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HEALTH AND WELLNESS PROGRAM MATERNITY

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Presentation on theme: "HEALTH AND WELLNESS PROGRAM MATERNITY"— Presentation transcript:

1 HEALTH AND WELLNESS PROGRAM MATERNITY
LIVE MORE WORRY LESS…

2 MATERNITY COVERAGE Benefit designed to care for the health of pregnant women, prenatal consultations, childbirth preparation courses (Psychoprophylaxis), outpatient and inpatient hospital benefits. Also provides information for a healthy pregnancy and childbirth.

3 WHAT DOES THIS BENEFIT COVER?
. WHAT DOES THIS BENEFIT COVER? Outpatient Benefits Regular Prenatal Control: includes consultations, auxiliary exams (check list of exams), folic acid (1st trimester) and vitamins (2nd trimester) * 1 monthly medical consultation in the first 7 months (1 to 32 weeks of gestation). 1 biweekly consultation during the 8th. month (33 to 36 weeks of gestation). 1 weekly consultation during the 9th. month (37 weeks until delivery). Abortion / threat of outpatient abortion. Complications in pregnancy, childbirth and outpatient puerperium. Outpatient obstetric emergency Regular postnatal control (2 visits within 45 days postpartum). Preparation course for childbirth (this benefit is provided only in Affiliated Establishments and under Credit modality).

4 WHAT DOES THIS BENEFIT COVER?
Hospital benefits Abortion / threat of hospital abortion. Complications in pregnancy, childbirth and hospital postpartum. Natural birth. Cesarean delivery. Multiple births (natural or by cesarean). Newborn Circumcision is covered if performed within hospitalization days. If performed after discharge its covered as outpatient surgery.

5 WHAT DOES THIS BENEFIT COVER?
Preparation course for childbirth- Psychoprophylaxis The objective of this course is to guide the couple on the process of maternity and to prepare them to face, in better conditions, the birth and first days of their newborn. The course consists of seven sessions two hours each.

6 WHAT DOES THIS BENEFIT COVER?
Congenital diseases A congenital disease or birth defect is any potential pathological condition (anomalies in structure, function, or metabolism) that originated before the birth of the child. It includes diseases caused by environmental, genetic or unknown factors that may be evident at birth or manifest later in life. These pathological conditions can be diagnosed before birth. Such as: cleft palate, Down syndrome, among others; or evidenced later by diagnosis in childhood, adolescence or adulthood, such as: malformations of the urinary tract, hemophilia, variable immunodeficiency, congenital scoliosis, among others. The Maternity benefit covers newborns from mothers whose birth is eligible for coverage under the insurance policy or health plan from their employer, and who have been enrolled within the month of birth. To know the detail of coverage, look up your insurance policy or health plan.

7 HOW DO I ATTEND? Outpatient Benefit
This benefit begins with clinical and/or laboratory evidence and/or confirmed pregnancy imaging study. Attention can be by Credit or Reimbursement (if included in your insurance policy or EPS health plan), except for Psicoprophylaxis that is only a Credit. Schedule an appointment by phone at the health center of your choice, which is included in the network of your insurance policy or EPS health plan. Approach the Health Center on the scheduled date, with your ID. Receive the order of care that the clinic will generate and pay the deductible amount in the cash desk. Attend your appointment and follow your doctor's instructions. In case the doctor requests additional examinations or medicines, you must assume the corresponding co-insurance. Also, certain types of exams may require a letter of guarantee.

8 HOW DO I ATTEND? Hospitalization Procedure Steps to follow (all clinics) 1. Coordinate with your doctor the date in which the hospitalization will take place. 2. The doctor will give you the order for internment.

9 HOW DO I ATTEND? In these clinics you must follow the next additional steps: 3. Once the order for internment has been received, you must go to the clinic's budget area to complete the letter of guarantee. 4. The Clinic will request the letter of guarantee (pre-certification) to Pacifico. 5. Pacifico will validate that coverages and procedures requested are appropriate according to the diagnosis presented and will authorize the Clinical Center, through a memo, to perform the medical care. This authorization will be given within one working day, as long as the Clinic has sent the due information. 6. Once the letter of guarantee is issued, the clinic will communicate you the results by telephone. 7. At the moment of your internship you must present your Identity Document (DNI or Foreigners Registration Card).

