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IMSS Insurance Terms & Conditions

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Posted by Jean on Enero 18, 2001

1. It shall be excluded from the family insurance: the holder of the family insured, the additional beneficiary or member, if the have:

Any pre-existing disease, such as malign tumors, cronic degenerated diseases, such as delayed complications of mellitus diabetes, disease (gaucher disease), cronic diseases on liver, cronical renal failure, valvular diseases continuance, (arrhythmia, angor, myocardial infaction) cronic obstructive lung disease with respiratory failure, degenerative diseases of central and peripheral nervous system, vascular cerebral disease continuance, peripheral vascular failure, among others.

-cronic systematic diseases of connective tissue
-addictions to alcoholism and other drug addictions
-mental disturbances, such as phychosis and insanity
-congenital diseases
-AIDS (VIH positive)
-continuance of skeletal muscle lesion or neurological traumatic that requires treatment

2. It shall not be provided the institutional services, during the times appointed to the holder of the insured family, additional beneficiaries or members by the following diseases and treatments:

Six Months
benign breast tumor

Ten Months
Birth

One Year
lithotrity, surgery of gynecological diseases, except malignant neoplasias of uterus, ovary, perineal ground, surgery of venous failure and varicose veins...surgery of paranasal breasts and nose, varicocele surgery, hemorrhoidectomy, and surgery of rectal fistula and rectum prolapse, amygdalectomy and adenoidectomy, hernia surgery, except hernias on intervertebral disc, hallux valgus surgery, strabismum surgery

Two Years
orthopaedic surgery

These periods shall be computed starting from the date that the holder of the family insured, additional beneficiaries and members be registered into the IMSS. Once concluded the sames, can be able to use institutional services. This does not limit to use the medical services for other diverse disease or treatment.

3. The Family Health Insurance does not cover:

esthetic surgery, acquisition of eyeglasses, contact lens, intraocular lens, hearing aids, surgery for correction of astimagtism, farsightedness, hypermetropia, myopia, treatment for self damage and suicide attempt, treatment for damages caused by professional practice on any sport of physical risk, preventive exam requested by the holder of the family insured, additional beneficiaries and members, treatments for disturbance of behavior and learning, dental treatments, except extractions, oturation and cleaning, surgical or medical correction treatment of fertility alteration.

4. The prestation of services of this insurance shall have a duration of 12 months starting from the date of initiating the services that shall be the first day of the following month from its registration. Your beneficiary menbers and additionals will receive medical attention in the medical unit close to your residence and the insured party on the one determined upon registration. If said unit is not on your locality, the IMSS is not obligated to move the patient from his residence to the clinic, whenever the institution determines the necessity of moving a patient to another medical unit, it shall be made in the terms appointed by the moving patient regulations.

5. The insurance will conclude by annual expiration, if not renewed within 30 days previous to the expiration date. If no renewal is made within the terms above mentioned, it shall be considered as initial registration, being applicable the waiting times, limitations regarding pre-existing of diseases and requisite of medical questionnaire.

6. The insurance can be previously concluded with no responsibility for the institution, only respecting the individual or individuals incurring in the following cases: to make undue use of the document, providing the quality of the insured party (carnet) without affecting the institution as to charge the medical assistance granted withour having right to it. On this cases the holder of the family insured owner of the documentation shall be jointly responsible of the consequences that would cause the bad use of the document.

If during the first year of insurance any of the diseases appointed as pre-existing appear, and was not declared by the holder of the family insured or his legal beneficiares or additional members upon filling fou the proper medical questionnarie

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Published or Updated on: February 18, 2001 by Discussion Thread Forum © 2009
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