Actualizacion Contrato de Salud

Condiciones Generales Uniformes
para el Contrato de Salud Previsional

aprobadas por la Superintendencia
de Salud
MAY 13
CONDICIONES GENERALES UNIFORMES PARA EL CONTRATO DE SALUD PREVISIONAL
APROBADAS POR LA SUPERINTENDENCIA DE SALUD
Contrato de Salud Previsional
(OSUHVHQWH&RQWUDWRGH6DOXG3UHYLVLRQDOHVGHSOD]RLQGH¿QLGR\ODVSDUWHVVyORSXHGHQGDUOHWpUPLQR
SRUODVFDXVDOHVHVWLSXODGDVHQpOVHFHOHEUDHQFRQIRUPLGDGFRQORGLVSXHVWRHQHO')/1GH
GHO0LQLVWHULRGH6DOXG\DODV,QVWUXFFLRQHVTXHHVWD6XSHULQWHQGHQFLDGH6DOXGGHWHUPLQHDO
HIHFWR
)RUPDQ SDUWH LQWHJUDQWH GHO &RQWUDWR GH 6DOXG 3UHYLVLRQDO DGHPiV GH OD QRUPDWLYD OHJDO \
DGPLQLVWUDWLYDORVVLJXLHQWHVGRFXPHQWRV
D/DV&RQGLFLRQHV*HQHUDOHVGHO&RQWUDWRGH6DOXG3UHYLVLRQDO
E(O)RUPXODULRGH'HFODUDFLyQGH6DOXG
F(O3ODQGH6DOXG&RPSOHPHQWDULR
G(O)RUPXODULRÒQLFRGH1RWL¿FDFLyQ)81WLSR\ORVGHPiVTXHVHVXVFULEDQGXUDQWH
ODYLJHQFLDGHO&RQWUDWR\
H$UDQFHOR1yPLQDGH3UHVWDFLRQHV9DORUL]DGDV
I/D6HOHFFLyQGH3UHVWDFLRQHV9DORUL]DGDV
J/DV&RQGLFLRQHVGHOD&REHUWXUD$GLFLRQDOSDUD(QIHUPHGDGHV&DWDVWUy¿FDVHQ&KLOH
&$(&
K/DV&RQGLFLRQHVSDUD$FFHGHUDOD&REHUWXUDGHODV*DUDQWtDV([SOtFLWDVHQ6DOXG
L/RV0HFDQLVPRVGH2WRUJDPLHQWRGH%HQH¿FLRV0LQLPRV
M/RV%HQH¿FLRV$GLFLRQDOHV
N/DV&RQGLFLRQHV3DUWLFXODUHVGHO3ODQ3UHYHQWLYRGH,VDSUHV33,
ÍNDICE
Condiciones generales uniformes para el contrato de salud previsional aprobadas por la Superintendencia
GH6DOXG
&RQWUDWRGH6DOXG3UHYLVLRQDO
ËQGLFH
TÍTULO I
%HQH¿FLDULRVGHOFRQWUDWRHLQLFLRGHYLJHQFLDGHVXVEHQH¿FLRV
$57Ë&8/2%HQH¿FLDULRVGHO&RQWUDWRGH6DOXG
$57Ë&8/29LJHQFLDGHO&RQWUDWRGH6DOXGH,QLFLRGH9LJHQFLDGHVXV%HQH¿FLRV
TÍTULO II
%HQH¿FLRV/HJDOHV
$57Ë&8/2%HQH¿FLRV0tQLPRV2EOLJDWRULRV
-8/ 13
$57Ë&8/2/H\5LFDUWH6RWR
MAY
$57Ë&8/2$WHQFLRQHVGH(PHUJHQFLDR8UJHQFLDFRQ5LHVJR9LWDORGH6HFXHOD)XQFLRQDO*UDYH
$57Ë&8/2%HQH¿FLDULRTXH$GTXLHUHOD&DOLGDG-XUtGLFDGH&RWL]DQWH
$57Ë&8/2)DOOHFLPLHQWRGHO&RWL]DQWH
TÍTULO III
%HQH¿FLRVFRQYHQFLRQDOHV
0$5
D3ODQGH6DOXG&RPSOHPHQWDULR\VXPRGL¿FDFLyQ
$57Ë&8/23ODQGH6DOXG&RPSOHPHQWDULR
$57Ë&8/23ODQGH6DOXG&RPSOHPHQWDULR*UXSDO\&RPSHQVDGR
$57Ë&8/20RGL¿FDFLyQGHO3ODQGH6DOXG&RPSOHPHQWDULRDSHWLFLyQGHOD¿OLDGR
E3DJRGHODVDWHQFLRQHVPpGLFDV\DUDQFHOGHSUHVWDFLRQHV

$57Ë&8/20RGDOLGDGHVGH3DJRGHODV$WHQFLRQHV0pGLFDV
$57Ë&8/2$ UDQFHOGH3UHVWDFLRQHV
TÍTULO IV
2EOLJDFLRQHVGHOD¿OLDGRH[FOXVLRQHV\UHVWULFFLRQHVGHFREHUWXUD\WpUPLQRGHFRQWUDWR
$57Ë&8/22EOLJDFLRQHVGHO$¿OLDGR
$57Ë&8/2'HFODUDFLyQGH6DOXG
$57Ë&8/2([FOXVLRQHVGH&REHUWXUD
$57Ë&8/25HVWULFFLyQGH&REHUWXUDSDUD(QIHUPHGDGHVR&RQGLFLRQHVGH6DOXG3UHH[LVWHQWHV'HFODUDGDV
$57Ë&8/2(QIHUPHGDGHVR&RQGLFLRQHVGH6DOXG3UHH[LVWHQWHV1R'HFODUDGDV
$57Ë&8/2&DXVDOHVGH7pUPLQDFLyQGHO&RQWUDWRGH6DOXG
TÍTULO V
3UHFLRGHO3ODQGH6DOXG&RPSOHPHQWDULR\VXPRGL¿FDFLyQ
$57Ë&8/23UHFLRGHO3ODQGH6DOXG&RPSOHPHQWDULR\VX5HDMXVWDELOLGDG
$57Ë&8/20RQWR'HFODUDFLyQ\3DJRGHOD&RWL]DFLyQSDUD6DOXG
$57Ë&8/2([FHGHQWHVGH&RWL]DFLyQ
$57Ë&8/2%,6([FHVRVGH&RWL]DFLyQ
$57Ë&8/2$GHFXDFLyQGHO&RQWUDWRGH6DOXG
$57Ë&8/2%,6$GHFXDFLRQHV(VSHFLDOHVGHO&RQWUDWRGH6DOXG
'LVSRVLFLRQHV¿QDOHV
$57Ë&8/2$XWRUL]DFLyQGHO$¿OLDGR
$57Ë&8/2)LVFDOL]DFLyQ\0HFDQLVPRVGH6ROXFLyQGH'LIHUHQFLDV
$57Ë&8/2'RPLFLOLR\1RWL¿FDFLRQHV
$57Ë&8/2)HFKD\)LUPDGHO&RQWUDWR
&RQGLFLRQHV GH OD FREHUWXUD DGLFLRQDO SDUD HQIHUPHGDGHV FDWDVWUy¿FDV HQ &KLOH
$57Ë&8/2,&REHUWXUDDGLFLRQDOSDUDHQIHUPHGDGHVFDWDVWUy¿FDV&$(&
'H¿QLFLyQGHFRQFHSWRV\FREHUWXUDV
0RQWRDFXPXODFLyQ\GXUDFLyQGHOGHGXFLEOH
&iOFXORGHOGHGXFLEOH
$WHQFLRQHVGHXUJHQFLD
&RQGLFLRQHVGHDFFHVRDODFREHUWXUDDGLFLRQDOSDUDHQIHUPHGDGHVFDWDVWUy¿FDV
3UHVWDFLRQHVQRFXELHUWDVSRUODFREHUWXUDDGLFLRQDOSDUDHQIHUPHGDGHVFDWDVWUy¿FDV
'HOWpUPLQRGHODFREHUWXUDDGLFLRQDOUHVSHFWRGHXQDGHWHUPLQDGDHQIHUPHGDGFDWDVWUy¿FD
3DJRGHOGHGXFLEOH
'HOWUDWDPLHQWRTXLU~UJLFRGHODREHVLGDGPyUELGD
'HODKRVSLWDOL]DFLyQGRPLFLOLDULD&$(&
'HODYLJHQFLDGHODFREHUWXUDDGLFLRQDO
$57Ë&8/2,,&REHUWXUDHVSHFLDOFDWDVWUy¿FDSDUDODVJDUDQWtDVH[SOtFLWDVHQ6DOXG*(6&$(&
$57Ë&8/2,,,'HODSHUPDQHQFLDGHODVFREHUWXUDVDGLFLRQDOHV
$57Ë&8/2,9)LVFDOL]DFLyQ\DUELWUDMH
Listado de anexos
$QH[R13HWLFLyQGHOEHQH¿FLR\GHULYDFLyQDODUHG
$QH[R10DQGDWR
$QH[R13DJDUp
$QH[R1&RQYHQLRGHSDJR
$QH[R1$XWRUL]DFLyQGHGHVFXHQWR
$QH[R10DQGDWRDXWRUL]DFLyQGHFDUJR
Condiciones para acceder a la Cobertura de las Garantías Explícitas en Salud ................................... 35
2
35,0(52*HQHUDOLGDGHV
6(*81'2&REHUWXUD
7(5&(52/LVWDGRGHSUHVWDFLRQHV
&8$572*DUDQWtDVH[SOtFLWDVHQVDOXG
48,1729LJHQFLD
6(;72)RUPDOLGDGHV\FRQGLFLRQHVGHDWHQFLyQ\GHDFFHVR
6e37,023UHFLR
2&7$92&REHUWXUD¿QDQFLHUDDGLFLRQDO
Garantías Explícitas en Salud del Régimen que rigen a contar del 1º de octubre de 2019
,QVX¿FLHQFLDUHQDOFUyQLFDWHUPLQDOHWDSD\
&DUGLRSDWtDVFRQJpQLWDVRSHUDEOHVHQPHQRUHVGHDxRV
&iQFHUFHUYLFRXWHULQR
$OLYLRGHOGRORU\FXLGDGRVSDOHDWLYRVSRUFiQFHUDYDQ]DGR
,QIDUWR$JXGRGHO0LRFDUGLR
'LDEHWHV0HOOLWXVWLSR
'LDEHWHV0HOOLWXVWLSR
&iQFHUGHPDPDHQSHUVRQDVGHDxRV\PiV
'LVUD¿DVHVSLQDOHV
7UDWDPLHQWRTXLU~UJLFRGHHVFROLRVLVHQPHQRUHVGHDxRV
7UDWDPLHQWRTXLU~UJLFRGHFDWDUDWDV
(QGRSUyWHVLV WRWDO GH FDGHUD HQ SHUVRQDV GH DxRV \ PiV FRQ DUWURVLV GH FDGHUD FRQ OLPLWDFLyQ
IXQFLRQDOVHYHUD
)LVXUDODELRSDODWLQD
&iQFHUHQPHQRUHVGHDxRV
(VTXL]RIUHQLD
&iQFHUGHWHVWtFXORHQSHUVRQDVGHDxRV\PiV
/LQIRPDVHQSHUVRQDVGHDxRV\PiV
6tQGURPHGHODLQPXQRGH¿FLHQFLDDGTXLULGD9,+6,'$
,QIHFFLyQUHVSLUDWRULDDJXGD,5$EDMDGHPDQHMRDPEXODWRULRHQPHQRUHVGHDxRV
1HXPRQtDDGTXLULGDHQODFRPXQLGDGGHPDQHMRDPEXODWRULRHQSHUVRQDVGHDxRV\PiV
+LSHUWHQVLyQDUWHULDOSULPDULDRHVHQFLDOHQSHUVRQDVGHDxRV\PiV
(SLOHSVLDQRUHIUDFWDULDHQSHUVRQDVGHVGHDxR\PHQRUHVGHDxRV
6DOXGRUDOLQWHJUDOSDUDQLxRV\QLxDVGHDxRV
3UHYHQFLyQGH3DUWR3UHPDWXUR
7UDVWRUQRV GH JHQHUDFLyQ GHO LPSXOVR \ FRQGXFFLyQ HQ SHUVRQDV GH DxRV \ PiV TXH UHTXLHUDQ
PDUFDSDVR
&ROHFLVWHFWRPtDSUHYHQWLYDGHOFiQFHUGHYHVtFXODHQSHUVRQDVGHDDxRV
&iQFHUJiVWULFR
&iQFHUGHSUyVWDWDHQSHUVRQDVGHDxRV\PiV
-8/ 13
MAY
9LFLRVGHUHIUDFFLyQHQSHUVRQDVGHDxRV\PiV
(VWUDELVPRHQPHQRUHVGHDxRV
5HWLQRSDWtDGLDEpWLFD
'HVSUHQGLPLHQWRGHUHWLQDUHJPDWyJHQRQRWUDXPiWLFR
+HPR¿OLD
'HSUHVLyQHQSHUVRQDVGHDxRV\PiV
7UDWDPLHQWRTXLU~UJLFRGHODKLSHUSODVLDEHQLJQDGHODSUyVWDWDHQSHUVRQDVVLQWRPiWLFDV
2UWHVLVR$\XGDV7pFQLFDVSDUDSHUVRQDVGHDxRV\PiV
3
$WDTXH FHUHEURYDVFXODU LVTXpPLFR HQ SHUVRQDV GH DxRV \ PiV
(QIHUPHGDGSXOPRQDUREVWUXFWLYDFUyQLFDGHWUDWDPLHQWRDPEXODWRULR
$VPDEURQTXLDOPRGHUDGD\JUDYHHQSHUVRQDVPHQRUHVGHDxRV
6tQGURPHGHGL¿FXOWDGUHVSLUDWRULDHQHOUHFLpQQDFLGR
7UDWDPLHQWRPpGLFRHQSHUVRQDVGHDxRV\PiVFRQDUWURVLVGHFDGHUD\RURGLOODOHYHR
PRGHUDGD
+HPRUUDJLDVXEDUDFQRLGHDVHFXQGDULDDUXSWXUDGHDQHXULVPDVFHUHEUDOHV
7XPRUHVSULPDULRVGHOVLVWHPDQHUYLRVRFHQWUDOHQSHUVRQDVGHDxRVRPiV
7UDWDPLHQWRTXLU~UJLFRGHKHUQLDGHO1~FOHR3XOSRVR/XPEDU
/HXFHPLDHQSHUVRQDVGHDxRV\PiV
8UJHQFLDRGRQWROyJLFDDPEXODWRULD
6DOXGRUDOLQWHJUDOGHODGXOWRGHDxRV
3ROLWUDXPDWL]DGRJUDYH
7UDXPDWLVPRFUDQHRHQFHIiOLFRPRGHUDGRRJUDYH
7UDXPDRFXODUJUDYH
)LEURVLVTXtVWLFD
$UWULWLVUHXPDWRLGHD
&RQVXPRSHUMXGLFLDORGHSHQGHQFLDGHULHVJREDMRDPRGHUDGRGHDOFRKRO\GURJDVHQSHUVRQDV
PHQRUHVGHDxRV
$QDOJHVLDGHOSDUWR
*UDQTXHPDGR
+LSRDFXVLDELODWHUDOHQSHUVRQDVGHDxRV\PiVTXHUHTXLHUHQXVRGHDXGtIRQR
5HWLQRSDWtDGHOSUHPDWXUR
'LVSODVLDEURQFRSXOPRQDUGHOSUHPDWXUR
+LSRDFXVLDQHXURVHQVRULDOELODWHUDOGHOSUHPDWXUR
(SLOHSVLDQRUHIUDFWDULDHQSHUVRQDVGHDxRV\PiV
$VPDEURQTXLDOHQSHUVRQDVGHDxRV\PiV
(QIHUPHGDGGHSDUNLQVRQ
$UWULWLVLGLRSiWLFDMXYHQLO
3UHYHQFLyQVHFXQGDULDLQVX¿FLHQFLDUHQDOFUyQLFD
'LVSODVLDOX[DQWHGHFDGHUDV
6DOXGRUDOLQWHJUDOGHODHPEDUD]DGD
(VFOHURVLVP~OWLSOHUHFXUUHQWHUHPLWHQWH
+HSDWLWLV&UyQLFDSRUYLUXV+HSDWLWLV%
+HSDWLWLV&UyQLFDSRU9LUXV+HSDWLWLV&
&iQFHUFRORUUHFWDOHQSHUVRQDVPD\RUHVGHDxRV
&iQFHUGHRYDULRHSLWHOLDO
&iQFHU9HVLFDOHQSHUVRQDVGHDxRV\PiV
2VWHRVDUFRPDHQSHUVRQDVGHDxRV\PiV
7UDWDPLHQWRTXLU~UJLFRGHOHVLRQHVGHODYiOYXODDyUWLFDHQSHUVRQDVGHDxRV\PiV
7UDVWRUQRELSRODUHQSHUVRQDVGHDxRV\PiV
+LSRWLURLGLVPRHQSHUVRQDVGHDxRV\PiV
7UDWDPLHQWRGH+LSRDFXVLD0RGHUDGD6HYHUD\3URIXQGDHQSHUVRQDVPHQRUHVGHDxRV
/XSXVHULWHPDWRVRVLVWpPLFR
7UDWDPLHQWRTXLU~UJLFRGHOHVLRQHVGHODVYiOYXODVPLWUDO\WULF~VSLGHHQSHUVRQDVGHDxRV\PiV
7UDWDPLHQWRGHHUUDGLFDFLyQGHKHOLFREDFWHUS\ORUL
&iQFHUGHSXOPyQHQSHUVRQDVGHDxRV\PiV
&iQFHUGHWLURLGHVGLIHUHQFLDGR\PHGXODUHQSHUVRQDVGHDxRV\PiV
4
&iQFHUUHQDOHQSHUVRQDVGHDxRV\PiV
0LHORPDP~OWLSOHHQSHUVRQDVGHDxRV\PiV
(QIHUPHGDGGH$O]KHLPHU\RWUDVGHPHQFLDV
Condiciones particulares Plan Preventivo de Isapres – PPI
35,0(52*HQHUDOLGDGHV
6(*81'2&REHUWXUD
7(5&(529LJHQFLD
&8$572)RUPDOLGDGHVFRQGLFLRQHVGHDWHQFLyQ\GHDFFHVR
48,1723UHFLR
6(;72%HQH¿FLDULRV
6e37,023URJUDPDVSUHYHQWLYRV
3URJUDPDGHOQLxR
3URJUDPDFRQWUROGHOHPEDUD]R
3URJUDPDGHSHUVRQDVGHDxRVRPiV
2EMHWLYRVVHJ~QFRQWURO3URJUDPDGHOQLxR
(OFRQWHQLGRGHHVWDV&RQGLFLRQHV*HQHUDOHVKDVLGRHVWDEOHFLGRSRUOD6XSHULQWHQGHQFLDGH6DOXG\HVWDUiD
GLVSRVLFLyQGHOD¿OLDGRHQODSiJLQDZHEGHOD,VDSUH7DOHVFRQGLFLRQHVVRQLJXDOHVSDUDWRGDVODV,QVWLWXFLRQHVGH
6DOXG3UHYLVLRQDOVDOYRODFDXVDOGHWpUPLQRFRQWHQLGDHQHOLQFLVR¿QDOGHODUWtFXORGHO')/1GH
GHO0LQLVWHULRGH6DOXGTXHVyORDSOLFDDODV,VDSUHVFHUUDGDV
/RVEHQH¿FLDULRVGHO&RQWUDWRGH6DOXGWLHQHQGHUHFKRGHFRQIRUPLGDGDODOH\DODV*DUDQWtDV([SOtFLWDVHQ
6DOXGUHODWLYDVDDFFHVRFDOLGDGSURWHFFLyQ¿QDQFLHUD\RSRUWXQLGDGFRQWHPSODGDVHQHO5pJLPHQ*HQHUDOGH
*DUDQWtDVHQ6DOXGDOVLVWHPDGHSURWHFFLyQ¿QDQFLHUDFUHDGRSRUOD/H\5LFDUWH6RWRDORWRUJDPLHQWRGHOH[DPHQ
GHPHGLFLQDSUHYHQWLYDSURWHFFLyQGHODPXMHUGXUDQWHHOHPEDUD]R\KDVWDHOVH[WRPHVGHOQDFLPLHQWRGHOKLMR
\GHOQLxRKDVWDORVDxRVDVtFRPRDOSDJRGHORVVXEVLGLRVSRULQFDSDFLGDGODERUDOFXDQGRSURFHGDDOSDJR
GHODVDWHQFLRQHVGHHPHUJHQFLDRXUJHQFLD\DORVEHQH¿FLRVFRQYHQFLRQDOHVHVWLSXODGRVHQHO3ODQGH6DOXG
&RPSOHPHQWDULRSDFWDGR
-8/ 13
MAY
5
TÍTULO I
BENEFICIARIOS DEL CONTRATO E INICIO DE VIGENCIA DE SUS BENEFICIOS
$57Ë&8/2%HQH¿FLDULRVGHO&RQWUDWRGH6DOXG
6RQEHQH¿FLDULRVGHOSUHVHQWH&RQWUDWR
(OFRWL]DQWH
/RVIDPLOLDUHVEHQH¿FLDULRVGHOFRWL]DQWHHVGHFLUDTXHOORVTXHUHVSHFWRGHpVWHFXPSODQFRQODVFDOLGDGHV
\UHTXLVLWRVTXHH[LJHODOH\SDUDVHUFDXVDQWHGHDVLJQDFLyQIDPLOLDUVHDTXHODSHUFLEDQRQRLQFOX\pQGRVHHQ
HVWDFDWHJRUtDHO&RQYLYLHQWH&LYLOGHOD¿OLDGRGH¿QLGRHQOD/H\\
/DVFDUJDVPpGLFDVFX\DLQFRUSRUDFLyQVHDDFHSWDGDSRUOD,VDSUH$TXHOODVHQWHUDUiQFXDQGRSURFHGDVXV
FRWL]DFLRQHVGHVDOXGHQHVD,VDSUH
7RGRVORVEHQH¿FLDULRVGHOSUHVHQWH&RQWUDWRGHEHUiQVHUFRQVLJQDGRVHQHO)RUPXODULRÒQLFRGH1RWL¿FDFLyQ
)81
D$GTXLVLFLyQ\SpUGLGDGHODFDOLGDGGHIDPLOLDUEHQH¿FLDULR3RUHOVyORPLQLVWHULRGHODOH\VHH[WHQGHUiQ
ORV HIHFWRV GHO &RQWUDWR D WRGR QXHYR IDPLOLDU EHQH¿FLDULR TXH GHFODUH HO FRWL]DQWH VXVFULELHQGR HO )81
UHVSHFWLYR\VHH[WLQJXLUiQUHVSHFWRGHTXLHQHVSLHUGDQGLFKDFRQGLFLyQ
&XDQGRVHDGTXLHUDRSLHUGDODFDOLGDGGHIDPLOLDUEHQH¿FLDULRHOFRWL]DQWHGHEHUiLQIRUPDUOR\DFUHGLWDUORHQOD
,VDSUHSDUDLQFRUSRUDURH[FOXLUDGLFKREHQH¿FLDULRPHGLDQWHHO)81UHVSHFWLYR
6LOD,VDSUHWRPDFRQRFLPLHQWRGHODSpUGLGDGHODFRQGLFLyQGHIDPLOLDUEHQH¿FLDULRSRGUiUHWLUDUORGHO&RQWUDWR
HPLWLHQGRHO)81FRUUHVSRQGLHQWHGHVGHHVHPRPHQWR\KDVWDHOYHQFLPLHQWRGHODSUy[LPDDQXDOLGDGGHO
&RQWUDWR(QFDVRGHQRKDFHUORVHHQWLHQGHTXHOD,VDSUHRSWySRUPDQWHQHUORFRPRFDUJDPpGLFD
E)DPLOLDUEHQH¿FLDULRUHFLpQQDFLGR(OIDPLOLDUEHQH¿FLDULRUHFLpQQDFLGRGHOFRWL]DQWHVHUiEHQH¿FLDULRGHO
SUHVHQWH&RQWUDWRGHVGHVXQDFLPLHQWRVLHVLQVFULWRHQOD,VDSUHDQWHVGHFXPSOLUXQPHVGHYLGD&XPSOLGDHVWD
FRQGLFLyQORVEHQH¿FLRVVHRWRUJDUiQGHVGHVXQDFLPLHQWRORVTXHVH¿QDQFLDUiQFRQODFRWL]DFLyQGHVFRQWDGD
GHODUHPXQHUDFLyQGHYHQJDGDHQHOPHVDQWHULRUDOQDFLPLHQWRVLQQHFHVLGDGGHOOHQDUXQD'HFODUDFLyQGH6DOXG
6L OD LQVFULSFLyQ GHO IDPLOLDU EHQH¿FLDULR VH UHDOL]D GHVSXpV GH FXPSOLGR XQ PHV GH YLGD \ DQWHV GH ORV
GtDV SRVWHULRUHV D VX QDFLPLHQWR \ VLHPSUH TXH pVWH QR VH HQFXHQWUH EDMR HO DPSDUR GH DOJ~Q VLVWHPD
SUHYLVLRQDOGHVDOXGORVEHQH¿FLRVVHRWRUJDUiQGHVGHHOPHVGHVXLQFRUSRUDFLyQDOD,VDSUH\VH¿QDQFLDUiQ
FRQODFRWL]DFLyQGHVFRQWDGDGHODUHPXQHUDFLyQGHYHQJDGDHQHOPHVDQWHULRUDDTXHOHQTXHVHSURGX]FD
ODUHIHULGDLQVFULSFLyQ\HQHVWHFDVRVHGHEHUiOOHQDUXQD'HFODUDFLyQGH6DOXG
$57Ë&8/29LJHQFLDGHOFRQWUDWRGHVDOXGHLQLFLRGHYLJHQFLDGHVXVEHQH¿FLRV
(OSUHVHQWH&RQWUDWRHQWUDHQYLJRUDSDUWLUGHODIHFKDGHVXVXVFULSFLyQODTXHpVWDFRQVLJQDGDHQHO)RUPXODULR
ÒQLFRGH1RWL¿FDFLyQ\VXVEHQH¿FLRVWHQGUiQYLJHQFLDDSDUWLUGHOSULPHUGtDGHOPHVVXEVLJXLHQWHDODVXVFULSFLyQ
GHOPLVPRVDOYRSDFWRGHYLJHQFLDDQWLFLSDGDGHEHQH¿FLRVGHOTXHVHGHMDUiFRQVWDQFLDHQHO)81WLSR
/RV QXHYRV EHQH¿FLDULRV LQFRUSRUDGRV DO &RQWUDWR WHQGUiQ GHUHFKR D VXV EHQH¿FLRV D SDUWLU GHO SULPHU GtD
GHOPHVVXEVLJXLHQWHDDTXHOHQTXHVHHIHFWXyODUHVSHFWLYDLQFRUSRUDFLyQ
3DUD ORV HIHFWRV GH HVWH &RQWUDWR \ ORV GHPiV HIHFWRV OHJDOHV D TXH KD\D OXJDU HO PHV GH VXVFULSFLyQ GHO
&RQWUDWR FRUUHVSRQGH DO PHV GH DQXDOLGDG GHO PLVPR VDOYR TXH ODV SDUWHV OR PRGL¿TXHQ H[SUHVDPHQWH HQ
ORVFDVRVTXHVHDSURFHGHQWH

