If I am insured with EsSalud, what are all the benefits I have?

From quality medical care to financial benefits in cases of temporary disability or maternity, being insured by EsSalud in Peru means having access to a wide range of health benefits and services. Find out all of them in the following article.

WHAT ARE ALL THE BENEFITS FOR BEING INSURED WITH ESSALUD?

In Peru, EsSalud, the Social Health Insurance, offers a wide range of benefits to its policyholders, thus guaranteeing comprehensive and quality care for the population. Through its different plans, users can access medical services, economic benefits and specialized assistance.

Below, we detail all the benefits of being insured by EsSalud:

EsSalud Seguro Regular (+SEGURO) coverage:

• Outpatient medical care and hospitalization.
• Immunizations, medicines and medical supplies.
• Rehabilitation services and social assistance activities.
• Economic benefits for temporary disability, childbirth, breastfeeding or burial.
• Coverage of maternity expenses.

Coverage of Potential Insurance (+Health):

• Outpatient and hospital care.
• Medical and accidental emergencies.
• Maternity care.
• Medication coverage.
• Additional benefits such as Home Assistance Program and EsSalud online.

Complementary Risk Work Insurance (+PROTECTION):

• Assistance and preventive advice on occupational health.
• Medical, hospital and surgical care until recovery or disability.
• Rehabilitation and labor readaptation.
• Coverage of prosthesis and orthopedic devices.
• Attention in risk activities according to the Law of Modernization of the Social Security in Health.

Agrarian Insurance EsSalud:

• Outpatient and inpatient medical care.
• Economic benefits for temporary disability, childbirth and funeral expenses.
• Maternity coverage.
• Welfare and social promotion benefits.
• Additional economic benefits.

EsSalud Accident Insurance (+VIDA):

• Compensation in case of death or disability due to accident.
• Coverage of up to S/ 75,000.00 in case of death.
• Special coverage for bereavement and burial.
• Designation of beneficiaries to receive the indemnity.
• Beneficiaries include spouse, children, parents, siblings and legal heirs.

EsSalud is committed to guaranteeing the well-being and safety of its policyholders, offering broad coverage ranging from prevention to specialized care in emergency situations and occupational risk.

HOW TO CHANGE MY ESSALUD CARE CENTER

Essalud policyholders are attended according to the home address of their National Identity Card - DNI, thus respecting the institutional policies to maintain order and the correct distribution of the insured population in the various health care centers, i.e. the health facility is assigned according to the home address stated in the DNI.

Exceptionally, the domiciliary address may be changed when the insured or the beneficiary moves temporarily to a province or department different from the address stated in the ID card (Metropolitan Lima and Callao are considered the same province DS 012-2019-TR).

If you are an Essalud insured and you need to update your medical care center or make a temporary change of address, the following requirements are required:

-Address update (according to DNI):

• Go to an EsSalud care platform or to the Centros de Mejor Atención al Ciudadano (MAC).
• Request a change of center.

- Change of temporary assignment (address different from the DNI):

• The change of temporary assignment proceeds for work, family, health or other particular reasons. In the case of travel for reasons other than work, the change of assignment is for a maximum period of six (6) months in a calendar year.

a) Temporary change of assignment for work reasons:

• Go to an EsSalud care platform or to the Centers for Better Attention to the Citizen (MAC).
• Submit Form 1010 - Single Insurance Form, duly filled out and signed by the employer and the member.
• The address must be indicated on the form.

b) Change of assignment other than work:

• Go to an EsSalud attention platform or to the Centers for Better Attention to the Citizen (MAC).
• Submit Form 1010 - Single Insurance Form, duly completed and signed duly completed and signed by the principal member and spouse, cohabitant, father, mother, guardian or curator, as applicable.
• The address must be indicated on the form.

NOTE: In no case will Essalud ask for an electricity bill, water bill, landline phone bill and rental contract or other similar.

