to obtain the maximum benefit under their plan.

Recommendations when using theses medical plans:

If someone needs orientation or information they can contact the specialized phone operators that are available 24/7.
It is recommended that members identify the period in which the insurance will remain in force to know when they can access coverage’s under their policy.
Members should know the different processes established by MAPFRE in order to access certain coverage’s in accordance to the policy’s general terms, conditions and limitations.