TÍTULO II
BENEFICIOS LEGALES
$57Ë&8/2%HQH¿FLRVPtQLPRVREOLJDWRULRV
/RVEHQH¿FLRVPtQLPRVTXHOD,VDSUHRWRUJDUiDVXVD¿OLDGRV\EHQH¿FLDULRVFRQVLVWHQHQ
/DV *DUDQWtDV ([SOtFLWDV HQ 6DOXG *(6 HQ FRQIRUPLGDG D OR GLVSXHVWR HQ OD /H\ 1 FX\DV
FRQGLFLRQHV SDUD DFFHGHU D OD FREHUWXUD VH GHWDOODQ HQ HO DQH[R UHIHULGR D HVWD PDWHULD \ TXH IRUPD SDUWH
del presente Contrato

(OSUHFLRGHODV*(6VHH[SUHVDHQXQLGDGHVGHIRPHQWRRPRQHGDGHFXUVROHJDOHQHOSDtV\VH¿MDSRU
OD,VDSUHHQIRUPDXQLWDULDHLJXDOLWDULDSDUDWRGRVORVEHQH¿FLDULRV(VWHSUHFLRHVLQGHSHQGLHQWHGHOSUHFLR
GHO 3ODQ GH 6DOXG &RPSOHPHQWDULR \ SRGUi VHU PRGL¿FDGR FDGD WUHV DxRV D PHQRV TXH HO 'HFUHWR TXH
HVWDEOHFHODV*DUDQWtDV([SOtFLWDVVHDUHYLVDGRHQXQSHUtRGRLQIHULRU
/DVH[FOXVLRQHV\UHVWULFFLRQHVGHFREHUWXUDLQGLFDGDVHQORVDUWtFXORV\GHOSUHVHQWH&RQWUDWR
QR VH DSOLFDQ D ORV EHQH¿FLRV GH ODV *(6 FX\R RWRUJDPLHQWR VH HIHFWXDUi SRU SUHVWDGRUHV VLWXDGRV HQ HO
WHUULWRULR QDFLRQDO TXH SDUD WDOHV HIHFWRV GHWHUPLQH OD ,VDSUH \ FRQIRUPH D ODV PRGDOLGDGHV \ FRQGLFLRQHV
HVWDEOHFLGDVHQOD/H\1
(O([DPHQGH0HGLFLQD3UHYHQWLYDDTXHWLHQHQGHUHFKRORVEHQH¿FLDULRVFRQVWLWXLGRSRUXQSODQSHULyGLFR
GHPRQLWRUHR\HYDOXDFLyQGHODVDOXGDORODUJRGHOFLFORYLWDOUHVSHFWRGHDTXHOODVHQIHUPHGDGHVRFRQGLFLRQHV
SUHYHQLEOHV R FRQWURODEOHV TXH IRUPHQ SDUWH GH ODV SULRULGDGHV VDQLWDULDV VHJ~Q OR GHWHUPLQH HO 0LQLVWHULR
GH6DOXG
/DDWHQFLyQGHODPXMHUGXUDQWHHOHPEDUD]R\KDVWDHOVH[WRPHVGHQDFLPLHQWRGHOKLMR
/DDWHQFLyQGHOQLxRUHFLpQQDFLGR\KDVWDORVDxRVGHHGDG
(O([DPHQGH0HGLFLQD3UHYHQWLYDFRQWUROGHHPEDUD]R\SXHUSHULR\FRQWUROGHVDOXGGHOQLxRVDQRVHUiQ
RWRUJDGRV HQ IRUPD JUDWXLWD HQ DTXHOODV LQVWLWXFLRQHV HVSHFLDOL]DGDV FRQ ODV TXH OD ,VDSUH FRQYHQJD \ VH
UHDOL]DUiQGHDFXHUGRFRQHOSURFHGLPLHQWRHVWDEOHFLGRSRUpVWD
/RV SURFHGLPLHQWRV \ PHFDQLVPRV SDUD HO RWRUJDPLHQWR GH ORV EHQH¿FLRV PtQLPRV VHxDODGRV HQ ORV 1V
\ SUHFHGHQWHV HVWDUiQ FRQWHQLGRV HQ DQH[RV UHIHULGRV D HVDV PDWHULDV TXH VH HQWUHJDUiQ DO
PRPHQWR GH OD VXVFULSFLyQ GHO SUHVHQWH &RQWUDWR \ HVWDUiQ VLHPSUH DFWXDOL]DGRV D GLVSRVLFLyQ GH ORV
EHQH¿FLDULRVHQODVR¿FLQDV\ODSiJLQDZHEGHOD,VDSUHSDUDVXFRQVXOWD
(O SDJR GH VXEVLGLRV SRU LQFDSDFLGDG ODERUDO FXDQGR HOOR VHD SURFHGHQWH SRU OLFHQFLDV PpGLFDV TXH QR
FRUUHVSRQGDQDDFFLGHQWHVGHOWUDEDMRQLDHQIHUPHGDGHVSURIHVLRQDOHV
&REHUWXUD 0tQLPD /D FREHUWXUD GHO 3ODQ GH 6DOXG &RPSOHPHQWDULR QR SRGUi VHU LQIHULRU DO GH OD
SUHYLVWDHQHOPLVPRSODQSDUDODSUHVWDFLyQJHQpULFDFRUUHVSRQGLHQWHQLDODFREHUWXUD¿QDQFLHUDTXHDVHJXUD
HO)RQDVDHQODPRGDOLGDGGHOLEUHHOHFFLyQDODUHVSHFWLYDSUHVWDFLyQFRQWHPSODGDVHQHODUDQFHOGHELHQGR
RWRUJDUVHODTXHUHVXOWHPD\RUHQWUHDPEDV
$57Ë&8/2/H\5LFDUWH6RWR
/DOH\1FUHyXQ6LVWHPDGH3URWHFFLyQ)LQDQFLHUDSDUDHORWRUJDPLHQWRGHGLDJQyVWLFRV\WUDWDPLHQWRV
-8/ 13
MAY
GHDOWRFRVWRSDUDFRQGLFLRQHVHVSHFt¿FDVGHVDOXGVHxDODGRVHQHOGHFUHWRUHVSHFWLYRGLFWDGRSRUHO0LQLVWHULR
GH6DOXG
(O)RQGR1DFLRQDOGH6DOXG)RQDVDSRUVXSDUWHHVHOHQFDUJDGRGHDVHJXUDUODSURWHFFLyQ¿QDQFLHUDTXH

WUDWDHVWDOH\DWRGRVORVEHQH¿FLDULRVGHORVVLVWHPDSUHYLVLRQDOHVGHVDOXGLQFOX\HQGRORVGHODV,VDSUHV
(QHVWHFRQWH[WRHVGHEHUGHOD,VDSUHIDFLOLWDUHODFFHVR\RWRUJDULQIRUPDFLyQVX¿FLHQWH\RSRUWXQDUHVSHFWRD
VXVEHQH¿FLDULRVGHO6LVWHPDGH3URWHFFLyQ)LQDQFLHUDTXHVHFUHDODOH\1\VXIXQFLRQDPLHQWR

$57Ë&8/2$WHQFLRQHVGHHPHUJHQFLDRXUJHQFLDFRQULHVJRYLWDORGHVHFXHODIXQFLRQDOJUDYH
7UDWiQGRVH GH DWHQFLRQHV GH XUJHQFLD R HPHUJHQFLD HVWR HV WRGD FRQGLFLyQ GH VDOXG R FXDGUR FOtQLFR TXH
LPSOLTXHULHVJRYLWDORVHFXHODIXQFLRQDOJUDYHSDUDXQDSHUVRQDGHQRPHGLDUDWHQFLyQPpGLFDLQPHGLDWDH
LPSRVWHUJDEOH TXH HVWpQ GHELGDPHQWH FHUWL¿FDGDV SRU XQ PpGLFR FLUXMDQR OD ,VDSUH SDJDUi GLUHFWDPHQWH
DODVFOtQLFDVXKRVSLWDOHVHOYDORUSRUODVSUHVWDFLRQHVUHFLELGDVSRUHOUHVSHFWLYREHQH¿FLDULRKDVWDTXHpVWH
VH HQFXHQWUH HVWDELOL]DGR GH PRGR TXH HVWp HQ FRQGLFLRQHV GH VHU GHULYDGR (Q WDO FDVR OD OH\ SURKtEH D
ORV SUHVWDGRUHV H[LJLU D ORV D¿OLDGRV R EHQH¿FLDULRV GLQHUR FKHTXHV X RWURV LQVWUXPHQWRV ¿QDQFLHURV SDUD
JDUDQWL]DUHOSDJRRFRQGLFLRQDUGHFXDOTXLHURWUDIRUPDGLFKDDWHQFLyQ
&RQWRGROD,VDSUHSRGUiUHFXSHUDUDTXHOODSDUWHGHOYDORUSDJDGRTXHGHDFXHUGRDO3ODQGH6DOXG&RPSOHPHQWDULR
VHDGHFDUJRGHOD¿OLDGRWRWDORSDUFLDOPHQWHSDUDORFXDOGHEHUiLQIRUPDUOHHOPRQWRGHODGHXGD\ODVDOWHUQDWLYDV
TXHRIUHFHSDUDVXSDJR6LGHQWURGHORVGtDVKiELOHVVLJXLHQWHVDODH[SHGLFLyQGHODUHIHULGDFRPXQLFDFLyQ
HOFRWL]DQWHQRSDJDODGHXGDRQRFRQYLHQHFRQOD,VDSUHXQDPRGDOLGDGSDUDVXSDJRVHHQWHQGHUiTXHOD
,VDSUHOHKDRWRUJDGRXQSUpVWDPRSRUHOUHIHULGRYDORUHOFXDOGHEHUiVHUSDJDGRHQFXRWDVLJXDOHV\VXFHVLYDV
FRQYHQFLPLHQWRVPHQVXDOHVHQODVTXHVHLQFOXLUiHOUHDMXVWHFRQIRUPHDOËQGLFHGH3UHFLRVDO&RQVXPLGRU\XQ
LQWHUpVHTXLYDOHQWHDODWDVDGHLQWHUpVFRUULHQWHSDUDRSHUDFLRQHVUHDMXVWDEOHVDTXHVHUH¿HUHHODUWtFXORGH
OD/H\1ODVTXHQRSRGUiQH[FHGHUHOGHODUHPXQHUDFLyQUHQWDRSHQVLyQLPSRQLEOHWUDWiQGRVHGH
GHSHQGLHQWHVLQGHSHQGLHQWHVRSHQVLRQDGRVRDXQDVXPDHTXLYDOHQWHDOSUHFLRGHO3ODQGH6DOXG&RPSOHPHQWDULR
FRQWUDWDGRHQHOFDVRGHFRWL]DQWHVYROXQWDULRV
/RV D¿OLDGRV LQGHSHQGLHQWHV R YROXQWDULRV SDJDUiQ GLUHFWDPHQWH D OD ,VDSUH OD FXRWD FRUUHVSRQGLHQWH \ ORV
GHSHQGLHQWHVRSHQVLRQDGRVGHEHUiQKDFHUORDWUDYpVGHVXHPSOHDGRURHQWLGDGHQFDUJDGDGHOSDJRGHOD
SHQVLyQ
/D,VDSUHSRGUiFRQYHQLUFRQVXVD¿OLDGRVODVJDUDQWtDVTXHHVWLPHSHUWLQHQWHVSDUDDVHJXUDUHOSDJRGHOR
DGHXGDGRVDOYRODXWLOL]DFLyQGHFKHTXHV
$57Ë&8/2%HQH¿FLDULRTXHDGTXLHUHODFDOLGDGMXUtGLFDGHFRWL]DQWH
(QHOHYHQWRTXHXQEHQH¿FLDULRDGTXLHUDODFDOLGDGMXUtGLFDGHFRWL]DQWHSRGUiRSWDUSRUSHUPDQHFHUHQOD
,VDSUH VXVFULELHQGR XQ &RQWUDWR GH 6DOXG HQ DOJ~Q SODQ GH DTXHOORV TXH OD ,VDSUH WHQJD HQ DFWXDO
FRPHUFLDOL]DFLyQHQHVSHFLDODTXHOORVFX\RSUHFLRVHDMXVWHDOPRQWRGHODFRWL]DFLyQOHJDOGHOEHQH¿FLDULR
(QHOQXHYR&RQWUDWRQRSRGUiQLPSRQHUVHDOEHQH¿FLDULRRWUDVUHVWULFFLRQHVTXHODVTXH\DVHHQFXHQWUHQ
YLJHQWHVQLH[LJtUVHOHXQDQXHYD'HFODUDFLyQGH6DOXG
$57Ë&8/2)DOOHFLPLHQWRGHOFRWL]DQWH
(QHOHYHQWRTXHHOFRWL]DQWHIDOOH]FDXQDYH]WUDQVFXUULGRXQDxRGHYLJHQFLDLQLQWHUUXPSLGDGHORVEHQH¿FLRV
FRQWUDFWXDOHVOD,VDSUHPDQWHQGUiSRUXQSHUtRGRQRLQIHULRUDXQDxRRDTXHOVXSHULRUTXHVHFRQYHQJDHQ
HO3ODQGH6DOXG&RPSOHPHQWDULRFRQWDGRGHVGHHOIDOOHFLPLHQWRWRGRVORVEHQH¿FLRVGHO&RQWUDWRGH6DOXG
YLJHQWHDODIHFKDHQTXHVHYHUL¿FyWDOFLUFXQVWDQFLDDWRGRVORVEHQH¿FLDULRVGHFODUDGRVSRUDTXHOHQWHQGLpQGRVH
LQFRUSRUDGRVHQpVWRVDOKLMRTXHHVWiSRUQDFHU\TXHKDEUtDVLGRVXEHQH¿FLDULROHJDOGHYLYLUHOFDXVDQWHDODpSRFD
GHVXQDFLPLHQWR'XUDQWHHOSHUtRGRTXHULMDHOEHQH¿FLROD,VDSUHWHQGUiGHUHFKRDSHUFLELUODVFRWL]DFLRQHVSDUD
VDOXGSURYHQLHQWHVGHODVSHQVLRQHVRUHPXQHUDFLRQHVGHYHQJDGDVSRUORVEHQH¿FLDULRVGHOFRWL]DQWHIDOOHFLGR
FXDQGRFRUUHVSRQGD$VXWpUPLQRHOEHQH¿FLDULRSRGUiRSWDUSRUFRQWUDWDUFRQOD,VDSUHHOPLVPR3ODQGH
6DOXG&RPSOHPHQWDULRSDJDQGRHOSUHFLRTXHUHVXOWHGHPXOWLSOLFDUHOSUHFLREDVHGHOPLVPRSRUHOIDFWRUTXH
FRUUHVSRQGDDVXVH[R\HGDGXRWURSODQGHDTXHOORVTXHOD,VDSUHPDQWHQJDHQDFWXDOFRPHUFLDOL]DFLyQ
FX\RSUHFLRVHDMXVWHDOPRQWRTXHSRUHOEHQH¿FLDULRVHHQWHUDEDHQOD,VDSUHGHDFXHUGRFRQODWDEODGH
IDFWRUHVYLJHQWHHQHOSODQGHOFRWL]DQWHIDOOHFLGRRXQRPHQRUVLDVtORVROLFLWDH[SUHVDPHQWH(QHOFDVR
GHODVSHUVRQDVEHQH¿FLDULDVDGVFULWDVDSODQHVGHVDOXGJUXSDOHVSDFWDGRVHQHOSRUFHQWDMHHTXLYDOHQWHDOD
FRWL]DFLyQOHJDOOD,VDSUHHVWDUiREOLJDGDDRIUHFHUOHVHOPLVPR3ODQGH6DOXGJUXSDOGHELHQGRpVWDVSDJDUODV
FRWL]DFLRQHVSDUDVDOXGSURYHQLHQWHVGHODVSHQVLRQHVRUHPXQHUDFLRQHVGHYHQJDGDVSRUHOODV
6LQ SHUMXLFLR GH OR DQWHULRU HO EHQH¿FLDULR SXHGH UHQXQFLDU DO SUHVHQWH EHQH¿FLR RSWDQGR SRU FRQWUDWDU
GLUHFWDPHQWHHOPLVPRSODQXRWURHQORVWpUPLQRVVHxDODGRVSUHFHGHQWHPHQWH
(Q WRGR FDVR HQ HO QXHYR &RQWUDWR TXH VH VXVFULED QR SRGUiQ SDFWDUVH RWUDV UHVWULFFLRQHV R H[FOXVLRQHV
TXH ODV TXH VH HQFRQWUDEDQ YLJHQWHV HQ HO &RQWUDWR TXH PDQWHQtD HO FRWL]DQWH IDOOHFLGR FRQ OD ,VDSUH QL
H[LJLUVHXQDQXHYD'HFODUDFLyQGH6DOXG
/RVEHQH¿FLDULRVGHOFRWL]DQWHIDOOHFLGRQRSRGUiQKDFHUXVRGHORVUHFXUVRVDFXPXODGRVHQODFXHQWDFRUULHQWH
GHH[FHGHQWHVDPHQRVTXHVHWUDWHGHORVKHUHGHURVGHOFRWL]DQWH