WHAT IS ESSALUD

The Peruvian Social Health Insurance, better known as Essalud, is the contributory health insurance aimed at all Peruvian citizens who meet certain characteristics. Essalud provides prevention, promotion, recovery, rehabilitation, economic benefits and social benefits.

Insurance administered by EsSalud:

- Regular Insurance (+SEGURO):

This is the insurance to which all active workers who work as employees or as members of workers' cooperatives are obligatorily affiliated.

Also, port workers, civil construction workers, fishing workers, pensioners affiliated to the former Caja de Beneficios y Seguridad Social del Pecador (CBSSP), fishing workers affiliated to the former CBSSP, independent artisanal fishermen, independent artisanal fishing processors, port workers, members of agricultural cooperatives, Beneficiaries of Law N° 30478 and pensioners who receive retirement, disability or survivors' pensions.

- Potential Insurance (+Health):

It is a health insurance that safeguards your and your family's well-being and protects you against unexpected situations.

The affiliation to +Salud Seguro Potestativo, commits EsSalud to attend to your health needs covered under the Health Plan, in exchange for the payment of a monthly contribution. This insurance does not establish additional payments for medical consultation, hospitalization days or emergency services.

It is aimed at any person residing in the country, national or foreign, without age limit, especially independent workers (professionals, technicians, artisans, merchants, transporters and artists) and their dependents, as well as university students, trainees and other entrepreneurs; who are not affiliated to the Comprehensive Health Insurance (SIS) or to EsSalud through an employer.

Affiliates may be:

• Cardholder (person of legal age)
• Spouse or common-law spouse (a)
• Child (minor or adult child) who is totally and permanently disabled for work.
• Work

-Complementary Risk Work Insurance (+PROTECTION):

This is the EsSalud insurance that provides coverage for occupational accidents and occupational disease to dependent or self-employed workers who perform risky activities.

The +PROTECCION insurance offers coverage for health benefits until the insured's full recovery and rehabilitation:

Assistance and promotional preventive counseling in occupational health to the employing entity and the insured worker.

Medical, pharmacological, hospital and surgical care, regardless of the level of complexity, until the full recovery of the insured worker or the declaration of total or partial permanent disability or death.

Rehabilitation and labor readaptation of the disabled insured worker, under this insurance through the Specialized Professional Rehabilitation Centers (CERP) and/or Basic Professional Rehabilitation Modules (MBRP).

Prosthetic and orthopedic appliances necessary for the insured disabled worker under this insurance.

- Essalud Agrarian Insurance:

This is a special social security regime that provides health, economic and social benefits to dependent and independent workers who carry out farming and/or breeding, poultry, agro-industrial or aquaculture activities, with the exception of the forestry industry.

This insurance provides coverage for:

• Prevention and promotion benefits: includes health education, risk assessment and control and immunizations.
• Health recovery benefits: includes medical care, both outpatient and inpatient, medicines and medical supplies, prostheses and essential orthopedic appliances, rehabilitation services.
• Welfare and social promotion benefits: Includes outreach activities, social assistance and rehabilitation for work, aimed at the promotion of the person and the protection of his/her health.
• Economic benefits: This is the amount of money granted by EsSalud to compensate for an economic loss derived from temporary incapacity for work (illness or accident), childbirth, as well as to contribute to the care of the newborn. It is also granted to the person who proves that he/she has paid the funeral expenses for the death of the insured person.
• Maternity benefits: consists of health care for the pregnant mother and childbirth care, extending to the puerperium period and to the health care of the newborn.

- EsSalud Accident Insurance (+VIDA):

+Vida is a personal accident insurance that provides indemnity in case of death or total or partial permanent disability as a result of an accident, and whose coverage is backed by THE CONSORTIUM, formed by MAPFRE PERU COMPAÑÍA DE SEGUROS Y REASEGUROS S. A and MAPFRE PERU VIDA COMPAÑÍA DE SEGUROS Y REASEGUROS.

Protects 24 hours a day, 365 days a year, inside and outside the country.