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Popular Insurance Scheme PDF Imprimir E-mail
Escrito por Benjamín González Rubio Aguilar   
Jueves, 29 de Octubre de 2009 05:01

The Social Health Protection System (Popular Insurance Scheme) seeks to provide health service coverage, through voluntary, public insurance for persons that are not affiliated to any social security institution.

Members of families affiliated to the Social Health Protection System through Popular Insurance will have access to the medical, surgical, pharmaceutical and hospital services that fully satisfy their health needs. The Popular Insurance Scheme currently provides coverage for 275 medical operations, described in the Universal Health Service Catalogue.

Beneficiaries

The protection unit of the Social Health Protection System is the family nucleus (families) which may comprise:

  1. Spouses; or
  2. Concubine and the man having a concubine; or
  3. Mother and/or father not married or living together without being married
  4. Underage children
  5. Underage children who are part of the family and have blood links with those mentioned in numbers 1 to 3
  6. Unmarried children up to 25 years old and proves to be students
  7. The dependen handicapped children
  8. Parents over the age of 64 who are financial dependents and live in the same household.
  9. Persons who despite not having blood links with those mentioned in numbers 1 to 3 live in the same dwelling and depend financially on them and are under 18 or dependent handicapped persons of any age.

Persons over the age of 18 can voluntarily become affiliated on an individual basis.

Affiliation Requirements

  • Reside in the National Territory
  • Being without any rights in any social security institutions (IMSS, ISSSTE, PEMEX, SEDENA, etc.)
  • In the Affiliation and Orientation Module apply for the affiliation of the family in a voluntary way.
  • Provide the necessary information to be able to carry out a socio-economic evaluation of the family, called Socio-Economic Household Features Card.
  • Submit original and copy of the following documents
    1. Proof of Address
    2. "Clave Única de Registro de Población" of each member of the family or any Official Document which has it, in case you don’t have it, copy of the birth certificate
    3. Official ID with photo in it of the person who will act as head of the family
    4. Receipt of payment for family quota that is always paid except in the case of families whose socio-economic condition means that they are entitled not to contribute
    5. Additional documentation for those situations of families having children among 18 and 25 years old or be beneficiary of any federal program to fight poverty
  • In case of those families with children between 18 and 25 years old a must present a proof that they are studying media or higher education
  • Families that already benefit from Federal Government programs to alleviate extreme poverty should present a document containing the folio number of the beneficiary

Affiliation Process

  • The member of the family entitled to join the system should attend an Affiliation and Orientation Module to express his desire to join the Health Protection Social System through the Popular Insurance Scheme, which can also be done through the affiliation and re-affiliation schemes set up for this purpose.
  • The Affiliation and Orientation Modules or the brigades ask the applicant to provide the necessary information to undertake the socioeconomic evaluation of the family called Household Socioeconomic Features Card in order to determine their ability to pay. This evaluation must be carried out every three years.
  • Personnel at the Affiliation and Orientation Module and/or the affiliation brigade will request the documents mentioned in the affiliation requirements and use the Household Socio-Economic Features Card. Once the card has been signed by the head of the family, it will be regarded as the families' application to join the Social Health Protection System (Popular Insurance)
  • The Affiliation and Orientation Module will be responsible for:
    • Providing the head of the family with the Charter of Rights and Obligations, which describes the medical actions covered by the Social Health Protection System.
    • Issue the Affiliation Policy to the Social Health Protection System indicating the householder, members of the family that are also beneficiaries, the duration of their rights, the annual family quota and the medical unit that corresponds to them. The Policy is the document that should be presented by the beneficiaries, together with an official identification with a photograph, when they make use of medical services.
  • Affiliation to the Social Health Protection System (Popular Insurance Scheme) will be formalized as soon as the head of the family is given the Affiliation Policy.

The family will be able to receive the medical services covered by the Popular Insurance Scheme on the first day of the month after their affiliation according to the capacity for treatment of the Health Secretariat in the state where the family has established its residence.

Última actualización el Lunes, 31 de Enero de 2011 10:59
 

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