TÍTULO III
BENEFICIOS CONVENCIONALES
$57Ë&8/23ODQGH6DOXG&RPSOHPHQWDULR
(Q HO 3ODQ GH 6DOXG &RPSOHPHQWDULR VH HVWLSXODQ HQ IRUPD GHWDOODGD ODV SUHVWDFLRQHV \ EHQH¿FLRV D FX\R
¿QDQFLDPLHQWR VH REOLJD OD ,VDSUH VX SUHFLR \ ODV GHPiV FRQGLFLRQHV SDUWLFXODUHV TXH FRUUHVSRQGDQ
El Plan de Salud Complementario puede contener alguna de las siguientes modalidades para el otorgamiento
GHODVSUHVWDFLRQHV\EHQH¿FLRVFX\RVUHTXLVLWRV\HIHFWRVUHJXODODOH\
D 3ODQ /LEUH (OHFFLyQ HV DTXpO HQ TXH OD HOHFFLyQ GHO SUHVWDGRU GH VDOXG HV UHVXHOWD GLVFUHFLRQDOPHQWH
SRUHOD¿OLDGRREHQH¿FLDULRVLQLQWHUYHQFLyQGHOD,VDSUH
E 3ODQ &HUUDGR HV DTXpO FX\D HVWUXFWXUD VyOR FRQWHPSOD HO ¿QDQFLDPLHQWR GH WRGDV ODV DWHQFLRQHV GH
VDOXG D WUDYpV GH GHWHUPLQDGRV SUHVWDGRUHV LQGLYLGXDOL]DGRV HQ HO SODQ QR SUHYLpQGRVH HO DFFHVR D ODV
SUHVWDFLRQHVEDMRODPRGDOLGDGGHOLEUHHOHFFLyQ
F3ODQFRQ3UHVWDGRUHV3UHIHUHQWHVHVDTXpOFX\DHVWUXFWXUDFRPELQDODDWHQFLyQEDMRODPRGDOLGDGGHOLEUH
HOHFFLyQ\HO¿QDQFLDPLHQWRGHEHQH¿FLRVDWUDYpVGHGHWHUPLQDGRVSUHVWDGRUHVSUHYLDPHQWHLQGLYLGXDOL]DGRV
HQHOSODQ
7UDWiQGRVHGHSODQHVFHUUDGRVRFRQSUHVWDGRUHVSUHIHUHQWHVHQHO3ODQGH6DOXG&RPSOHPHQWDULRVHLGHQWL¿FD
HO QRPEUH GHO R ORV SUHVWDGRUHV LQVWLWXFLRQDOHV D WUDYpV GH ORV FXDOHV VH RWRUJDUiQ ODV SUHVWDFLRQHV VHDQ
pVWDV DPEXODWRULDV X KRVSLWDODULDV DVt FRPR ORV SUHVWDGRUHV TXH VXEVLGLDULDPHQWH EULQGDUiQ ODV DWHQFLRQHV
GH VDOXG D VXV EHQH¿FLDULRV HQ HO HYHQWR GH FRQ¿JXUDUVH XQD LQVX¿FLHQFLD 7UDWiQGRVH GH DWHQFLRQHV GH
XUJHQFLD DGHPiV GHEHUiQ PHQFLRQDUVH ORV SURFHGLPLHQWRV SDUD DFFHGHU D ORV SUHVWDGRUHV \ OD FREHUWXUD
TXH VH RWRUJDUi D HVDV DWHQFLRQHV VHD TXH pVWDV VH UHDOLFHQ SRU GLFKRV SUHVWDGRUHV R SRU RWURV GLVWLQWRV
(QWRGRFDVRFRQRFDVLyQGHXQDHPHUJHQFLD\KDELHQGRLQJUHVDGRDXQSUHVWDGRUGLVWLQWRDORVVHxDODGRV
HQHO3ODQGH6DOXG&RPSOHPHQWDULRHOD¿OLDGRWHQGUiGHUHFKRDVHUWUDVODGDGRDDOJXQRGHORVSUHVWDGRUHV
LQGLYLGXDOL]DGRV HQ HO SODQ \ OD ,VDSUH SRU VX SDUWH D WUDVODGDU DO SDFLHQWH D XQR GH HVWRV SUHVWDGRUHV
VXMHWiQGRVH D ODV UHJODV VHxDODGDV HQ HO DUWtFXOR GHO ')/ 1 GH GHO 0LQLVWHULR GH 6DOXG
&XDOTXLHUDVHDODPRGDOLGDGFRQYHQLGDHO3ODQGH6DOXG&RPSOHPHQWDULRQRSRGUiFRQWHPSODUXQDFREHUWXUD
LQIHULRUDODVHxDODGDHQHODUWtFXOR1GHOSUHVHQWH&RQWUDWR
$57Ë&8/23ODQGH6DOXG&RPSOHPHQWDULRJUXSDO\FRPSHQVDGR
(O3ODQGH6DOXG&RPSOHPHQWDULRSXHGHVHULQGLYLGXDORJUXSDOWDPELpQGHQRPLQDGRVFROHFWLYRV/RVSODQHV

LQGLYLGXDOHV SXHGHQ VHU D VX YH] FRPSHQVDGRV /DV GLVSRVLFLRQHV GHO SUHVHQWH DUWtFXOR VHUiQ DSOLFDEOHV
VyOR DO 3ODQ GH 6DOXG &RPSOHPHQWDULR JUXSDO \ DO 3ODQ GH 6DOXG &RPSOHPHQWDULR LQGLYLGXDO FRPSHQVDGR
&XDQGR XQ 3ODQ GH 6DOXG &RPSOHPHQWDULR WHQJD DOJXQD GH ODV UHIHULGDV FDOLGDGHV VH GHMDUi FRQVWDQFLD
HVFULWDGHHOORHQHO)81UHVSHFWLYR
D3ODQGH6DOXG&RPSOHPHQWDULRJUXSDORFROHFWLYR3RUHOKHFKRGHSHUWHQHFHUHOFRWL]DQWHDXQDGHWHUPLQDGD
HPSUHVDRJUXSRGHGRVRPiVWUDEDMDGRUHVVHSRGUiFRQYHQLUFRQOD,VDSUHHORWRUJDPLHQWRGHEHQH¿FLRV
GLVWLQWRVGHORVTXHSRGUtDREWHQHUFRQODVRODFRWL]DFLyQLQGLYLGXDOGHQRPHGLDUGLFKDFLUFXQVWDQFLD7RGRV
ORVEHQH¿FLRVDTXHWHQJDQGHUHFKRODVSHUVRQDVFRWL]DQWHV\EHQH¿FLDULDVVHHVWLSXODQHQIRUPDH[SUHVDHQ
HO3ODQGH6DOXG&RPSOHPHQWDULR$GHPiVHOSODQJUXSDOGHEHUiHQXPHUDUODVFRQGLFLRQHVGHYLJHQFLDGHO
-8/ 13
PLVPRHVWRHVDTXHOORVKHFKRVRFLUFXQVWDQFLDVFX\DYDULDFLyQRDOWHUDFLyQSRGUiGDUOXJDUDODPRGL¿FDFLyQ
MAY
RWpUPLQRGHOSODQJUXSDOFRPRDVLPLVPRLQGLFDUORVUHTXLVLWRVTXHHQIRUPDLQGLYLGXDOGHEHUHXQLUOD
SREODFLyQFRWL]DQWHSDUDLQJUHVDU\PDQWHQHUVHHQHOSODQJUXSDO
(QHOHYHQWRGHTXHSRUFXDOTXLHUFDXVDVHHOLPLQHQORVEHQH¿FLRVDGLFLRQDOHVSRUHOFHVHGHODVFRQGLFLRQHV
EDMRODVFXDOHVVHRWRUJDURQHOORVyORSRGUiGDURULJHQDPRGL¿FDFLRQHVFRQWUDFWXDOHVUHODWLYDVDOPRQWRGHOD
FRWL]DFLyQSDFWDGDRDORVEHQH¿FLRVFRQYHQLGRVSXGLHQGRVLHPSUHHOD¿OLDGRGHVDKXFLDUHO&RQWUDWR&RQ
WRGROD,QVWLWXFLyQGHEHUiRIUHFHUDOFRWL]DQWHXQQXHYR3ODQGH6DOXG&RPSOHPHQWDULRHOFXDOHQFDVRDOJXQR
SRGUiFRQWHPSODUHORWRUJDPLHQWRGHEHQH¿FLRVPHQRUHVDORVTXHSRGUtDREWHQHUGHDFXHUGRDODFRWL]DFLyQOHJDO
DTXHGpRULJHQODUHPXQHUDFLyQGHOWUDEDMDGRUHQHOPRPHQWRGHPRGL¿FDUVHVX&RQWUDWR'HLJXDOPRGRGHEHUi
SURFHGHUOD,VDSUHHQFDVRTXHHOWpUPLQRGHO3ODQGH6DOXG&RPSOHPHQWDULRJUXSDOSDUDHOD¿OLDGRWHQJDVX
RULJHQHQHOWpUPLQRGHVXUHODFLyQODERUDOFRQODHPSUHVDGHVGHHOPRPHQWRHQTXHOHFRQVWHWDOFLUFXQVWDQFLD
VLQSHUMXLFLRGHODREOLJDFLyQGHOFRWL]DQWHGHLQIRUPDUOD

Si cesan todas o algunas de las condiciones previstas para la vigencia del Plan de Salud Complementario
JUXSDOOD,VDSUHSRGUiRSWDUSRUPRGL¿FDUORRGHUHFKDPHQWHSRQHUOHWpUPLQRGHDFXHUGRDORTXHDFRQWLQXDFLyQ
VHH[SUHVD
L 0RGL¿FDFLyQ GHO 3ODQ GH 6DOXG &RPSOHPHQWDULR JUXSDO (Q FDVR GH PRGL¿FDUVH HO 3ODQ GH
6DOXG&RPSOHPHQWDULRJUXSDOSRUHOFHVHGHDOJXQDVRWRGDVODVFRQGLFLRQHVEDMRODVFXDOHVVHSDFWy
OD,VDSUHGHEHUiFRPXQLFDUSRUHVFULWRHVWHKHFKRDWRGDVODVD¿OLDGDVRD¿OLDGRVD¿QGHSRGHUFRQYHQLU
FRQODVSHUVRQDVFRWL]DQWHVODPRGL¿FDFLyQGHOPRQWRGHODFRWL]DFLyQSDFWDGDRDGHORVEHQH¿FLRV
FRQYHQLGRVORTXHGHEHUiVHUDFHSWDGRSRUFDGDXQDGHHOODV
'LFKDV PRGL¿FDFLRQHV VHUiQ IRUPDOL]DGDV PHGLDQWH OD VXVFULSFLyQ GH XQ QXHYR 3ODQ GH 6DOXG
&RPSOHPHQWDULR JUXSDO \ GHO )81 UHVSHFWLYR OR TXH QR VHUi QHFHVDULR VL HQ OD FRQWUDWDFLyQ GHO
SODQ R HQ IRUPD SRVWHULRU VH KD PDQGDWDGR D XQD R PiV SHUVRQDV TXH ORV UHSUHVHQWHQ SDUD
QHJRFLDU ODV DQWHGLFKDV PRGL¿FDFLRQHV DMXVWDU ODV FRQGLFLRQHV GH YLJHQFLD HQ VX FDVR \ VXVFULELU
ORVLQVWUXPHQWRVFRUUHVSRQGLHQWHV
(Q WRGR FDVR ORV EHQH¿FLRV SDFWDGRV QR VXIULUiQ DOWHUDFLyQ DOJXQD HQ WDQWR QR VH FRQYHQJD OD
PRGL¿FDFLyQGHO3ODQGH6DOXG&RPSOHPHQWDULRJUXSDO
LL 2IUHFLPLHQWR GH XQ 3ODQ LQGLYLGXDO SRU WpUPLQR GHO 3ODQ JUXSDO Si no se llega a un
DFXHUGR FRQ ODV R ORV FRWL]DQWHV R VXV UHSUHVHQWDQWHV FRPXQHV VREUH ODV PRGL¿FDFLRQHV
FRQWUDFWXDOHV GHO SODQ JUXSDO OD ,VDSUH FRPXQLFDUi SRU HVFULWR D ODV SHUVRQDV D¿OLDGDV HO
WpUPLQR GHO 3ODQ GH 6DOXG &RPSOHPHQWDULR JUXSDO \ OD DOWHUQDWLYD GH RSWDU SRU ORV SODQHV
LQGLYLGXDOHV GH TXH GLVSRQH SDUD HOODV R ELHQ GHVD¿OLDUVH /D RIHUWD GH SODQHV FRPR PtQLPR
GHEHUi FRQWHPSODU HO 3ODQ GH 6DOXG &RPSOHPHQWDULR TXH VH HQFXHQWUH FRPHUFLDOL]DQGR
OD ,VDSUH \ TXH WHQJD HO SUHFLR TXH PiV VH DMXVWD DO PRQWR GH OD FRWL]DFLyQ OHJDO TXH FRUUHVSRQGD
D OD UHPXQHUDFLyQ GHO WUDEDMDGRU DO PRPHQWR GH WHUPLQDUVH HO 3ODQ GH 6DOXG &RPSOHPHQWDULR
JUXSDO
(O D¿OLDGR GHEHUi RSWDU SRU DOJXQD DOWHUQDWLYD TXH OH SURSRQH OD ,VDSUH KDVWD HO ~OWLPR GtD KiELO
GHO PHV VLJXLHQWH DO GH OD H[SHGLFLyQ GH OD FRPXQLFDFLyQ VL VH UHPLWH SRU FRUUHR R GH VX HQWUHJD
VL pVWD HV SHUVRQDO $QWH HO VLOHQFLR GHO FRWL]DQWH VH HQWHQGHUi TXH DFHSWD HO SODQ RIUHFLGR SRU
OD,VDSUHTXHPiVVHDMXVWDDVXFRWL]DFLyQOHJDO
6L OD DFHSWDFLyQ HV H[SUHVD ODV SDUWHV VXVFULELUiQ HO SODQ FRQYHQLGR \ HO UHVSHFWLYR )81
TXHGDQGR HQ SRGHU GHO FRWL]DQWH XQD FRSLD GH FDGD GRFXPHQWR 6L OD DFHSWDFLyQ HV WiFLWD OD
,VDSUHHPLWLUi\¿UPDUiHO)81FRUUHVSRQGLHQWH\ORUHPLWLUiSRUFDUWDFHUWL¿FDGDDOFRWL]DQWHMXQWRFRQ
ODFRSLDGHO3ODQGH6DOXGUHVSHFWLYRDQWHVGHODHQWUDGDHQYLJHQFLDGHORVEHQH¿FLRVGHOQXHYR3ODQ
GH6DOXG&RPSOHPHQWDULR
(O3ODQGH6DOXG&RPSOHPHQWDULRJUXSDOVHPDQWHQGUiYLJHQWHKDVWDHO~OWLPRGtDGHOPHVVLJXLHQWH
D DTXHO HQ TXH H[SLUH HO SOD]R FRQFHGLGR DO FRWL]DQWH SDUD SURQXQFLDUVH VREUH HO 3ODQ GH 6DOXG
&RPSOHPHQWDULRSURSXHVWRSRUOD,VDSUH
E3ODQGH6DOXG&RPSOHPHQWDULRFRPSHQVDGR/DVSDUWHVSRGUiQFRQYHQLUTXHHOD¿OLDGRVHDGVFULEDDXQ
3ODQGH6DOXG&RPSOHPHQWDULRFX\RSUHFLRVHDVXSHULRUDVXFRWL]DFLyQLQGLYLGXDOGHVDOXGFDVRHQHOFXDOVX
SUHFLR¿QDOVHUi¿QDQFLDGRDGHPiVFRQODFRPSHQVDFLyQHIHFWXDGDYROXQWDULDPHQWHSRURWURD¿OLDGRGHOD,VDSUH
(QFDVRGHWpUPLQRGHODFRPSHQVDFLyQOD,VDSUHFRPXQLFDUiDORWURFRWL]DQWHFRPSHQVDGRSRUHVFULWRGLFKD
WHUPLQDFLyQ\ODRSFLyQGHPDQWHQHUHOSODQDOFXDOHVWDEDDGVFULWRSDJDQGRODFRWL]DFLyQDGLFLRQDOFXDQGR
FRUUHVSRQGDVXVFULELUXQ3ODQGH6DOXG&RPSOHPHQWDULRTXHVHHQFXHQWUHFRPHUFLDOL]DQGROD,VDSUH\TXH
WHQJDHOSUHFLRTXHPiVVHDMXVWHDOPRQWRGHODFRWL]DFLyQOHJDODOPRPHQWRGHWHUPLQDUVHODFRPSHQVDFLyQR
ELHQGHVD¿OLDUVH(OD¿OLDGRGHEHUiRSWDUSRUDOJXQDGHODVDOWHUQDWLYDVTXHOHSURSRQHOD,VDSUHKDVWDHO~OWLPR
GtDKiELOGHOPHVVLJXLHQWHDOGHODH[SHGLFLyQGHODFRPXQLFDFLyQVLVHUHPLWHSRUFRUUHRRGHVXHQWUHJDVL
pVWDHVSHUVRQDO$QWHHOVLOHQFLRGHOFRWL]DQWHVHHQWHQGHUiTXHDFHSWDHOSODQRIUHFLGRSRUOD,VDSUHTXHPiV
VHDMXVWDDVXFRWL]DFLyQOHJDO6LODDFHSWDFLyQHVH[SUHVDODVSDUWHVVXVFULELUiQHOSODQFRQYHQLGR\HOUHVSHFWLYR
)81TXHGDQGR HQ SRGHU GHO FRWL]DQWH XQD FRSLD GH FDGD GRFXPHQWR 6L OD DFHSWDFLyQ HV WiFLWD OD ,VDSUH
HPLWLUiHO)81FRUUHVSRQGLHQWH¿UPDGRVyORSRUpVWD\ORUHPLWLUiSRUFDUWDFHUWL¿FDGDDOFRWL]DQWHMXQWRFRQ
ODFRSLDGHO3ODQGH6DOXGUHVSHFWLYRDQWHVGHODHQWUDGDHQYLJHQFLDGHORVEHQH¿FLRVGHOQXHYRSODQ
(O3ODQGH6DOXG&RPSOHPHQWDULRFRPSHQVDGRVHPDQWHQGUiYLJHQWHKDVWDHO~OWLPRGtDGHOPHVVLJXLHQWHD
DTXHOHQTXHH[SLUHHOSOD]RFRQFHGLGRDOFRWL]DQWHSDUDSURQXQFLDUVHVREUHHO3ODQGH6DOXG&RPSOHPHQWDULR
SURSXHVWRSRUOD,VDSUH
$57Ë&8/20RGL¿FDFLyQGHO3ODQGH6DOXG&RPSOHPHQWDULRDSHWLFLyQGHOD¿OLDGR
/D ,VDSUH GHEHUi RIUHFHU XQ QXHYR 3ODQ GH 6DOXG &RPSOHPHQWDULR VL pVWH HV UHTXHULGR SRU HO D¿OLDGR \ VH
IXQGDPHQWD HQ VX FHVDQWtD R HQ XQD YDULDFLyQ SHUPDQHQWH GH VX FRWL]DFLyQ OHJDO R GH OD FRPSRVLFLyQ GH
VXJUXSRIDPLOLDUFLUFXQVWDQFLDVTXHGHEHUiQDFUHGLWDUVHGRFXPHQWDGDPHQWHDQWHOD,VDSUH

