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Health Insurance: PYMES

Group medical plan for Small 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 Small Group health plans (PYMES) adapt to groups’ needs and budget.

Among the benefits that this product offers, are the following:

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

Pharmacy:
Coverage for the cost of prescribed medication.

Benefits and Advantages

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

MAPFRE medical plans for small groups may include additional benefits and coverage’s:

Additional benefits

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Dental Insurance

According to the acquired plan, MAPFRE offers members preventive and restorative, major restorative and orthodontic 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.

Added values:

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Living well with Diabetes and MAPFRE

When registering members benefit by having an economical and fixed $15 copay for supplies, discounts and promotions. You may 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.

MAPFRE offers members, employers and providers, as well as everyone interested in learning more about the small group medical plan, a Call Center available 24/7 with phone operators specialized in service related to health benefits.

Through an advanced digital transformation we offer a Health Portal that provides direct access to specialized personnel available to address, the needs of and offer orientation to, providers, employers and members.

General Conditions

MAPFRE’s medical plans for the Small Groups allow peace of mind by offering a comprehensive policy that provides coverage to the employees 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 inform 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 health insurance coverage for Small Groups to pay special attention to the policy’s general terms, conditions and limitations to obtain the maximum benefit under their plan.

Recommendations when using the medical plan:

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.
If someone needs orientation they can contact the specialized phone operators that are available 24/7.
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.