Instructions: To begin the claim process, it is necessary to fill out the claim form for cancer, organ transplant and critical illnesses [To download the pdf document and print it, click on ] In addition, you must have available the following documents, as the case may be.
If your claim is due to Cancer: Positive pathology (results of pathology of tissue obtained during surgery or another performed procedure).
If your claim is due to any Pernicious Illness: Copy of the study where it was diagnosed.
Support documents for the payment of benefits:
Invoices from:
• Pathology or any study related to the positive diagnosis, depending upon the policy.
• Hospital- indicating the period of hospitalization and diagnosis.
• Surgery.
• Blood or plasma.
• Chemotherapy, radiotherapies, experimental therapies, etc.
• Medical visits during the hospitalization –which are not the surgeon.
• Private nurse during hospitalization or in the home, depending upon the policy. It cannot be a relative of the insured person.
• Prosthesis, if applicable.
• Ambulance.
• Air transportation – if there is medical recommendation for the trip.
• Lodging and meal expenses for the adult who accompanied the insured person.
• Funeral home, for funeral services- does not include property at the cemetery.
Documents indicating the use of blood or plasma not replaced by donors.
Document confirming that the claimant traveled on the basis of a medical recommendation made by the specialist physician and one with a license.
If there was a stay in intensive care, document which evidences specifically the date and time of arrival and departure.
If the insured person dies, the Certificate of Death, original (not a copy).
Verification of studies, if the claimant is a student, and is between 20 and 25 years of age.
Note:
All claims may be presented with the corresponding Claim Form duly filled out and signed. The following information is of vital importance:
• Complete and legible postal address.
• Social Security of the person paying for the policy(ies).
All the invoices must include the date of incurrence, must be duly identified by the provider, medical description and the charge for the services received.
*Please include copy of your last voucher as evidence of the withholding or any other evidence of payment.
IMPORTANT NOTICE
Any person who knowingly and with the intention to defraud presents false information in an insurance application or, who were to present, help or make to present, a fraudulent claim for the payment of a loss or benefit, or were to present more than one claim for the same damage or loss, shall incur in a serious crime and if convicted, shall be sanctioned for each violation with a penalty of a fine no lesser than five thousand (5,000) dollars, nor greater than ten thousand (10,000) dollars or penalty of prison for a fixed term of three (3) years, or both penalties. If there were aggravating circumstances involved, the established prison term may be increased up to a maximum of five (5) years; if there were mitigating circumstances involved, it could be reduced up to a minimum of two (2) years.