7DPELpQGHEHUiRIUHFHUVHHQFDVRTXHVHPRGL¿TXHHOGRPLFLOLRFRQVLJQDGRSRUHOD¿OLDGRDOLQFRUSRUDUVHDO
SODQ\VHDFUHGLWDTXHGLFKRFDPELRGL¿FXOWDVLJQL¿FDWLYDPHQWHHODFFHVRGHORVEHQH¿FLDULRVDORVSUHVWDGRUHV
LQGLYLGXDOL]DGRVHQSODQ6HSUHVXPHTXHVHFRQ¿JXUDHVDGL¿FXOWDGFXDQGRHOFDPELRGHGRPLFLOLRLPSRUWHHO
WUDVODGRGHOFRWL]DQWHDRWUDUHJLyQGHOSDtV
,JXDOREOLJDFLyQWHQGUiOD,VDSUHVLpVWDLQFXUUHHQDOJXQRGHORVVLJXLHQWHVLQFXPSOLPLHQWRV
D)DOWDGHDWHQFLyQFRQWLQXD\RSRUWXQDSRUSDUWHGHOPpGLFRGHFDEHFHUDRQHJDWLYDGHOD,VDSUHDUHPSOD]DU
DOSURIHVLRQDODVLJQDGRSRUpVWDRHOHJLGRSRUHOFRWL]DQWH
E)DOWDGHGHULYDFLyQHQFDVRVHLQVX¿FLHQFLDGHOSUHVWDGRUGHULYDFLyQDXQSUHVWDGRURSUHVWDGRUHVGLVWLQWRV
GHORVLQGLFDGRVHQHOSODQRIDOWDGHDWHQFLyQHIHFWLYD\RSRUWXQDSRUSDUWHGHOSUHVWDGRUGHULYDGR
F(QJHQHUDOODIDOWDGHRWRUJDPLHQWRGHODDWHQFLyQGHVDOXGDOFRWL]DQWHREHQH¿FLDULRTXHVHKDFHxLGRDORV
SURFHGLPLHQWRVGHDFFHVR\GHULYDFLyQGH¿QLGRVHQHOSODQVLQSHUMXLFLRGHODREOLJDFLyQGHOD,VDSUHSUHYLVWD
HQHODUWtFXOROHWUD&Q~PHURGHO')/1GHGHO0LQLVWHULRGH6DOXG
/DIDFXOWDGUHJXODGDHQHVWDOHWUDQRSULYDDOFRWL]DQWHGHODRSFLyQGHVROLFLWDUHOWpUPLQRGHO&RQWUDWRGH6DOXG
SRUHOLQFXPSOLPLHQWRGHODVREOLJDFLRQHVSRUSDUWHGHOD,VDSUHHQFRQIRUPLGDGDODVUHJODVJHQHUDOHV
B) PAGO DE LAS ATENCIONES MÉDICAS Y ARANCEL DE PRESTACIONES
$57Ë&8/20RGDOLGDGHVGHSDJRGHODVDWHQFLRQHVPpGLFDV
/DVSDUWHVDFXHUGDQTXHODVPRGDOLGDGHVFRQTXHRSHUDUiOD,VDSUHSDUDTXHHOD¿OLDGR\ORVEHQH¿FLDULRVSXHGDQ
DFFHGHU\SDJDUODVSUHVWDFLRQHV\EHQH¿FLRVGHVDOXGWDQWRKRVSLWDODULRVFRPRDPEXODWRULRVVHUiQODVVLJXLHQWHV
D2UGHQGH$WHQFLyQ0pGLFDR%RQR2SHUDFRQDTXHOORVSUHVWDGRUHVLQGLYLGXDOHVHLQVWLWXFLRQDOHVGHVDOXG
TXHKD\DQFRQYHQLGRFRQOD,VDSUHUHFLELUHVWHGRFXPHQWRFRPRPHGLRGHSDJR
(VWHGRFXPHQWRHVSHUVRQDOHLQWUDQVIHULEOH\VHUiHPLWLGRSRUOD,VDSUHGHELHQGRSDJDUHOD¿OLDGRDOPRPHQWR
GHDGTXLULUORHOPRQWRFRUUHVSRQGLHQWHDODSDUWHQRERQL¿FDGDRFRSDJR
/D2UGHQGH$WHQFLyQ0pGLFDR%RQRWHQGUiXQSOD]RGHYLJHQFLDGHGtDVFRUULGRVFRQWDGRGHVGHODIHFKD
GHVXHPLVLyQ
E3DJRGLUHFWRFRQUHHPEROVRSRVWHULRU2SHUDFXDQGRHOD¿OLDGRSDJDHOYDORUWRWDOGHODSUHVWDFLyQHQ
IRUPDGLUHFWDDOSUHVWDGRULQGLYLGXDORLQVWLWXFLRQDOVROLFLWDQGRSRVWHULRUPHQWHDOD,VDSUHHOSDJRRUHHPEROVR
GHODERQL¿FDFLyQTXHOHFRUUHVSRQGHSRUWDOSUHVWDFLyQVHJ~QVX3ODQGH6DOXG&RPSOHPHQWDULR
3DUDHVWRVHIHFWRVHOEHQH¿FLDULRGHEHHQWUHJDUDOD,VDSUHODEROHWDRIDFWXUDRULJLQDOGHOSUHVWDGRULQGLYLGXDOR
LQVWLWXFLRQDOXRWURGRFXPHQWRDXWpQWLFRTXHGHQFXHQWDGHOSDJRORVTXHTXHGDUiQHQSRGHUGHOD,VDSUHFRPR
UHVSDOGRGHODJHVWLyQUHDOL]DGD$VLPLVPRHQHVWHGRFXPHQWRRHQRWURTXHFRPSOHPHQWHDODXWpQWLFRDPERV
HPLWLGRVSRUHOSUHVWDGRUGHVDOXGGHEHLQGLFDUVHORVLJXLHQWH
1RPEUHGHOSUHVWDGRULQVWLWXFLRQDOHLQGLYLGXDOTXHHQWUHJyODDWHQFLyQHQFDVRGHVHUGLVWLQWRV
FRQVX¿UPD\WLPEUH
587GHOSUHVWDGRULQVWLWXFLRQDOHLQGLYLGXDOTXHHQWUHJyODDWHQFLyQHQFDVRGHVHUGLVWLQWRV
1RPEUH\587GHOSDFLHQWH
'HWDOOHFRQHOQRPEUH\IHFKDGHODVSUHVWDFLRQHVRWRUJDGDV
9DORUGHODSUHVWDFLyQ
(OUHHPEROVRGHEHUiVHUVROLFLWDGRGHQWURGHOSOD]RGHGtDVFRUULGRVFRQWDGRGHVGHODIHFKDGHHPLVLyQGH
ODEROHWDRIDFWXUD\VLHPSUHTXHWDOGRFXPHQWRKD\DVLGRHPLWLGRHQUD]yQGHSUHVWDFLRQHVRWRUJDGDVGHQWUR
-8/ 13
GHOSHUtRGRGHYLJHQFLDGHEHQH¿FLRV
MAY
(OUHHPEROVRVHHIHFWXDUiPHGLDQWHGLQHURHIHFWLYRFKHTXHXRWURPHGLRTXHFRQYHQJDQODVSDUWHVVHJ~QOR
GHWHUPLQHOD,VDSUHH[FOXVLYDPHQWHDOD¿OLDGRREHQH¿FLDULRRDTXLHQORVUHSUHVHQWHOHJDOPHQWHGHQWURGHO
SOD]RGHGtDVKiELOHVFRQWDGRGHVGHODVROLFLWXG
F3URJUDPDGH$WHQFLyQ0pGLFDR3$0 Opera este sistema por las prestaciones otorgadas en forma

KRVSLWDODULD\WDPELpQUHVSHFWRGHDOJXQDVDPEXODWRULDVTXHGHWHUPLQHOD,VDSUH
(QDTXHOORVFDVRVHQTXHHOSUHVWDGRUQRHQWUHJXHGLUHFWDPHQWHHO3URJUDPDGH$WHQFLyQ0pGLFDDOD,VDSUHSDUDVX
WUDPLWDFLyQHOD¿OLDGRREHQH¿FLDULRGHEHUiSUHVHQWDUDOD,VDSUHHO3URJUDPDGH$WHQFLyQ0pGLFDGHQWURGHOSOD]R
GHGtDVFRUULGRVGHVGHODHPLVLyQGHO3$0RGHVGHODIDFWXUDFLyQGHODVSUHVWDFLRQHVVHJ~QVHDHOFDVR
(QWRGRFDVROD,VDSUHGHEHUiRWRUJDUODFREHUWXUDUHTXHULGDGHQWURGHOSOD]RGHGtDVFRUULGRVGHVGHODSUHVHQWDFLyQGHO3$0
G0RGDOLGDGHVHVSHFLDOHVGHSDJRFRQGHWHUPLQDGRVSUHVWDGRUHV/D,VDSUHSRGUiFRQYHQLUFRQGHWHUPLQDGRV
SUHVWDGRUHVPRGDOLGDGHVGHSDJRGLVWLQWDVDODVLQGLFDGDVSUHFHGHQWHPHQWHLQIRUPDQGRGHELGDPHQWHDORV
D¿OLDGRV(QWUHHOORVVHFRQVLGHUDHOXVRGHWUDQVDFFLRQHVSRUPHGLRVGHWUDQVPLVLyQHOHFWUyQLFDGHGDWRV
/RVEHQH¿FLDULRVDOUHTXHULUODV2UGHQHVGH$WHQFLyQ0pGLFDR%RQRV\ORV5HHPEROVRVFRPRDVLPLVPRSDUD
WUDPLWDU3URJUDPDVGH$WHQFLyQ0pGLFDGHEHUiQDFUHGLWDUVXLGHQWLGDG6LODSHWLFLyQODKDFHXQDSHUVRQDGLVWLQWD
GHOD¿OLDGRREHQH¿FLDULRDTXHOODGHEHUiSUHVHQWDUHOSRGHUVLPSOHFRUUHVSRQGLHQWH
/DVERQL¿FDFLRQHVVHSDJDUiQFRQVLGHUDQGRORVYDORUHVUHDOHVGHODVSUHVWDFLRQHVDSOLFiQGRVHVREUHpVWRV
ORVSRUFHQWDMHVWRSHV\Pi[LPRVGHERQL¿FDFLyQVHxDODGRVHQHOUHVSHFWLYR3ODQGH6DOXG&RPSOHPHQWDULR6L
UHTXHULGDOD,VDSUHSDUDHORWRUJDPLHQWRGHORVEHQH¿FLRVSDFWDGRVHVWLPDFRQORVDQWHFHGHQWHVTXHWHQJDHQ
VXSRGHUTXHQRFRUUHVSRQGHRWRUJDUODFREHUWXUDVROLFLWDGDGHEHUiPDQLIHVWiUVHORH[SUHVDPHQWH\SRUHVFULWR
DOLQWHUHVDGRHQHOSOD]RGHGtDVKiELOHVFRQWDGRGHVGHODSUHVHQWDFLyQGHODVROLFLWXGUHVSHFWLYD/DUHIHULGD
FRPXQLFDFLyQGHEHUiHQWUHJDUVHSHUVRQDOPHQWHDOLQWHUHVDGRRUHPLWLUVHDOFRWL]DQWHSRUFDUWDFHUWL¿FDGDDO
~OWLPRGRPLFLOLRUHJLVWUDGRHQOD,VDSUHGHDFXHUGRDORHVWDEOHFLGRHQHODUWtFXORGHOSUHVHQWH&RQWUDWR\
FRPSOHPHQWDULDPHQWHSRUFRUUHRHOHFWUyQLFRGHDFXHUGRDODVLQVWUXFFLRQHVTXHVREUHODPDWHULDVHHQFXHQWUHQ
YLJHQWHV
$57Ë&8/2$UDQFHOGHSUHVWDFLRQHV
(O$UDQFHOGH3UHVWDFLRQHVHVXQFDWiORJRYDORUL]DGRTXHFRQWHPSODDORPHQRVWRGDVODVSUHVWDFLRQHVGHO
$UDQFHOGHO)RQGR1DFLRQDOGH6DOXGHQVXPRGDOLGDGGHOLEUHHOHFFLyQ(O$UDQFHOVHUiXWLOL]DGRSDUDGHWHUPLQDU
ODVSUHVWDFLRQHVFRPSUHQGLGDVHQHO&RQWUDWRGH6DOXG\ODFREHUWXUDTXHDpVWDVFRUUHVSRQGD\HVUHDMXVWDGR
HQODIRUPD\FRQGLFLRQHVTXHVHxDOHHO3ODQGH6DOXG&RPSOHPHQWDULR'LFKR$UDQFHOGHEHUiVHULGHQWL¿FDGR
HQHO3ODQGH6DOXG&RPSOHPHQWDULRFRQWUDWDGRLQGLFiQGRVHDGHPiVODXQLGDGHQTXHVHH[SUHVD
(QHOFDVRGHORVDUDQFHOHVH[SUHVDGRVHQSHVRVHVWRVGHEHUiQVHUUHDMXVWDGRVDORPHQRVXQDYH]DODxR
\HOUHDMXVWHQRSRGUiVHULQIHULRUDOGHODYDULDFLyQSRUFHQWXDODFXPXODGDTXHKD\DH[SHULPHQWDGRHO
ËQGLFHGH3UHFLRVDO&RQVXPLGRUHQWUHHOPHVSUHFHGHQWHDDTXpOHQTXHVHHIHFWXyHO~OWLPRUHDMXVWH\HOPHV
DQWHSUHFHGHQWHDDTXpOHQTXHVHDSOLTXHHOQXHYRUHDMXVWHDPERVLQFOXVLYH
/D,VDSUHSXHGHFUHDU\HVWDEOHFHU1RUPDV7pFQLFR$GPLQLVWUDWLYDVSDUDORVHIHFWRVGHLQWHUSUHWDUVX$UDQFHO
'LFKDV QRUPDV QR IRUPDUiQ SDUWH GHO SUHVHQWH &RQWUDWR \ HQ QLQJ~Q FDVR SRGUiQ LPSRQHU D ORV D¿OLDGRV
UHVWULFFLRQHVROLPLWDFLRQHVGHFXDOTXLHUHVSHFLHDORVGHUHFKRVHPDQDGRVGHO&RQWUDWRGH6DOXG
TÍTULO IV
2%/,*$&,21(6'(/$),/,$'2(;&/86,21(6<5(675,&&,21(6'(
COBERTURA Y TÉRMINO DE CONTRATO
A) OBLIGACIONES DEL AFILIADO
$57Ë&8/22EOLJDFLRQHVGHOD¿OLDGR
/DVSULQFLSDOHVREOLJDFLRQHVGHOD¿OLDGRVRQODVVLJXLHQWHV
D3URSRUFLRQDULQIRUPDFLyQFRPSOHWD\YHUGDGHUDWDQWRDOPRPHQWRGHVXLQFRUSRUDFLyQDOD,VDSUHFRPRHQ
FDGDXQDGHODVPRGL¿FDFLRQHVTXHH[SHULPHQWHVX&RQWUDWRGH6DOXGDFHUFDGHORVDQWHFHGHQWHVVX\RVRGH
VXVEHQH¿FLDULRVUHIHULGRVHVSHFLDOPHQWHDODFDOLGDGODERUDO\PRQWRGHVXVLQJUHVRV
E'HFODUDUGHPDQHUD¿GHGLJQDWRGDODLQIRUPDFLyQTXHOD,VDSUHUHTXLHUDHQOD'HFODUDFLyQGH6DOXGWDQWRGH
VXVLWXDFLyQSHUVRQDOFRPRGHFDGDXQRGHVXVEHQH¿FLDULRV7UDWiQGRVHGHHQIHUPHGDGHVRFRQGLFLRQHVGH
VDOXGSUHH[LVWHQWHVODLQIRUPDFLyQFRPSOHWD\YHUGDGHUDGHEHUiVHUSURSRUFLRQDGDDOVXVFULELUHO&RQWUDWRGH
6DOXGRDODLQFRUSRUDFLyQGHOEHQH¿FLDULRFXDQGRpVWDIXHUHSRVWHULRU
F 'DU FXHQWD D OD ,VDSUH SRU HVFULWR \ GHQWUR GHO PiV EUHYH SOD]R HO WpUPLQR GH OD FDOLGDG GH EHQH¿FLDULR
GHO&RQWUDWRGH6DOXGGHFXDOTXLHUDGHODVSHUVRQDVLQWHJUDQWHVGHOPLVPRDMXVWDQGRVXVFRQGLFLRQHVDODQXHYD
VLWXDFLyQ(QHOPHVGHPDU]RGHFDGDDxRGHEHUiDFUHGLWDUDQWHOD,VDSUHODFRQGLFLyQGHIDPLOLDUEHQH¿FLDULR
GHORVKLMRVPD\RUHVGHDxRV
G 'HFODUDU \ SDJDU HQ IRUPD tQWHJUD \ RSRUWXQD HO SUHFLR GHO 3ODQ GH 6DOXG &RPSOHPHQWDULR SDFWDGR \ HO
SUHFLR GH ORV EHQH¿FLRV TXH FRQIRUPDQ OD FRWL]DFLyQ VHJ~Q HO DUWtFXOR GH HVWH &RQWUDWR WUDWiQGRVH GH
XQD¿OLDGRLQGHSHQGLHQWHFRWL]DQWHYROXQWDULRLPSRQHQWHYROXQWDULRRFHVDQWH