10 HOW DO I ATTEND? Unscheduled Hospital Care Procedure (Emergency) In case of an emergency, the clinic will provide you the required medical care and later will send the letter of guarantee (if necessary) within 24 hours. The coverage will be given according to your insurance policy or EPS health plan. Its important to present your Identity Document (DNI or Foreigner Registration Card). In case you don’t have it or you are disabled, the clinic must attend you according to the Emergency Law.

11 HOW DO I ATTEND? Preparation course for childbirth - Psychoprophylaxis
This benefit starts with the indication from your treating physician and its only given by credit. Schedule an appointment by phone at the health center of your choice, included in the network of your insurance policy or EPS health plan. Attend to the health center the scheduled date with your Identity Document (ID or Foreigner Registration Card). Receive the order of attendance that will generate the health center. Attend your appointment. At the moment of your medical internment you have to present your Identity Document (DNI or Foreigner Registration Card).

12 HOW DO I ATTEND? Congenital diseases
Schedule an appointment by phone at the health center of your choice, included in the network of your insurance policy or EPS health plan. Attend to the health center on the scheduled date with your Identity Document (ID or Foreigner Registration Card). Receive the Care Order that will generate the health center and go to the cashier to pay the deductible. Attend your appointment. In case the doctor requests additional examinations or medicines, you must assume the corresponding co- insurance. Also, certain types of tests or procedures may require a letter of guarantee.

13 WHERE I ATTEND Here you will find the list of main establishments that offer the Maternity benefit in the city of Lima. DISTRICT PROVIDER ADDRESS PHONE La Molina Clínica Montefiori Av. Separadora Industrial N° 380 SANNA Centro Clínico La Molina Av. Raul Ferrero N° 1256 Miraflores Clínica Good Hope Av. Malecón Balta N° 956 San Borja Clínica Santa Isabel Av. Guardia Civil N° 133 Clínica Vesalio Calle Joseph Thompson N° 140 SANNA San Borja Av. Guardia Civil N° 337 San Isidro Centro Medico Medex Av. Republica de Panamá N° 3065 Clínica Javier Prado Av. Javier Prado Este N° 499 Clínica Limatambo Av. Republica de Panamá N° 3606 SANNA El Golf Av. Aurelio Miroquesada N° 1030 San Juan de Miraflores Clínica Santa Maria del Sur Av. Belisario Suarez N° 998 San Miguel Clínica San Judas Tadeo Calle Manuel Raygada N° 170 Santiago de Surco Centro Medico Jockey Salud Av. Javier Prado Este N° 4200 Clínica Padre Luis Tezza Av. El Polo N° Urb. El Derby

14 TERMS AND CONDITIONS The Maternity benefit begins with clinical and/or laboratory evidence and/or confirmed pregnancy imaging study. The examination for diagnosis of Amenorrhea or suspected pregnancy will be by gynecological outpatient appointments.

15 COVERAGE AND EXCLUSIONS (EPS)
This benefit applies to holders, spouses or partners and daughters under the age of 18. To qualify for complex maternity coverage (cesarean section, abortion and complications), at the time of conception, the regular affiliate must be registered in the EPS health plan or in the valid policy of the employer. If at the time of conception, he or she is affiliated with EsSalud (and not with EPS) and comply with the conditions to be considered as a regular insured, will only have Simple Tier coverage (prenatal consultations, vaginal delivery and postnatal controls) In case of starting Simple Tier Care and needing Complex Tier Care, the clinic will inform the insured that he or she have the alternative to be treated through EsSalud, for which he or she must contact Pacific in order to manage their reference to EsSalud. The clinic must confirm by a memo that the patient has received the information.

16 THANK YOU


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