H+DFHUFRUUHFWRXVRGHORVEHQH¿FLRV\SUHVWDFLRQHVTXHRWRUJDHOSUHVHQWH&RQWUDWRWDQWRHOD¿OLDGRFRPR
VXV EHQH¿FLDULRV (QWUH RWUDV VH HQWHQGHUi FRPR IDOWD D HVWD REOLJDFLyQ OD VROLFLWXG R SHUFHSFLyQ GH
EHQH¿FLRV IUDFFLRQDQGR YDORUHV R WDULIDV GHO SUHVWDGRU R IXQGDGRV HQ GRFXPHQWRV R GLDJQyVWLFRV IDOVRV
SUHVWDFLRQHVQRUHDOL]DGDVGRFXPHQWRVDGXOWHUDGRVXRWRUJDGRVDSHUVRQDVGLVWLQWDVGHOFRWL]DQWHRGHVXV
EHQH¿FLDULRV UHJLVWUDGRV HQ OD ,VDSUH X REWHQLGDV GH SUHVWDGRUHV GLIHUHQWHV DO LQGLFDGR HQ HO
GRFXPHQWR R OD SUHVHQWDFLyQ GH GRFXPHQWRV LQFRPSOHWRV R FRQ RPLVLyQ GH LQIRUPDFLyQ SDUD OD REWHQFLyQ
GHEHQH¿FLRVVXSHULRUHVRGLVWLQWRVDORVTXHOHFRUUHVSRQGDQ
I&XPSOLUFRQORVH[iPHQHVFRQWUROHVSHULWDMHVHLQWHUFRQVXOWDVTXHOD&RQWUDORUtD0pGLFDGHOD,VDSUHHQXVR
GHVXVIDFXOWDGHVOHVROLFLWHUHDOL]DU\HQWUHJDUOHWRGDODGRFXPHQWDFLyQTXHDTXHOODOHUHTXLHUDDFHUFDGHVXV
DQWHFHGHQWHVGHVDOXG(OFRVWRGHWDOHVH[iPHQHVFRQWUROHVSHULWDMHVHLQWHUFRQVXOWDVVHUiQGHFDUJRGHOD
,VDSUH
J &RPXQLFDU D OD ,VDSUH GHQWUR GH ORV GLH] GtDV VLJXLHQWHV FRQWDGRV GHVGH OD IHFKD HQ TXH VH KD\DQ
SURGXFLGRFXDOTXLHUDGHORVVLJXLHQWHVKHFKRV
L &DPELRDGLFLyQRHOLPLQDFLyQGHHPSOHDGRU
LL &HVDQWtD
LLL 0RGL¿FDFLyQGHODVLWXDFLyQSUHYLVLRQDO
K ,QIRUPDU D OD ,VDSUH OD SpUGLGD R URER GH OD FUHGHQFLDO \R FpGXOD GH LGHQWLGDG GH FXDOTXLHUD GH ORV
EHQH¿FLDULRVGHO&RQWUDWRGHQWURGHORVGLH]GtDVVLJXLHQWHVDODIHFKDHQTXHWRPyFRQRFLPLHQWRGHDOJXQR
GHORVKHFKRVPHQFLRQDGRV
L$GMXQWDUODGRFXPHQWDFLyQSHUWLQHQWHFDGDYH]TXHVROLFLWHXQEHQH¿FLRTXHDFUHGLWHIHKDFLHQWHPHQWHVXSURFHGHQFLD
M,QIRUPDUDOD,VDSUHWRGRFDPELRGHGRPLFLOLRTXHVHSURGX]FDGXUDQWHODYLJHQFLDGHHVWH&RQWUDWRSHUVRQDOPHQWH
RPHGLDQWHFDUWDFHUWL¿FDGDFRUUHRHOHFWUyQLFRIRUPXODULRGLVHxDGRSRUOD,VDSUHXRWURPHGLRHVFULWRRHOHFWUyQLFR
GHQWURGHORVGLH]GtDVVLJXLHQWHVGHSURGXFLGRHOFDPELR/D,VDSUHGHEHUiSURSRUFLRQDUDOD¿OLDGRXQGRFXPHQWR
HQTXHFRQVWHHOFXPSOLPLHQWRGHVXREOLJDFLyQ
N&RODERUDUFRQOD,VDSUHHQHOFXPSOLPLHQWRSRUSDUWHGHpVWDGHODVPHWDVGHFREHUWXUDGHO([DPHQGH
0HGLFLQD3UHYHQWLYD
$57Ë&8/2'HFODUDFLyQGH6DOXG
/DVHQIHUPHGDGHVRFRQGLFLRQHVGHVDOXGSUHH[LVWHQWHVRULJLQDGDVFRQSRVWHULRULGDGDOQDFLPLHQWRFRQRFLGDV
SRUHOD¿OLDGR\GLDJQRVWLFDGDVFRQDQWHULRULGDGDODVXVFULSFLyQGHOFRQWUDWRGHEHUiQVHUUHJLVWUDGDV¿GHG
LJQDPHQWHSRUHOSRWHQFLDOD¿OLDGRHQHOGRFXPHQWRGHQRPLQDGR'HFODUDFLyQGH6DOXGMXQWRFRQORVGHPiVDQ
WHFHGHQWHVGHVDOXGTXHUHTXLHUDOD,VDSUH/D'HFODUDFLyQGH6DOXGGHEHUiVHUVXVFULWDSRUODVSDUWHVHQIRUPD
SUHYLDDODFHOHEUDFLyQGHO&RQWUDWRRDODLQFRUSRUDFLyQGHOEHQH¿FLDULRHQVXFDVR6yORHQHVWHGRFXPHQWRVH
SRGUiQFRQYHQLUODVUHVWULFFLRQHVGHFREHUWXUD/D'HFODUDFLyQGH6DOXGIRUPDSDUWHHVHQFLDOGHO&RQWUDWRVLQ
HPEDUJRODIDOWDGHWDOGHFODUDFLyQQRORLQYDOLGDUiSHURKDUiSUHVXPLUGHGHUHFKRTXHOD,VDSUHUHQXQFLyDOD
SRVLELOLGDGGHUHVWULQJLUODFREHUWXUDRGHSRQHUWpUPLQRDODFRQYHQFLyQSRUODRPLVLyQGHDOJXQDHQIHUPHGDGR
FRQGLFLyQGHVDOXGSUHH[LVWHQWH
(QYLUWXGGHORV¿QHVGHOFRQWUDWRGHVDOXGQRVHFRQVLGHUDQSUHH[LVWHQWHV\SRUWDQWRQRGHFODUDEOHVODV
HQIHUPHGDGHVRFRQGLFLRQHVGHVDOXGFRQJpQLWDVGHFXDOTXLHUWLSRODVFXDOHVOHKD\DQVLGRGLDJQRVWLFDGDVDO
EHQH¿FLDULRKDVWDHOWpUPLQRGHVXSHUtRGRQHRQDWDO(QHVWRVFDVRVOD,VDSUHQRSXHGHUHVWULQJLUFREHUWXUDQL
UHFKD]DUODD¿OLDFLyQ
$57Ë&8/2([FOXVLRQHVGHFREHUWXUD
'HO3ODQGH6DOXG&RPSOHPHQWDULRVyORVHH[FOX\HQGHFREHUWXUDODVVLJXLHQWHVSUHVWDFLRQHV
-8/ 13
D &LUXJtD SOiVWLFD FRQ ¿QHV GH HPEHOOHFLPLHQWR X RWUDV SUHVWDFLRQHV FRQ HO PLVPR ¿Q 1R VH FRQVLGHUDUiQ
MAY
FRQ ¿QHV GH HPEHOOHFLPLHQWR ODV FLUXJtDV SOiVWLFDV GHVWLQDGDV D FRUUHJLU PDOIRUPDFLRQHV R GHIRUPDFLRQHV
VXIULGDVSRUODFULDWXUDGXUDQWHHOHPEDUD]RRHOQDFLPLHQWRQLODGHVWLQDGDDUHSDUDUGHIRUPDFLRQHVVXIULGDV
SRUXQDFFLGHQWHQLODVTXHWHQJDQXQD¿QDOLGDGHVWULFWDPHQWHFXUDWLYDRUHSDUDGRUD
E $WHQFLyQ SDUWLFXODU GH HQIHUPHUtD VDOYR TXH VH WUDWH GH SUHVWDFLRQHV TXH VH HQFXHQWUHQ HQ HO $UDQFHO
)RQDVDHQODPRGDOLGDGOLEUHHOHFFLyQ
F+RVSLWDOL]DFLyQFRQ¿QHVGHUHSRVR
G3UHVWDFLRQHVFXELHUWDVSRURWUDVOH\HVKDVWDHOPRQWRGHORFXELHUWR$VROLFLWXGGHOD¿OLDGROD,VDSUHGHEHUi
FREUDU HO VHJXUR REOLJDWRULR GH DFFLGHQWHV SHUVRQDOHV D TXH VH UH¿HUH OD /H\ 1 GLUHFWDPHQWH HQ OD
&RPSDxtDGH6HJXURVFRUUHVSRQGLHQWH

H/DVTXHUHTXLHUDXQEHQH¿FLDULRFRPRFRQVHFXHQFLDGHVXSDUWLFLSDFLyQHQDFWRVGHJXHUUD
I/DVHQIHUPHGDGHVRFRQGLFLRQHVGHVDOXGSUHH[LVWHQWHVQRGHFODUDGDV
J 3UHVWDFLRQHV RWRUJDGDV IXHUD GHO WHUULWRULR QDFLRQDO VDOYR TXH HO 3ODQ GH 6DOXG &RPSOHPHQWDULR LQGLTXH
OR FRQWUDULR FDVR HQ HO FXDO SURFHGHUi OD FREHUWXUD HQ ORV WpUPLQRV \ EDMR ODV FRQGLFLRQHV TXH DOOt
VHFRQYHQJDQ
K7RGDVDTXHOODVSUHVWDFLRQHV\PHGLFDPHQWRVHQHVWH~OWLPRFDVRGHFDUiFWHUDPEXODWRULRQRFRQWHPSODGRV
HQHO$UDQFHOGHOD,VDSUH6LQHOFRQVHQWLPLHQWRGHOD,VDSUHQRSURFHGHUiODKRPRORJDFLyQGHSUHVWDFLRQHV
VDOYRTXHOD6XSHULQWHQGHQFLDODRUGHQHHQFDVRVH[FHSFLRQDOHVFRQIRUPHDO')/1GHGHO0LQLVWHULR
GH6DOXG
$57Ë&8/25HVWULFFLRQHVDOD&REHUWXUD
6H HQWHQGHUi TXH VRQ SUHH[LVWHQWHV DTXHOODV HQIHUPHGDGHV SDWRORJtDV R FRQGLFLRQHV GH VDOXG TXH KD\DQ
VLGR FRQRFLGDV SRU HO D¿OLDGR \ GLDJQRVWLFDGDV PpGLFDPHQWH FRQ DQWHULRULGDG D OD VXVFULSFLyQ GHO &RQWUDWR
RDODLQFRUSRUDFLyQGHOEHQH¿FLDULRHQVXFDVR
D&REHUWXUDSDUDHQIHUPHGDGHVRFRQGLFLRQHVGHVDOXGSUHH[LVWHQWHVGHFODUDGDV Las prestaciones de salud

SRUHQIHUPHGDGHVSDWRORJtDVRFRQGLFLRQHVGHVDOXGSUHH[LVWHQWHVGHFODUDGDVSRUHOD¿OLDGRRVXVEHQH¿FLDULRV
WHQGUiQ XQD FREHUWXUD ¿QDQFLHUD QR LQIHULRU D OD TXH RWRUJD )RQDVD HQ OD 0RGDOLGDG GH /LEUH (OHFFLyQ QL
DOGHODSUHYLVWDHQHOPLVPR3ODQGH6DOXG&RPSOHPHQWDULRSDUDODSUHVWDFLyQJHQpULFDFRUUHVSRQGLHQWH
SRUXQSOD]RGHPHVHVFRQWDGRGHVGHODVXVFULSFLyQGHO&RQWUDWRRDODLQFRUSRUDFLyQGHOEHQH¿FLDULRHQVX
FDVR
6LQ SHUMXLFLR GH OR DQWHULRU \ FRQ HO VROR SURSyVLWR GH VHU DFHSWDGR HQ OD ,VDSUH HQ FDVRV FDOL¿FDGRV \
FRQIRUPH FRQ ODV LQVWUXFFLRQHV TXH GLFWH DO HIHFWR OD 6XSHULQWHQGHQFLD GH 6DOXG HO IXWXUR D¿OLDGR SRGUi
VROLFLWDU SRU HVFULWR FRQ FRSLD D OD ,QWHQGHQFLD GH )RQGRV \ 6HJXURV 3UHYLVLRQDOHV GH 6DOXG OD H[WHQVLyQ
GH OD UHVWULFFLyQ GH FREHUWXUD SRU PHVHV PiV GXUDQWH ORV FXDOHV ODV SUHVWDFLRQHV DVRFLDGDV D GLFKD
HQIHUPHGDG SDWRORJtD R FRQGLFLyQ GH VDOXG SUHH[LVWHQWH GHFODUDGD WHQGUiQ D OR PHQRV OD FREHUWXUD TXH
FRQWHPSODHODUDQFHO)RQDVDHQODPRGDOLGDGOLEUHHOHFFLyQ
7UDQVFXUULGRV ORV SOD]RV VHxDODGRV SUHFHGHQWHPHQWH VHJ~Q FRUUHVSRQGD ODV SUHVWDFLRQHV GH VDOXG SRU
HQIHUPHGDGHV SDWRORJtDV R FRQGLFLRQHV GH VDOXG SUHH[LVWHQWHV GHFODUDGDV VH FXEULUiQ FRQIRUPH DO SODQ
FRQYHQLGR
E&REHUWXUDSRUDWHQFLyQGHSDUWR/DFREHUWXUDSDUDODVSUHVWDFLRQHVRULJLQDGDVHQODDWHQFLyQGHOSDUWRVHUi
FRPRPtQLPRHTXLYDOHQWHDODSURSRUFLyQUHVXOWDQWHHQWUHQ~PHURGHPHVHVWUDQVFXUULGRVGHVGHODVXVFULSFLyQ
GHOFRQWUDWRKDVWDODRFXUUHQFLDGHOSDUWR\HOQ~PHURWRWDOGHPHVHVGHGXUDFLyQHIHFWLYDGHOHPEDUD]RDSOLFDGD
DO3ODQGH6DOXGFRQYHQLGR\YLJHQWH
$57Ë&8/2(QIHUPHGDGHVRFRQGLFLRQHVGHVDOXGSUHH[LVWHQWHVQRGHFODUDGDV
/D,VDSUHFRQFXUULUiDOSDJRGHODVSUHVWDFLRQHVSRUHQIHUPHGDGHVRFRQGLFLRQHVGHVDOXGSUHH[LVWHQWHVQR
GHFODUDGDVHQORVPLVPRVWpUPLQRVHVWLSXODGRVHQHO&RQWUDWRSDUDSUHVWDFLRQHVRULJLQDGDVSRUHQIHUPHGDGHV
RFRQGLFLRQHVGHVDOXGQRSUHH[LVWHQWHVFXELHUWDVSRUHOSODQVLVHDFUHGLWDTXHODRPLVLyQVHGHELyDMXVWD
FDXVD GH HUURU R FXDQGR KD\D WUDQVFXUULGR XQ SOD]R GH DxRV FRQWDGRV GHVGH OD VXVFULSFLyQ GHO &RQWUDWR
R OD LQFRUSRUDFLyQ GHO EHQH¿FLDULR HQ VX FDVR VLQ TXH HO EHQH¿FLDULR KD\D UHTXHULGR DWHQFLyQ PpGLFD SRU
ODSDWRORJtDRFRQGLFLyQGHVDOXGSUHH[LVWHQWHGXUDQWHORVDQWHGLFKRVFLQFRDxRV(QHVWRVFDVRVWDPSRFR
SURFHGHUiODWHUPLQDFLyQGHO&RQWUDWRGH6DOXG6HSUHVXPLUiODPDODIHVLOD,VDSUHSUREDUHTXHHOD¿OLDGR
RFXOWyHOKHFKRGHODDWHQFLyQD¿QGHIDYRUHFHUVHGHHVWDGLVSRVLFLyQ
$57Ë&8/2&DXVDOHVGHWpUPLQRGHO&RQWUDWRGH6DOXG
(O SUHVHQWH &RQWUDWR GH 6DOXG QR SRGUi GHMDUVH VLQ HIHFWR GXUDQWH VX YLJHQFLD VDOYR SRU DOJXQDV GH ODV
VLJXLHQWHVFDXVDOHV
,QFXPSOLPLHQWRGHODVREOLJDFLRQHVGHOD¿OLDGR
/D,VDSUHVyORSRGUiSRQHUWpUPLQRDO&RQWUDWRGH6DOXGFXDQGRHOFRWL]DQWHLQFXUUDHQDOJXQRGHORVVLJXLHQWHV
LQFXPSOLPLHQWRVFRQWUDFWXDOHV

D)DOVHDURQRHQWUHJDUGHPDQHUD¿GHGLJQDWRGDODLQIRUPDFLyQHQOD'HFODUDFLyQGH6DOXGHQORVWpUPLQRVGHO
DUWtFXORGHO')/1GHGHO0LQLVWHULRGH6DOXGVDOYRTXHHOD¿OLDGRREHQH¿FLDULRGHPXHVWUHQMXVWD
FDXVDGHHUURU
/DVLPSOHRPLVLyQGHXQDHQIHUPHGDGSUHH[LVWHQWHQRGDUiGHUHFKRDWHUPLQDUHOFRQWUDWRVDOYRTXHOD,VDSUHGHPXHVWUH
TXHODRPLVLyQOHFDXVDSHUMXLFLRV\TXHGHKDEHUFRQRFLGRGLFKDHQIHUPHGDGQRKDEUtDFRQWUDWDGR
E1RSDJRGHFRWL]DFLRQHVSRUSDUWHGHORVFRWL]DQWHVHQVLWXDFLyQGHFHVDQWtDYROXQWDULRVHLQGHSHQGLHQWHVWDQWR
DTXHOORVTXHUHYLVWDQWDOFDOLGDGDOD¿OLDUVHFRPRORVTXHODDGTXLHUDQSRVWHULRUPHQWHSRUXQFDPELRHQVXVLWXDFLyQ
ODERUDO3UHYLRDOHMHUFLFLRGHHVWDIDFXOWDGOD,VDSUHGHEHUiKDEHUFRPXQLFDGRDODIHFWDGRGHOQRSDJRGHOD
FRWL]DFLyQ\GHVXVSRVLEOHVFRQVHFXHQFLDVGHQWURGHORVWUHVPHVHVVLJXLHQWHVFRQWDGRVGHVGHDTXHOHQTXH
QRVHKD\DSDJDGRODFRWL]DFLyQ
F,PSHWUDUIRUPDOPHQWHXREWHQHULQGHELGDPHQWHSDUDpORSDUDDOJXQRGHVXVEHQH¿FLDULRVEHQH¿FLRVTXHQROHV
FRUUHVSRQGDQRTXHVHDQPD\RUHVDORVTXHSURFHGDQ,JXDOVDQFLyQVHDSOLFDUiFXDQGRVHEHQH¿FLHDXQWHUFHUR
DMHQRDO&RQWUDWR
/D,VDSUHSRGUiSHUVHJXLUODVUHVSRQVDELOLGDGHVFLYLOHVRFULPLQDOHVDTXHGLHUHOXJDUHOWpUPLQRGHO&RQWUDWR
GH6DOXGHQFRQWUDGHTXLHQHVUHVXOWHQUHVSRQVDEOHV
G2PLWLUGHO&RQWUDWRDDOJ~QIDPLOLDUEHQH¿FLDULRGHORVLQGLFDGRVHQODVOHWUDVE\FGHODUWtFXORGHO')/1

GHGHO0LQLVWHULRGH6DOXGFRQHO¿QGHSHUMXGLFDUDOD,VDSUH
3DUDHMHUFHUODIDFXOWDGGHSRQHUWpUPLQRDO&RQWUDWROD,VDSUHGHEHUiFRPXQLFDUSRUHVFULWRWDOGHFLVLyQDOFRWL]DQWH
GHQWURGHOSOD]RGHQRYHQWDGtDVFRQWDGRGHVGHTXHWRPHFRQRFLPLHQWRGHOKHFKRFRQVWLWXWLYRGHODFDXVDOGH
WHUPLQDFLyQ(IHFWXDGDWDOFRPXQLFDFLyQORVEHQH¿FLRVFRQH[FHSFLyQGHODVSUHVWDFLRQHVGHULYDGDVGHHQIHUPHGDGHV
SUHH[LVWHQWHVQRGHFODUDGDVVHJXLUiQVLHQGRGHFDUJRGHOD,VDSUHKDVWDHOWpUPLQRGHOPHVVLJXLHQWHDODIHFKD
GHVXFRPXQLFDFLyQRKDVWDHOWpUPLQRGHODLQFDSDFLGDGODERUDOHQFDVRGHTXHHOFRWL]DQWHVHHQFXHQWUHHQGLFKD
VLWXDFLyQ\VLHPSUHTXHHVWHSOD]RVHDVXSHULRUDODQWHVLQGLFDGR
(OFRWL]DQWHSRGUiUHFODPDUDOD6XSHULQWHQGHQFLDGHHVWDGHFLVLyQGHQWURGHOSOD]RGHYLJHQFLDGHORVEHQH¿FLRV
DQWHVLQGLFDGRV(IHFWXDGRHOUHFODPRVHPDQWHQGUiYLJHQWHHO&RQWUDWRKDVWDODUHVROXFLyQGHpVWHFRQH[FHSFLyQ
GHODVSUHVWDFLRQHVGHULYDGDVGHHQIHUPHGDGHVSUHH[LVWHQWHVQRGHFODUDGDV
(OGHUHFKRGHOD,QVWLWXFLyQGH6DOXG3UHYLVLRQDODSRQHUWpUPLQRDO&RQWUDWRFDGXFDUiGHVSXpVGHQRYHQWDGtDV
FRQWDGRVGHVGHTXHWRPHFRQRFLPLHQWRGHOKHFKRFRQVWLWXWLYRGHODFDXVDOGHWHUPLQDFLyQ
2) Incumplimiento de las obligaciones de la Isapre.

(VWHLQFXPSOLPLHQWRGHEHUiVHUGHFODUDGRSRUOD6XSHULQWHQGHQFLDGH6DOXGROD-XVWLFLD2UGLQDULDDVROLFLWXG
GHOD¿OLDGR
'HVDKXFLRGHOD¿OLDGR
(OD¿OLDGRSRGUiXQDYH]WUDQVFXUULGRHOSULPHUDxRGHYLJHQFLDGHEHQH¿FLRVFRQWUDFWXDOHVGHVDKXFLDUHOSUHVHQWH
&RQWUDWRGH6DOXG
3DUDHVWRV¿QHVHOD¿OLDGRHQYLDUiXQDFRPXQLFDFLyQHVFULWDDODLVDSUHSRUFXDOTXLHUPHGLRLGyQHR(VWD
FRPXQLFDFLyQGHEHUiHIHFWXDUVH\DVHDPDQXDORHOHFWUyQLFDFRQXQDDQWHODFLyQGHDORPHQRVXQPHV
GHOFXPSOLPLHQWRGHOSULPHUDxRGHEHQH¿FLRVFRQWUDFWXDOHVRGHODIHFKDSRVWHULRUHQTXHVHKDUiHIHFWLYDOD
GHVD¿OLDFLyQ\GHEHUiFRQWHQHUDGHPiVGHVXYROXQWDGLQHTXtYRFDGHGHVD¿OLDUVHVXQRPEUHFRPSOHWRHO
Q~PHURGHVXFpGXODQDFLRQDOGHLGHQWLGDGVXGRPLFLOLRVLLQJUHVDUiDO)RQDVDRDXQDLVDSUHIHFKD\¿UPD
6LDODIHFKDGHWpUPLQRGHO&RQWUDWRSRUGHVDKXFLRRSRUPXWXRDFXHUGRGHORVFRQWUDWDQWHVHOFRWL]DQWHHVWi
HQVLWXDFLyQGHLQFDSDFLGDGODERUDOHO&RQWUDWRVHH[WHQGHUiGHSOHQRGHUHFKRKDVWDHO~OWLPRGtDGHOPHVHQ
TXH¿QDOLFHGLFKDLQFDSDFLGDG\PLHQWUDVQRVHGHFODUHVXLQYDOLGH]
-8/ 13
4) Cierre de Sucursal.
MAY
$QWHVGHFXPSOLUVHHOSULPHUDxRGHYLJHQFLDGHORVEHQH¿FLRVFRQWUDFWXDOHVHOD¿OLDGRSXHGHGHVDKXFLDUHO&RQWUDWR
GH6DOXGHQFDVRTXHHOFLHUUHGH¿QLWLYRGHXQDVXFXUVDOHQWRUSH]FDVHULDPHQWHHODFFHVRDORVEHQH¿FLRVSDFWDGRV
5) Cesantía.
(OD¿OLDGRSXHGHVROLFLWDUDOD,VDSUHHOWpUPLQRGHVX&RQWUDWRGH6DOXGLQFOXVRDQWHVGHFXPSOLUXQDxRGH
YLJHQFLDGHORVEHQH¿FLRVFRQWUDFWXDOHVVLODSHWLFLyQODIXQGDPHQWDHQVXVLWXDFLyQGHFHVDQWtDODTXHGHEHUi
VHUGHELGDPHQWHDFUHGLWDGDDQWHOD,VDSUH\VLHPSUHTXHQRVHDSRVLEOHXWLOL]DUORVH[FHGHQWHVGHFRWL]DFLRQHV
SDUDSDJDUORLQGLFDGRHQHOLQFLVRSULPHURGHODUWtFXORGHHVWH&RQWUDWR
6) Mutuo acuerdo.
)DOOHFLPLHQWRGHOD¿OLDGRHQFDVRTXHVHUHQXQFLHDOEHQH¿FLRVHxDODGRHQHODUWtFXORGHOpresente
Contrato.

8) Cierre del registro de la Isapre.
'HVDKXFLRGHOD¿OLDGRVROLFLWDQGRGHQWURGHORVVHVHQWDGtDVVLJXLHQWHVDODHQWUDGDHQYLJHQFLDGH
ODV*DUDQWtDV([SOtFLWDVHQ6DOXGRGHVXVSRVWHULRUHVPRGL¿FDFLRQHV
TÍTULO V
PRECIO DEL PLAN DE SALUD COMPLEMENTARIO Y SU MODIFICACIÓN
$57Ë&8/23UHFLRGHO3ODQGH6DOXG&RPSOHPHQWDULR\VXUHDMXVWDELOLGDG
(OSUHFLRGHEHUiFRQVWDUHQHO3ODQGH6DOXG&RPSOHPHQWDULR\VHH[SUHVDHQXQLGDGHVGHIRPHQWRRPRQHGD
GHFXUVROHJDOHQHOSDtV(QHOFDVRGH3ODQHVGH6DOXG&RPSOHPHQWDULRVJUXSDOHV\ORVFRQWUDWRVFHOHEUDGRV
FRQLVDSUHVFHUUDGDVHOSUHFLRSRGUiH[SUHVDUVHHQXQSRUFHQWDMHHTXLYDOHQWHDODFRWL]DFLyQOHJDOGHVDOXG
(O SUHFLR ¿QDO GHO 3ODQ GH 6DOXG &RPSOHPHQWDULR VH REWLHQH GH OD PXOWLSOLFDFLyQ GHO ³SUHFLR EDVH´ TXH
FRUUHVSRQGHDODVLJQDGRSRUODLVDSUHDOUHVSHFWLYRSODQ\TXHHVLGpQWLFRSDUDWRGDVODVSHUVRQDVTXHOR
FRQWUDWHQSRUORVIDFWRUHVTXHFRUUHVSRQGDQDOD¿OLDGR\DORVEHQH¿FLDULRVGHFRQIRUPLGDGDODWDEODGH
IDFWRUHVSRUVH[RHGDG\FRQGLFLyQGHFRWL]DQWHRFDUJDFRQWHQLGDHQHO3ODQGH6DOXG&RPSOHPHQWDULR
TXHHOD¿OLDGRREHQH¿FLDULRGHFODUDFRQRFHU\DFHSWDU(VWDWDEODQRSRGUiYDULDUSDUDORVEHQH¿FLDULRVPLHQWUDV
VHHQFXHQWUHQDGVFULWRVDOSODQQLSRGUiDOWHUDUVHSDUDTXLHQHVVHLQFRUSRUHQDpODPHQRVTXHODPRGL¿FDFLyQ
FRQVLVWDHQGLVPLQXLUGHIRUPDSHUPDQHQWHORVIDFWRUHVWRWDORSDUFLDOPHQWH
(OSUHFLR¿QDOGHO3ODQGH6DOXG&RPSOHPHQWDULRSRGUiYDULDUSRUORVVLJXLHQWHVPRWLYRV
D3RUUHYLVLyQ\DGHFXDFLyQGHO&RQWUDWRGH6DOXGFRQIRUPHDOLQFLVRWHUFHURGHODUWtFXORGHO')/1GH
GHO0LQLVWHULRGH6DOXG
E 3RU YDULDFLyQ GHO Q~PHUR GH EHQH¿FLDULRV DSOLFDQGR OD7DEOD GH )DFWRUHV FRQWHQLGD HQ HO 3ODQ GH 6DOXG
&RPSOHPHQWDULR(QHVWHFDVRHOQXHYRSUHFLRUHJLUiDSDUWLUGHOPHVVLJXLHQWHGHHIHFWXDGDODPRGL¿FDFLyQ
F3RUODUHGXFFLyQGHOIDFWRUTXHFRUUHVSRQGDDOD¿OLDGRREHQH¿FLDULRHQUD]yQGHVXHGDGVHJ~QOD7DEODGH
)DFWRUHVDQWHVUHIHULGD(OSUHFLRGHO3ODQGH6DOXG&RPSOHPHQWDULRYDULDUiGHVGHHOPHVVLJXLHQWHHQTXHVH
FXPSODODDQXDOLGDG
G3RUUHDMXVWHDQXDOXQDYH]FXPSOLGRVORVUHVSHFWLYRVSHUtRGRVDQXDOHVWUDWiQGRVHGHSODQHVSDFWDGRVHQ
SHVRV(OtQGLFHGHYDULDFLyQTXHXWLOL]DUi\ODIHFKDGHVXDSOLFDFLyQGHEHUiQFRQVLJQDUVHHQHO3ODQGH6DOXG
&RPSOHPHQWDULR
$57Ë&8/20RQWRGHFODUDFLyQ\SDJRGHODFRWL]DFLyQSDUDVDOXG
/DFRWL]DFLyQSDUDVDOXGGHOD¿OLDGRFRUUHVSRQGHUiDODVXPDGHOSUHFLRGHO3ODQGH6DOXG&RPSOHPHQWDULR
FDOFXODGRHQODIRUPDLQGLFDGDHQHODUWtFXORDQWHULRUPiVHOSUHFLRGHOD&REHUWXUD$GLFLRQDOSDUD(QIHUPHGDGHV
&DWDVWUy¿FDV HQ &KLOH &$(& VL FRUUHVSRQGH PiV HO SUHFLR TXH OD ,VDSUH FREUH SRU HO DVHJXUDPLHQWR GH
ODV *DUDQWtDV ([SOtFLWDV HQ 6DOXG *(6 \ PiV HO SUHFLR GH ORV EHQH¿FLRV DGLFLRQDOHV FRQWUDWDGRV SRU HO
D¿OLDGR VL FRUUHVSRQGH WRGRV ORV FXDOHV VH GHWDOODQ HQ HO )81 UHVSHFWLYR /D FRWL]DFLyQ SDUD VDOXG GHO
D¿OLDGRGHEHUiVHUGHFODUDGD\SDJDGDSRUHOHPSOHDGRUHQWLGDGHQFDUJDGDGHOSDJRGHODSHQVLyQWUDEDMDGRU
LQGHSHQGLHQWH R FRWL]DQWH YROXQWDULR VHJ~Q VHD HO FDVR GHQWUR GH ORV SULPHURV GtDV GHO PHV VLJXLHQWH
D DTXHO HQ TXH VH KD\DQ GHYHQJDGR ODV UHPXQHUDFLRQHV SHQVLRQHV \ UHQWDV FRUUHVSRQGLHQWHV SOD]R TXH
VH SURUURJDUi KDVWD HO SULPHU GtD KiELO VLJXLHQWH VL GLFKR SOD]R H[SLUDUH HQ GtD ViEDGR GRPLQJR R IHVWLYR
(OSDJRGHEHUiHIHFWXDUVHHQODVR¿FLQDVGHDWHQFLyQGHS~EOLFRGHOD,VDSUHRDWUDYp]GHODVHQWLGDGHVRLQVWLWXFLRQHV
UHFDXGDGRUDVDXWRUL]DGDVSRUHOOD6LQHPEDUJRFXDQGRHOHPSOHDGRUUHDOLFHODGHFODUDFLyQ\HOSDJRGHODV
FRWL]DFLRQHVDWUDYpVGHXQPHGLRHOHFWUyQLFRHOSOD]RVHH[WHQGHUiKDVWDHOGtDGHFDGDPHVDXQFXDQGRpVWH
IXHUHGtDViEDGRGRPLQJRRIHVWLYR3DUDHIHFWRVGHSDJRHOYDORUGHODXQLGDGGHIRPHQWRVHUiHOGHO~OWLPRGtD
GHOPHVDQWHULRUDOGHOSDJRGHODFRWL]DFLyQ
(QFDVRGHQRSDJRGHODFRWL]DFLyQSDFWDGDSDUDVDOXGOD,VDSUHGHEHUiLQIRUPDUWDOFLUFXQVWDQFLDDOD¿OLDGR
VHD FRWL]DQWH GHSHQGLHQWH SHQVLRQDGR LQGHSHQGLHQWH YROXQWDULR R FHVDQWH GHQWUR GH ORV WUHV PHVHV
VLJXLHQWHVFRQWDGRVGHVGHDTXpOHQTXHQRVHKD\DSDJDGRODFRWL]DFLyQ
/D IDOWD GH SDJR GH OD FRWL]DFLyQ SRU SDUWH GHO HPSOHDGRU R SRU SDUWH GH OD HQWLGDG HQFDUJDGD GHO SDJR
GHODSHQVLyQQRIDFXOWDDOD,VDSUHSDUDSRQHUWpUPLQRDO&RQWUDWRQLSDUDVXVSHQGHUHORWRUJDPLHQWRGHORV
EHQH¿FLRV\SUHVWDFLRQHV(QHOHYHQWRTXHHOFRWL]DQWHGHSHQGLHQWHSHUGLHUDVXFDOLGDGGHWDOSRUFXDOTXLHU
FDXVD VHUi FRQVLGHUDGR SDUD ORV HIHFWRV GH HVWH &RQWUDWR FRPR D¿OLDGR HQ VLWXDFLyQ GH FHVDQWtD \ HQ WDO
FDVRVHUiHOREOLJDGRGLUHFWRGHOSDJRGHODFRWL]DFLyQSDUDVDOXG

(QHOFDVRGHWUDEDMDGRUHVLQGHSHQGLHQWHVFRWL]DQWHVYROXQWDULRVRWUDEDMDGRUHVTXHKDELHQGRVLGRGHSHQGLHQWHV
VHHQFXHQWUHQHQVLWXDFLyQGHFHVDQWtDODIDOWDGHQRWL¿FDFLyQRSRUWXQDVHxDODGDHQHOSiUUDIRDQWHSUHFHGHQWH
DGHPiVLPSHGLUiDOD,VDSUHSRQHUWpUPLQRDO&RQWUDWRSRUQRSDJRGHODFRWL]DFLyQ\FREUDULQWHUHVHVUHDMXVWHV\
PXOWDV
$57Ë&8/2([FHGHQWHVGHFRWL]DFLyQ
7RGDYH]TXHVHSURGXMHUHQH[FHGHQWHVGHODFRWL]DFLyQOHJDOHQUHODFLyQFRQHOSUHFLRGHODV*DUDQWtDV([SOtFLWDV
HQ6DOXG\HOSUHFLRGHOSODQFRQYHQLGRVHUiQLQHPEDUJDEOHV\GHSURSLHGDGGHOD¿OLDGRHLQFUHPHQWDUiQXQD
FXHQWDFRUULHQWHLQGLYLGXDOTXHOD,VDSUHDEULUiHQIDYRUGHOD¿OLDGRFX\RVIRQGRVVHPHVWUDOPHQWHVHUHDMXVWDUiQ
\GHYHQJDUiQHOLQWHUpVHVWDEOHFLGRHQODOH\
(OD¿OLDGRVyORSRGUiUHQXQFLDUDHOORVSDUDGHVWLQDUORVD¿QDQFLDUORVEHQH¿FLRVDGLFLRQDOHVGHORVSODQHVGH
VDOXGLQGLYLGXDOHVFRPSHQVDGRVGHORVSODQHVJUXSDOHV\ORVFHOHEUDGRVFRQ,VDSUHVFHUUDGDV(VWDUHQXQFLD
VyOR SURGXFLUi HIHFWRVKDFLD HOIXWXUR\VHUiYiOLGD KDVWDTXH HO D¿OLDGR RSWHSRUUHWUDFWDUVHGH HOOD RELHQ
FXDQGRSRUFXDOTXLHUFDXVDFDPELHGH3ODQGH6DOXG/RVGRFXPHQWRVTXHGHQFXHQWDGHWDOHVFRQYHQFLRQHV
IRUPDUiQSDUWHLQWHJUDQWHGHOSUHVHQWH&RQWUDWR
$OPRPHQWRGHFHOHEUDUVHHO&RQWUDWRGH6DOXGHOPRQWRGHORVH[FHGHQWHVQRSRGUiVHUVXSHULRUDOGHOD
FRWL]DFLyQOHJDOSDUDVDOXGFDOFXODGDVREUHHOPRQWRSURPHGLRGHORV~OWLPRVWUHVPHVHVGHODUHPXQHUDFLyQ
UHQWDRSHQVLyQVHJ~QVHDHOFDVRVLQSHUMXLFLRGHOWRSHOHJDOHVWDEOHFLGR&RQWRGRODWRWDOLGDGGHORVH[FHGHQWHV
VLHPSUHLQFUHPHQWDUiODFXHQWDFRUULHQWHLQGLYLGXDOGHOFRWL]DQWH
/RVIRQGRVDFXPXODGRVSXHGHQVHUUHTXHULGRVSRUHOD¿OLDGRHQFXDOTXLHUPRPHQWRSDUDDOJXQRGHORVLJXLHQWHV
¿QHV
&XEULUODVFRWL]DFLRQHVHQFDVRGHFHVDQWtD
&RSDJRHVWRHVDTXHOODSDUWHGHODSUHVWDFLyQTXHHVGHFDUJRGHOD¿OLDGR
)LQDQFLDUSUHVWDFLRQHVGHVDOXGQRFXELHUWDVSRUHO&RQWUDWR
3DUDSDJDUODVFXRWDVGHORVSUpVWDPRVGHVDOXGTXHOD,QVWLWXFLyQGH6DOXG3UHYLVLRQDOOHKXELHVH
RWRUJDGRDOD¿OLDGR
&XEULUFRWL]DFLRQHVDGLFLRQDOHVYROXQWDULDV
)LQDQFLDUXQ3ODQGH6DOXG&RPSOHPHQWDULRFXDQGRHOD¿OLDGRUH~QDORVUHTXLVLWRVTXHODOH\
HVWDEOHFHSDUDSHQVLRQDUVHGXUDQWHHOODSVRFRPSUHQGLGRHQWUHODVROLFLWXGGHODMXELODFLyQ\HO
PRPHQWRHQTXHpVWDVHKDFHHIHFWLYD
/D,VDSUHFREUDUiVHPHVWUDOPHQWHDOD¿OLDGRSRUODPDQWHQFLyQGHODFXHQWDFRUULHQWHGHH[FHGHQWHVXQSRUFHQWDMH
FX\RPRQWRPi[LPRVHUi¿MDGRSRUOD6XSHULQWHQGHQFLD
/D,VDSUHLQIRUPDUiDOD¿OLDGRHOHVWDGRGHODFXHQWDFRUULHQWHFRQXQGHWDOOHGHOPRQWRDFXPXODGRGHELGDPHQWH
DFWXDOL]DGRDQWHVXUHTXHULPLHQWR\DOFXPSOLUVHODVUHVSHFWLYDVDQXDOLGDGHV\DOWHUPLQDUHO&RQWUDWRGH6DOXG
$57Ë&8/2%,6([FHVRVGHFRWL]DFLyQ
/DFRWL]DFLyQHQH[FHVRFRUUHVSRQGHDODFRWL]DFLyQSHUFLELGDSRUOD,VDSUHHQHOUHVSHFWLYRPHVTXHVREUHSDVH
HOPRQWRTXHUHVXOWHPD\RUHQWUHHOWRWDOGHODFRWL]DFLyQSDFWDGD\ODFRWL]DFLyQOHJDOPtQLPDSDUDVDOXG
/RVPRQWRVTXHOD,VDSUHSHUFLEDSRUFRQFHSWRGHFRWL]DFLyQHQH[FHVRHVWDQDIHFWRVDGHYROXFLyQTXHGHEH
HIHFWXDUVHDODSHUVRQDD¿OLDGDRH[D¿OLDGDFXDQGRGLFKDFRWL]DFLyQOHKD\DVLGRGHVFRQWDGDGHVXUHPXQHUDFLyQ
RUHQWDVLQFDXVD
$57Ë&8/2$GHFXDFLyQGHO&RQWUDWRGH6DOXG
$QXDOPHQWHHQHOPHVGHVXVFULSFLyQGHO&RQWUDWROD,VDSUHSRGUiUHYLVDUORV&RQWUDWRVGH6DOXGSXGLHQGR
VyORPRGL¿FDUHOSUHFLREDVHGHO3ODQGH6DOXG&RPSOHPHQWDULRHQFRQGLFLRQHVJHQHUDOHVTXHQRLPSRUWHQ
GLVFULPLQDFLyQ HQWUH ORV D¿OLDGRV GH XQ PLVPR SODQ /DV UHYLVLRQHV QR SRGUiQ WHQHU HQ FRQVLGHUDFLyQ HO
HVWDGRGHVDOXGGHOD¿OLDGR\REHQH¿FLDULR(VWDVFRQGLFLRQHVJHQHUDOHVGHEHUiQVHUODVPLVPDVTXHVH
HVWpQRIUHFLHQGRDHVDIHFKDDORVQXHYRVFRQWUDWDQWHVHQHOUHVSHFWLYRSODQ
MAY 13
/D DGHFXDFLyQ SURSXHVWD GHEHUi VHU FRPXQLFDGD DO DIHFWDGR PHGLDQWH FDUWD FHUWL¿FDGD H[SHGLGD FRQ D OR
PHQRVWUHVPHVHVGHDQWLFLSDFLyQDOYHQFLPLHQWRGHOSHUtRGRDQXDO(QWDOHVFLUFXQVWDQFLDVHOD¿OLDGRSRGUi
DFHSWDUHO&RQWUDWRFRQODDGHFXDFLyQGHSUHFLRSURSXHVWDSRUOD,VDSUH\HQHOHYHQWRTXHQDGDGLJDVH
HQWHQGHUiTXHDFHSWDODSURSXHVWD
(QODPLVPDRSRUWXQLGDG\IRUPDTXHVHFRPXQLTXHODDGHFXDFLyQOD,VDSUHGHEHUiRIUHFHUXQRRPiV
SODQHVDOWHUQDWLYRVFX\RSUHFLREDVHVHDHTXLYDOHQWHDOYLJHQWHDPHQRVTXHHOSUHFLRGHOSODQTXHVH
DGHF~DFRUUHVSRQGDDOSODQFRQPHQRUSUHFLRHQOD,VDSUH/RVSODQHVDOWHUQDWLYRVTXHVHRIUH]FDQGHEHUiQ
VHU LGpQWLFRV SDUD WRGRV ORV DILOLDGRV GHO SODQ FX\R SUHFLR VH DGHF~D ORV TXH HQ FDVR GH UHFKD]DU OD
DGHFXDFLyQSRGUiQDFHSWDUDOJXQRGHORVSODQHVDOWHUQDWLYRVTXHVHOHVRIUH]FDRELHQGHVDILOLDUVH
/D6XSHULQWHQGHQFLDSRGUiGHMDUVLQHIHFWRDO]DVGHSUHFLRVTXHQRVHDMXVWHQDORVHxDODGRSUHFHGHQWHPHQWH

$57Ë&8/2%,6$GHFXDFLRQHVHVSHFLDOHVGHO&RQWUDWRGH6DOXG
6LHQODUHYLVLyQDQXDOGHOFRQWUDWRHOPRQWRGHORVH[FHGHQWHVDGHVWLQDUDODFXHQWDFRUULHQWHLQGLYLGXDOVXSHUD
HOGHODFRWL]DFLyQOHJDOSDUDVDOXGOD,VDSUHHVWDUiREOLJDGDDRIUHFHUDOD¿OLDGRXQ3ODQGH6DOXGDOWHUQDWLYR
FX\RSUHFLRPiVVHDSUR[LPHDO3ODQDFWXDOPHQWHFRQYHQLGRHQQLQJ~QFDVRHOD¿OLDGRHVWDUiREOLJDGRDVXVFULELU
HO3ODQGH6DOXGDOWHUQDWLYR
(QORVSODQHVFRQSUHVWDGRUHVFHUUDGRVRSUHIHUHQWHVHQODPLVPDRSRUWXQLGDGHQFDVRGHWpUPLQRGHOFRQYHQLR
HQWUHOD,VDSUH\HOSUHVWDGRULQVWLWXFLRQDOFHUUDGRRSUHIHUHQWHRFXDOTXLHUPRGL¿FDFLyQTXHpVWRVLQWURGX]FDQ
OD ,VDSUH SRGUi DGHFXDU HO FRQWUDWR GHELHQGR LQIRUPDU DO FRWL]DQWH HQ OD FDUWD UHVSHFWLYD OD FLUFXQVWDQFLD GH
KDEHUVH SXHVWR WpUPLQR R GH KDEHUVH PRGL¿FDGR HO UHIHULGR FRQYHQLR $GHPiV OD ,QVWLWXFLyQ SRQGUi HQ
FRQRFLPLHQWRGHOD¿OLDGRODVDGHFXDFLRQHVSURSXHVWDVDOSODQYLJHQWH\ORVSODQHVGHVDOXGDOWHUQDWLYRVGH
FRQGLFLRQHVHTXLYDOHQWHVDDTXpO
&RQWRGRVHSRGUiQHIHFWXDUPRGL¿FDFLRQHVGHORVEHQH¿FLRVFRQWUDFWXDOHVSRUPXWXRDFXHUGRGHODVSDUWHV
ORTXHGDUiRULJHQDODVXVFULSFLyQGHXQQXHYR3ODQGH6DOXG&RPSOHPHQWDULRGHHQWUHORVTXHVHHQFXHQWUH
FRPHUFLDOL]DQGROD,VDSUH
DISPOSICIONES FINALES
$57Ë&8/2$XWRUL]DFLyQGHOD¿OLDGR
&DGDYH]TXHHOD¿OLDGRRXQEHQH¿FLDULRVROLFLWHDOD,VDSUHXQEHQH¿FLRFXDOTXLHUDGHO&RQWUDWRGH6DOXGVH
HQWHQGHUiTXHODIDFXOWDSDUDUHTXHULUGHORVSUHVWDGRUHVVHDQpVWRVS~EOLFRVRSULYDGRVODHQWUHJDGHOD
FHUWL¿FDFLyQPpGLFDTXHVHDQHFHVDULDSDUDGHFLGLUUHVSHFWRGHODSURFHGHQFLDGHWDOEHQH¿FLR/D,VDSUH
DGRSWDUiODVPHGLGDVQHFHVDULDVSDUDPDQWHQHUODFRQ¿GHQFLDOLGDGGHHVWDVFHUWL¿FDFLRQHV
6L OD ,VDSUH FRQVLGHUD TXH OD LQIRUPDFLyQ SURSRUFLRQDGD SRU HO SUHVWDGRU HV LQFRPSOHWD LPSUHFLVD R WHPH
IXQGDGDPHQWHTXHQRVHDMXVWDDODYHUGDGSRGUiGHVLJQDUXQPpGLFRFLUXMDQRLQGHSHQGLHQWHGHODVSDUWHV
TXHVHHQFXHQWUHLQVFULWRHQXQUHJLVWURTXHSDUDHVWRVHIHFWRVPDQWLHQHOD6XSHULQWHQGHQFLDSDUDTXHUHYLVH
SHUVRQDOPHQWHOD¿FKDFOtQLFD6LGHODUHYLVLyQUHVXOWDTXHQRFRUUHVSRQGHRWRUJDUODFREHUWXUD¿QDQFLHUD
VROLFLWDGDOD,VDSUHORLQIRUPDUiDOD¿OLDGRHOTXHSRGUiUHFXUULUDQWHOD6XSHULQWHQGHQFLDD¿QGHTXHpVWD
UHVXHOYDODFRQWURYHUVLD
AVLPLVPRHQYLUWXGGHODUWtFXORGHO')/1GHGHO0LQLVWHULRGH6DOXGOD,VDSUHHVWiDXWRUL]DGD
SDUDVXEURJDUDOD¿OLDGRREHQH¿FLDULRHQORVGHUHFKRV\DFFLRQHVTXHpVWHWHQJDFRQWUDWHUFHURVHQUD]yQ
GHORVKHFKRVTXHKLFLHURQQHFHVDULDODUHVSHFWLYDSUHVWDFLyQ\KDVWDHOPRQWRTXHFRUUHVSRQGDDORTXH
OD,VDSUHKD\DSDJDGRXRWRUJDGR
$57Ë&8/2)LVFDOL]DFLyQ\PHFDQLVPRVGHVROXFLyQGHGLIHUHQFLDV
LD,VDSUHHVWiDIHFWDDODVXSHUYLJLODQFLD\FRQWUROGHOD6XSHULQWHQGHQFLDGH6DOXGDWUDYpVGHOD,QWHQGHQFLD
GH)RQGRV\6HJXURV3UHYLVLRQDOHVGH6DOXG(O,QWHQGHQWHGH)RQGRV\6HJXURV3UHYLVLRQDOHVGH6DOXGSRGUi
FRQRFHUODVGLIHUHQFLDVTXHVXUMDQHQWUHOD,VDSUH\VXVFRWL]DQWHVREHQH¿FLDULRVDWUDYpVGHXQUHFODPR
DGPLQLVWUDWLYRRXQDGHPDQGDDUELWUDO(QHVWH~OWLPRFDVRDFWXDUiHQFDOLGDGGHiUELWURDUELWUDGRU\UHVROYHUi
ODVFRQWURYHUVLDVTXHTXHGHQGHQWURGHODHVIHUDGHVXSHUYLJLODQFLD\FRQWUROTXHOHFRPSHWHDOD6XSHULQWHQGHQFLD\
VLQSHUMXLFLRGHTXHHOD¿OLDGRSXHGDRSWDUSRUUHFXUULUDODMXVWLFLDRUGLQDULD(QWRGRFDVRODVSDUWHVSRGUiQVRPHWHU
GLFKDGL¿FXOWDGSUHYLDPHQWHDPHGLDFLyQ
1RREVWDQWHORVUHFODPRVSRUUHFKD]RVRPRGL¿FDFLRQHVGHOLFHQFLDVPpGLFDV\FiOFXORGHORVVXEVLGLRVSRULQFDSDFLGDG
ODERUDOGHEHUiQHIHFWXDUVHDQWHOD&RPLVLyQGH0HGLFLQD3UHYHQWLYDH,QYDOLGH]&203,1FRUUHVSRQGLHQWHDOGRPLFLOLR
LQGLFDGRHQHVWH&RQWUDWRGHQWURGHORVTXLQFHGtDVKiELOHVVLJXLHQWHVDODUHFHSFLyQGHOSURQXQFLDPLHQWRGHOD,VDSUH6L
OD,VDSUHQRFXPSOHORUHVXHOWRSRUOD&203,1FRPSHWHQWHHOFRWL]DQWHSRGUiVROLFLWDUHOSDJRGHORVUHIHULGRVVXEVLGLRV
DOD6XSHULQWHQGHQFLDGH6DOXG
$57Ë&8/2'RPLFLOLR\QRWL¿FDFLRQHV
3DUDWRGRVORVHIHFWRVGHOSUHVHQWH&RQWUDWRODVSDUWHVDFXHUGDQTXHHOGRPLFLOLRGHOD¿OLDGRFRUUHVSRQGHUiDO~OWLPR
LQIRUPDGRSRUHOFRQWUDWDQWHSRUHVFULWRDOD,VDSUH\DOOtVHHQYLDUiQWRGDVODVFRPXQLFDFLRQHVHQWDQWRHOFRWL]DQWH
QRLQIRUPHVXFDPELRFXDQGRFRUUHVSRQGDHQORVWpUPLQRVVHxDODGRVHQODOHWUDMGHO$UWtFXORSUHFHGHQWH
$57Ë&8/2)HFKD\¿UPDGHOFRQWUDWR
&RQIHFKDBBBBBBBBGHOPHVGHBBBBBBBBBBBBBBBGHODxRBBBBBBBVHVXVFULEHHOSUHVHQWHFRQWUDWRHQ
GXSOLFDGRTXHGDQGRXQHMHPSODUHQSRGHUGHOD¿OLDGR\RWURHQSRGHUGHOD,VDSUH
)LUPDRKXHOODGLJLWDOGHOD¿OLDGR Firma Isapre

CAEC
CONDICIONES DE LA COBERTURA ADICIONAL PARA ENFERMEDADES

&$7$675Ï),&$6(1&+,/(
3RUHOSUHVHQWHDFWRHLQVWUXPHQWRHOD¿OLDGRTXHVXVFULEHSRUVt\HQUHSUHVHQWDFLyQGHVXVEHQH¿FLDULRV
ORV TXH VH LQGLYLGXDOL]DQ HQ HO )RUPXODULR ÒQLFR GH 1RWL¿FDFLyQ )81 GHO FRQWUDWR GH VDOXG SUHYLVLRQDO
VXVFULWR FRQ OD ,VDSUH SDFWD FRQ pVWD OD &REHUWXUD$GLFLRQDO SDUD (QIHUPHGDGHV &DWDVWUy¿FDV HQ &KLOH HQ
DGHODQWH &$(& \ OD FREHUWXUD HVSHFLDO *(6&$(& TXH VH GHWDOODQ D FRQWLQXDFLyQ
(O $QH[R 1 TXH VH UH¿HUH D OD SHWLFLyQ GHO EHQH¿FLR \ GHULYDFLyQ D OD 5HG &$(& SURFHGLPLHQWR \
IRUPXODULRV\\HO$QH[R1UHODWLYRDORVUHTXLVLWRVSDUDDFFHGHUDO¿QDQFLDPLHQWRGHOGHGXFLEOHSRU
OD ,VDSUH VH DGMXQWDQ D ODV SUHVHQWHV FRQGLFLRQHV JHQHUDOHV /RV UHVWDQWHV DQH[RV PHQFLRQDGRV HQ HVWH
LQVWUXPHQWR VH HQFXHQWUDQ D GLVSRVLFLyQ GHO D¿OLDGR \ EHQH¿FLDULRV HQ WRGDV ODV $JHQFLDV GH OD ,VDSUH
$57Ë&8/2,&REHUWXUD$GLFLRQDOSDUD(QIHUPHGDGHV&DWDVWUy¿FDV&$(&
(VWHEHQH¿FLRWLHQHSRU¿QDOLGDGDXPHQWDUODFREHUWXUDTXHRWRUJDDOD¿OLDGR\VXVEHQH¿FLDULRVVX3ODQGH
6DOXG &RPSOHPHQWDULR HQ HO iPELWR GH ODV SUHVWDFLRQHV KRVSLWDODULDV DVt FRPR HQ HO GH ODV DPEXODWRULDV
TXH H[SUHVDPHQWH VH LQGLFDQ HQ HO SUHVHQWH LQVWUXPHQWR TXH VHDQ RWRUJDGDV GHQWUR GHO WHUULWRULR QDFLRQDO
5HVSHFWRGHDTXHOODVHQIHUPHGDGHVGLDJQyVWLFRVFRQGLFLRQHVGHVDOXG\WUDWDPLHQWRVTXHHVWpQFRPSUHQGLGRV
HQ HO 5pJLPHQ GH *DUDQWtDV ([SOtFLWDV HQ 6DOXG HQ DGHODQWH *(6 UHJLUi OR GLVSXHVWR HQ HO$UWtFXOR ,, GH
HVWDVPLVPDV&RQGLFLRQHV
3DUD HO RWRUJDPLHQWR GH &$(& OD ,VDSUH SRQH D GLVSRVLFLyQ GH ORV EHQH¿FLDULRV XQ VLVWHPD FRQIRUPDGR
SRUXQD5HG&HUUDGDGH$WHQFLyQ\PRGDOLGDGGHDWHQFLyQPpGLFDFHUUDGDHQDGHODQWHOD³5('&$(&´TXH
WLHQH FRPR ¿QDOLGDG SUHVWDU DWHQFLyQ GH VDOXG D GLFKDV SHUVRQDV DQWH OD HYHQWXDOLGDG GH SUHVHQWDU DOJXQD
GHODVHQIHUPHGDGHVFDWDVWUy¿FDVFXELHUWDVSRUHOSUHVHQWHEHQH¿FLRDGLFLRQDO3DUDDFFHGHUDOD5HG&$(&
HO EHQH¿FLDULR GHEHUi VROLFLWDU SUHYLD \ H[SUHVDPHQWH D OD ,VDSUH VX LQJUHVR \ pVWD HIHFWXDUi OD GHULYDFLyQ
DO SUHVWDGRU PpGLFR \R LQVWLWXFLRQDO FRUUHVSRQGLHQWH GH DFXHUGR FRQ OR LQGLFDGR HQ HO DQH[R 1 GH ODV
SUHVHQWHV&RQGLFLRQHV)RUPXODULRV\
3RU UHJOD JHQHUDO HVWH EHQH¿FLR QR DXPHQWD OD FREHUWXUD GH ODV SUHVWDFLRQHV DPEXODWRULDV VDOYR DTXpOODV
TXH H[SUHVD \ H[SOtFLWDPHQWH VH LQGLFDQ \ UHJXODQ HQ HVWH LQVWUXPHQWR /DV SUHVWDFLRQHV DPEXODWRULDV
H[FHSFLRQDOPHQWHFXELHUWDVSRUHVWHEHQH¿FLRDGLFLRQDOVRQODVVLJXLHQWHV
D/DVGURJDVLQPXQRVXSUHVRUDVHQFDVRGHWUDVSODQWHV
E5DGLRWHUDSLD
F'URJDVFLWRWy[LFDVDSOLFDGDVHQFLFORVGHTXLPLRWHUDSLDSDUDHOWUDWDPLHQWRGHOFiQFHU\
G/RVPHGLFDPHQWRVGH¿QLGRVFRPRFRDG\XYDQWHVRELRPRGXODGRUHVTXHVHXVDQDQWHVGXUDQWHRGHVSXpV
GHORVFLFORVGHTXLPLRWHUDSLDTXHHVWpQFRQVLGHUDGRVHQORVSURJUDPDVGHO0LQLVWHULRGH6DOXG
'(),1,&,Ï1'(&21&(3726<&2%(5785$6
a) 5(' &$(& &RQMXQWR GH SUHVWDGRUHV GH VDOXG LQGLYLGXDOHV H LQVWLWXFLRQDOHV \ WLSR GH KDELWDFLyQ TXH
ODFRQIRUPDQ
/D,VDSUHGHULYDUiDFXDOTXLHUDGHORVSUHVWDGRUHVGHOD5HG&$(&\GHQWURGHpVWDDORDORVPpGLFRV
TXHH[SUHVDPHQWHOHLQGLTXHDOEHQH¿FLDULR/RVHVWDEOHFLPLHQWRVGHOD5HGGHEHUiQHVWDUXELFDGRVHQ
HO WHUULWRULR QDFLRQDO \ FXPSOLU FRQ ORV UHTXLVLWRV HVWDEOHFLGRV HQ HO 'HFUHWR 1 5HJODPHQWR GH
+RVSLWDOHV\&OtQLFDV3ULYDGDVGHO&yGLJR6DQLWDULR\ODVQRUPDVVREUHDFUHGLWDFLyQKRVSLWDODULDYLJHQWHV
-8/ 13
/D,VDSUHSRGUiUHHPSOD]DUFXDOTXLHUDGHORVSUHVWDGRUHVGHOD5HG&$(&LQIRUPDQGRGHHOORSUHYLDPHQWH
MAY
D OD 6XSHULQWHQGHQFLD GH 6DOXG FRQ GtDV GH DQWHODFLyQ D VX LQFRUSRUDFLyQ IRUPDO D OD 5HG &$(&
UHPLWLpQGROHODLQIRUPDFLyQGHFDSDFLGDGGHFDPDVSDEHOORQHVTXLU~UJLFRV\HVSHFLDOLGDGHVGHOSUHVWDGRU
(QWRGRFDVRHOSUHVWDGRUTXHVHLQFRUSRUHDOD5HG&$(&GHEHUiPDQWHQHUODVFRQGLFLRQHVGHFDOLGDG
PpGLFDHLGRQHLGDGWpFQLFDGHOSUHVWDGRUUHHPSOD]DGR
/D 5HG DFWXDOL]DGD HVWR HV ORV SUHVWDGRUHV LQGLYLGXDOHV H LQVWLWXFLRQDOHV \ GHQWUR GH HVWRV ~OWLPRV
ORV SUHVWDGRUHV LQGLYLGXDOHV TXH IRUPDQ SDUWH GHO FRQYHQLR GHEHUi HVWDU SHUPDQHQWHPHQWH D
GLVSRVLFLyQ GH ORV D¿OLDGRV \ EHQH¿FLDULRV HQ OD SiJLQD ZHE \ HQ ODV VXFXUVDOHV GH OD ,VDSUH (V
UHVSRQVDELOLGDGGHOEHQH¿FLDULRLQIRUPDUVHVREUHORVSUHVWDGRUHVTXHFRQIRUPDQOD5HG\ODVFRQGLFLRQHV
GHDFFHVRDHOOD

&2%(5785$ $',&,21$/ 3$5$ (1)(50('$'(6 &$7$675Ï),&$6 (V HO ¿QDQFLDPLHQWR GHO
GH ORV FRSDJRV RULJLQDGRV SRU HQIHUPHGDGHV FDWDVWUy¿FDV TXH VXSHUHQ HO GHGXFLEOH FDOFXODGR GH
DFXHUGR D OR HVWDEOHFLGR HQ OD OHWUD H GHO SUHVHQWH DUWtFXOR VLQ SHUMXLFLR GH ODV H[FOXVLRQHV VHxDODGDV
HQHO$UWtFXOR,Q~PHURGHOSUHVHQWHLQVWUXPHQWR
&23$*2(VODGLIHUHQFLDTXHVHSURGXFHHQWUHHOYDORUFREUDGRSRUODVSUHVWDFLRQHVFXELHUWDVSRUHO3ODQGH
6DOXG&RPSOHPHQWDULR\ODERQL¿FDFLyQHIHFWLYDTXHRWRUJDGLFKRSODQ/RVSDJRVHIHFWXDGRVSRUORVEHQH¿FLDULRV
SRUSUHVWDFLRQHV\VHUYLFLRVQRFXELHUWRVSRUHO3ODQGH6DOXG&RPSOHPHQWDULR\SDJRVHIHFWXDGRVIXHUDGHOD
5HGQRVHFRQVLGHUDUiQFRPRFRSDJRVSDUDHIHFWRVGHODSUHVHQWHFREHUWXUD
(1)(50('$'(6 &$7$675Ï),&$6 7RGR GLDJQyVWLFR HQIHUPHGDG R SDWRORJtD TXH FXPSOD FRQ OR
LQGLFDGR HQ HVWH DUWtFXOR \ TXH UHSUHVHQWH SDUD HO EHQH¿FLDULR FRSDJRV VXSHULRUHV DO GHGXFLEOH HVWDEOHFLGR
HQ OD OHWUD H GH HVWH QXPHUDQGR \ HQ ORV Q~PHURV \ GHO SUHVHQWH DUWtFXOR \ HVWp H[FOXLGD HQ HO
QXPHUDQGRGHHVWHDUWtFXOR
6H HQWHQGHUi SRU GLDJQyVWLFRV DTXHOORV LQGLFDGRV HQ HO GHFUHWR TXH HVWDEOH]FD *(6 HVWR VyOR DSOLFDEOH
SDUD HIHFWRV GH *(6 &$(& \ SRU OD 2UJDQL]DFLyQ 0XQGLDO GH OD 6DOXG HQ OD &ODVL¿FDFLyQ ,QWHUQDFLRQDO
GH(QIHUPHGDGHV&,(RODYLJHQWHDODpSRFDGHODSUHVWDFLyQ
'('8&,%/( 6H GH¿QH FRPR GHGXFLEOH D OD VXPD GH ORV FRSDJRV FRUUHVSRQGLHQWHV D XQ PLVPR
GLDJQyVWLFR TXH KDEUiQ GH VHU DFXPXODGRV SDUD WHQHU GHUHFKR D HVWD FREHUWXUD DGLFLRQDO SDUD
HQIHUPHGDGHV FDWDVWUy¿FDV \ TXH HQ FRQVHFXHQFLD QR VRQ GH FDUJR GH HVWH EHQH¿FLR 3DUD HIHFWRV
GHO FyPSXWR GHO GHGXFLEOH QR VH FRQWDELOL]DUiQ ORV FRSDJRV TXH WHQJDQ VX RULJHQ HQ SUHVWDFLRQHV QR
FXELHUWDVSRUHVWHEHQH¿FLRRTXHHVWDQGRFXELHUWDVVHKD\DQRWRUJDGRIXHUDGHOD5HG
02172$&808/$&,Ï1<'85$&,Ï1'(/'('8&,%/(
(OGHGXFLEOHHVHOHTXLYDOHQWHDODFDQWLGDGGHWUHLQWDYHFHVODFRWL]DFLyQSDFWDGDHQHO3ODQGH6DOXGSRUFDGD
EHQH¿FLDULRTXHORXWLOLFHFRQXQPtQLPRGH8)\XQPi[LPRGH8)SDUDFDGDHQIHUPHGDGFDWDVWUy¿FD
RGLDJQyVWLFR
(OGHGXFLEOHHVDQXDOHVWRHVVHDFXPXODGXUDQWHXQDxRFRQWDELOL]DGRGHVGHODIHFKDHQTXHHOEHQH¿FLDULR
HQWHUHHOFRSDJRSRUODSULPHUDSUHVWDFLyQTXHWHQJDVXRULJHQHQXQDHQIHUPHGDGFDWDVWUy¿FDHQORVWpUPLQRV
HVWDEOHFLGRVHQHOQ~PHURGHOSUHVHQWHDUWtFXOR$OFDERGHXQDxRGHHVDIHFKDVHUHLQLFLDUiHOFyPSXWRGHO
GHGXFLEOHSRURWURDxR\DVtVXFHVLYDPHQWH
/RVFRSDJRVDFRQWDELOL]DUHQHOGHGXFLEOHVRQVyORDTXHOORVTXHWLHQHQVXRULJHQHQXQJDVWRLQFXUULGRHQOD
5HG&$(&VDOYRORLQGLFDGRHQHOQ~PHURSRUXQDPLVPDHQIHUPHGDGFDWDVWUy¿FD\VXVFRPSOLFDFLRQHV
(OGHGXFLEOHQRVHSRGUiFRQIRUPDUFRQFRSDJRVHIHFWXDGRVSRUKRVSLWDOL]DFLRQHVGHULYDGDVGHHQIHUPHGDGHV
TXHQRUHYLVWDQHOFDUiFWHUGHFDWDVWUy¿FDHQORVWpUPLQRVGHHVWDFREHUWXUDDGLFLRQDOQLSRUODDFXPXODFLyQGH
FRSDJRVFRUUHVSRQGLHQWHVDPiVGHXQEHQH¿FLDULRRTXHIXHUDQDWHQGLGDVIXHUDGHOD5HG
(QFDVRTXHODFREHUWXUDDGLFLRQDOSDUDHQIHUPHGDGHVFDWDVWUy¿FDVVHDXWLOL]DGDSRUPiVGHXQEHQH¿FLDULRGHO
FRQWUDWRGHVDOXGRHQPiVGHXQDHQIHUPHGDGFDWDVWUy¿FDSDUDXQPLVPREHQH¿FLDULRHOGHGXFLEOHWRWDOVHUi
GHFRWL]DFLRQHVSDFWDGDVSRUFDGDSHUtRGRDQXDOHOTXHQRSRGUiH[FHGHUGH8)8QDYH]
FRPSOHWDGRGLFKRGHGXFLEOHWRWDO\HQODHYHQWXDOLGDGGHSURGXFLUVHXQDWHUFHUDHQIHUPHGDGFDWDVWUy¿FDGXUDQWH
HVHSHUtRGRDQXDOHQTXH\DVHKDQDFXPXODGR\SDJDGR\DVHDGLUHFWDPHQWHR¿QDQFLDGRHQFRQIRUPLGDGDODV
UHJODVHVWDEOHFLGDVHQHOSUHVHQWHLQVWUXPHQWRXQHTXLYDOHQWHDFRWL]DFLRQHVFRQXQPtQLPRGH8)\XQ
Pi[LPRGH8)QRVHUiQHFHVDULRFRPSOHWDUXQRQXHYRKDVWDHOSUy[LPRSHUtRGRDQXDOHQWHQGLpQGRVHSRU
WDODTXHOTXHVHLQLFLDFRQHOFRSDJRGHODSULPHUDSUHVWDFLyQGHOEHQH¿FLR
&È/&8/2'(/'('8&,%/(
(OGHGXFLEOHVHGHWHUPLQDUiPXOWLSOLFDQGRSRUHOPRQWRGHODFRWL]DFLyQYLJHQWH
3DUDHIHFWRVGHOFiOFXORGHOGHGXFLEOHVHHQWHQGHUiTXHOD8QLGDGGH)RPHQWRDXWLOL]DUVHUiHOYDORUTXHHVWD
XQLGDGWHQJDDO~OWLPRGtDGHOPHVDQWHULRUDDTXHOHQTXHVHHIHFW~HODSUHVWDFLyQTXHGDRULJHQDOFRSDJR
FRUUHVSRQGLHQWH
/DGHWHUPLQDFLyQGHODFRWL]DFLyQYLJHQWHVHUHDOL]DUiGHDFXHUGRDODVVLJXLHQWHVUHJODVVHJ~QFRUUHVSRQGD
3/$1(6,1',9,'8$/(63$&7$'26(181,'$'(6021(7$5,$6/DFRWL]DFLyQYLJHQWHFRUUHVSRQGHUiDOD
FRWL]DFLyQWRWDOSDFWDGDGHDFXHUGRDO3ODQGH6DOXG&RPSOHPHQWDULRYLJHQWH
20
b) 3/$1(6,1',9,'8$/(6<*583$/(63$&7$'26(1(/325&(17$-('(/$&27,=$&,Ï1/(*$/
7UDWiQGRVH GH 3ODQHV GH 6DOXG SDFWDGRV HQ HO SRUFHQWDMH GH FRWL]DFLyQ OHJDO \ VyOR SDUD HIHFWRV GH
FiOFXOR OD FRWL]DFLyQ YLJHQWH VHUi GHWHUPLQDGD HQ EDVH DO SURPHGLR GH ODV FRWL]DFLRQHV GHFODUDGDV R
SDJDGDV HQ ORV ~OWLPRV PHVHV \R ODV HTXLYDOHQWHV HQ HO FDVR GH SDJR GH VXEVLGLR SRU LQFDSDFLGDG
ODERUDO 'LFKR SURPHGLR GHEH FDOFXODUVH UHWURDFWLYDPHQWH D SDUWLU GH OD FRWL]DFLyQ GHFODUDGD R SDJDGD
GHOPHVLQPHGLDWDPHQWHDQWHULRUDODVROLFLWXGGHOSUHVHQWHEHQH¿FLR
6LHQHOUHIHULGRSHUtRGRVHUHJLVWUDUDQPHQRVGHVHLVFRWL]DFLRQHVGHFODUDGDVRSDJDGDVODFRWL]DFLyQ
YLJHQWH VH GHWHUPLQDUi HQ EDVH DO SURPHGLR GHO Q~PHUR GH PHVHV TXH UHJLVWUHQ LQIRUPDFLyQ
(QHOFDVRGHQRH[LVWLULQIRUPDFLyQGHQWURGHODOXGLGRSHUtRGRGHPHVHVVHFRQVLGHUDUiHODSOLFDGR
DO~OWLPRGDWRGHODUHQWDLPSRQLEOHTXHKD\DVLGRGHFODUDGDRSDJDGD
c) 3/$1(6,1',9,'8$/(6&203(16$'26*583$/(620$75,021,$/(63DUDHIHFWRVGHGHWHUPLQDU
ODFRWL]DFLyQYLJHQWHDXWLOL]DUSDUDODGH¿QLFLyQGHOGHGXFLEOHVHFDOFXODUiHOPRQWRHQIXQFLyQGHOSUHFLR
EDVHGHO3ODQGH6DOXG&RPSOHPHQWDULRFRQWUDWDGR\ORVIDFWRUHVGHULHVJRGHORVEHQH¿FLDULRVYLJHQWHV
GH DFXHUGR DO SURFHGLPLHQWR DSOLFDGR SDUD OD GHWHUPLQDFLyQ GH OD FRWL]DFLyQ SDUD XQ 3ODQ GH 6DOXG
LQGLYLGXDO
$7(1&,21(6'(85*(1&,$
7UDWiQGRVH GH XQD KRVSLWDOL]DFLyQ TXH UHTXLHUD DWHQFLyQ LQPHGLDWD H LPSRVWHUJDEOH HQ XQ SUHVWDGRU
DMHQR D OD 5(' &$(& HO RWRUJDPLHQWR GH HVWH EHQH¿FLR DGLFLRQDO HVWDUi VXSHGLWDGR DO FXPSOLPLHQWR HQ
IRUPDFRSXODWLYDDODVVLJXLHQWHVFRQGLFLRQHV
D(OEHQH¿FLDULRRVXUHSUHVHQWDQWHGHEHUiVROLFLWDUHOLQJUHVRDOD5HG&$(&DOD,VDSUH\
E(OPpGLFRWUDWDQWHGHEHUiDXWRUL]DUHOWUDVODGR\
F/D,VDSUHGHEHUiGHULYDUDOSDFLHQWHDXQSUHVWDGRUGHOD5HG&$(&SDUDORFXDOGLVSRQGUiGHXQSOD]R
GHGRVGtDVKiELOHVFRQWDGRVGHVGHODIRUPXODFLyQGHODVROLFLWXGUHVSHFWLYD\
G(OSDFLHQWHGHEHLQJUHVDUDOHVWDEOHFLPLHQWRGHOD5HG&$(&TXHFRUUHVSRQGDEDMRODVFRQGLFLRQHV
LQGLFDGDVHQODGHULYDFLyQ
(QWDQWRQRVHFXPSODQODVFRQGLFLRQHVVHxDODGDVSUHFHGHQWHPHQWHHOSDFLHQWHJR]DUiVyORGHORVEHQH¿FLRV
GH VX 3ODQ GH 6DOXG &RPSOHPHQWDULR VLQ SHUMXLFLR GH ORV GHUHFKRV \ EHQH¿FLRV UHVSHFWR D ODV XUJHQFLDV
YLWDOHV R FRQ VHFXHOD IXQFLRQDO JUDYH TXH FRQWHPSOD HO ')/ 1 GH HQ VX DUWtFXOR
6yOR HQ FDVR GH XUJHQFLD FRQ ULHVJR YLWDO R GH VHFXHOD IXQFLRQDO JUDYH HO WUDVODGR GHO SDFLHQWH VHUi SDUWH
GH OD SUHVHQWH FREHUWXUD VHJ~Q ODV FRQGLFLRQHV DQWHULRUPHQWH VHxDODGDV \ VHUi OD ,VDSUH OD TXH GHVLJQDUi
HOSUHVWDGRUGHOD5HGTXHUHDOL]DUiHOWUDVODGR
8QDYH]FXPSOLGDVODVFRQGLFLRQHVVHxDODGDV\GHVGHODIHFKDHQTXHHOSDFLHQWHLQJUHVHDOSUHVWDGRUGHOD
5HG&$(&HQHOWLSRGHKDELWDFLyQGH¿QLGDSRUOD,VDSUHVHLQLFLDUiODFREHUWXUD\HOFyPSXWRGHOGHGXFLEOH
6yOR HQ HVWH FDVR ORV FRSDJRV GHULYDGRV GH OD DWHQFLyQ GH XUJHQFLD FRQ ULHVJR YLWDO R VHFXHOD IXQFLRQDO
JUDYHHQHOSUHVWDGRUDMHQRDOD5HG&$(&VHFRPSXWDUiQSDUDHOFiOFXORGHOGHGXFLEOHGHHVWHEHQH¿FLR
7UDWiQGRVH GH XQD KRVSLWDOL]DFLyQ HQ XQ SUHVWDGRU GH OD 5HG &$(& RULJLQDGD SRU XQD XUJHQFLD FRQ
ULHVJRYLWDORVHFXHODIXQFLRQDOJUDYHHOEHQH¿FLDULRRVXUHSUHVHQWDQWHGHEHUiGDUDYLVRDOD,VDSUHGHQWUR
GH ODV SULPHUDV KRUDV FRQWDGDV GHVGH HO LQJUHVR DO FHQWUR DVLVWHQFLDO FRQ HO REMHWR TXH OD ,QVWLWXFLyQ
SXHGDDGPLQLVWUDUHOFDVR\FRQWURODUTXHODVFRQGLFLRQHVGHDWHQFLyQGHOSDFLHQWHHQHOSUHVWDGRUVHDMXVWHQ
DORVWpUPLQRVSDFWDGRVSDUDHORWRUJDPLHQWRGHHVWDFREHUWXUD
(VWHEHQH¿FLRRSHUDUiGHVGHHOLQJUHVRDOD5HGVLHPSUH\FXDQGRGXUDQWHWRGDVXHVWDGtDHOSDFLHQWHVH
KD\DPDQWHQLGRHQHOWLSRGHKDELWDFLyQDODTXHIXHGHULYDGRSRUOD,VDSUHSDUDHVWDFREHUWXUDVDOYRTXHSRUVX
FRQGLFLyQGHVDOXGKD\DUHTXHULGRXQDKDELWDFLyQGLIHUHQWHHQDOJ~QSHUtRGRWDOHVFRPRKDELWDFLyQGHFXLGDGRV
LQWHQVLYRVRLQWHUPHGLRV(QFDVRFRQWUDULR\QRREVWDQWHTXHHOHVWDEOHFLPLHQWRSHUWHQH]FDDOD5HG&$(&QR
RSHUDUiHVWDFREHUWXUD(QHOHYHQWRGHTXHQRVHKD\DGDGRHODYLVRUHVSHFWLYRHOEHQH¿FLRDGLFLRQDORSHUDUi
LJXDOPHQWHGHVGHHOLQJUHVRDOD5HGVLHPSUHTXHVHFXPSODQODVFRQGLFLRQHVUHIHULGDVDOWLSRGHKDELWDFLyQ
&21',&,21(6'($&&(62$/$&2%(5785$$',&,21$/3$5$(1)(50('$'(6&$7$675Ï),&$6
-8/ 13
MAY
(O EHQH¿FLDULR R TXLHQ DFW~H HQ VX UHSUHVHQWDFLyQ HQ FDVR GH PHQRUHV GH HGDG R GH SDFLHQWHV LPSHGLGRV
GHHIHFWXDUHOSURFHGLPLHQWRSRUVLPLVPRVGHEHUiVROLFLWDUHOLQJUHVRDOD5HGGHDWHQFLyQPpGLFDDSDUWLU
GHO PRPHQWR HQ TXH SUHVXPD TXH OD HQIHUPHGDG TXH VH OH KD GLDJQRVWLFDGR SXHGH WUDQVIRUPDUVH HQ XQD
HQIHUPHGDG FDWDVWUy¿FD SDUD OR FXDO GHEHUi VROLFLWDU D OD ,VDSUH OD GHVLJQDFLyQ \ GHULYDFLyQ DO SUHVWDGRU
FRUUHVSRQGLHQWHORDQWHULRUGHDFXHUGRDORGHVFULWRHQHO$QH[R1

8QD YH] VROLFLWDGD OD GHULYDFLyQ SRU SDUWH GHO EHQH¿FLDULR R VX UHSUHVHQWDQWH OD ,VDSUH GLVSRQGUi GH GtDV
KiELOHV \ GtDV KiELOHV VHJ~Q VH WUDWH GH SDFLHQWHV KRVSLWDOL]DGRV R QR UHVSHFWLYDPHQWH SDUD GHVLJQDU HO
SUHVWDGRU
(Q HO FDVR GHO SDFLHQWH KRVSLWDOL]DGR HO EHQH¿FLDULR R UHSUHVHQWDQWH GHEHUi FRQWDU FRQ OD DXWRUL]DFLyQ GHO
PpGLFR WUDWDQWH SDUD VX WUDVODGR 'H QR FRQWDUVH FRQ OD DXWRUL]DFLyQ SDUD HO WUDVODGR SRU SDUWH GHO PpGLFR
WUDWDQWHQRSRGUiJR]DUGHORVEHQH¿FLRVGHHVWDFREHUWXUD
6yOR GHVGH HO PRPHQWR HQ TXH HO EHQH¿FLDULR KD\D VLGR GHULYDGR D OD 5HG DFHSWDGR ODV FRQGLFLRQHV GH
GHULYDFLyQ \ KD\D LQJUHVDGR FRPHQ]DUi HO FyPSXWR GH ORV FRSDJRV SDUD DFXPXODU HO GHGXFLEOH 8QD YH]
SDJDGR HO GHGXFLEOH FRUUHVSRQGLHQWH GH DFXHUGR D ODV QRUPDV TXH HVWDEOHFH HO SUHVHQWH LQVWUXPHQWR
FRPHQ]DUiDRSHUDUODFREHUWXUDDGLFLRQDOSDFWDGDSDUDODV(QIHUPHGDGHV&DWDVWUy¿FDV
&XDOTXLHUDVHDODHQIHUPHGDGFDWDVWUy¿FDHOEHQH¿FLDULRQXQFDYHUiDOWHUDGDODFREHUWXUDGHHVWHEHQH¿FLR
DGLFLRQDO SRU QR H[LVWLU FDSDFLGDG VX¿FLHQWH GH DWHQFLyQ HQ HO SUHVWDGRU TXH OD ,VDSUH KD GHVLJQDGR SDUD
VX WUDWDPLHQWR (Q WDO VLWXDFLyQ HO EHQH¿FLDULR R VX UHSUHVHQWDQWH GHEHUi LQIRUPDU D OD ,VDSUH OD FXDO VH
HQFDUJDUiGHGHULYDUDOSDFLHQWHDRWURSUHVWDGRUGHFDUDFWHUtVWLFDVVLPLODUHVDOSULPHURXELFDGRHQHOWHUULWRULR
QDFLRQDO GHELHQGR PDQWHQHUVH ODV FRQGLFLRQHV GH FDOLGDG PpGLFD H LGRQHLGDG WpFQLFD GH pVWH 1R VH
HQWHQGHUi SRU LQVX¿FLHQFLD HQ OD 5HG OD LPSRVLELOLGDG GH UHDOL]DU HO WUDWDPLHQWR SRU SDUWH GH FXDOTXLHU
SUHVWDGRUXELFDGRHQHOWHUULWRULRQDFLRQDO
$VLPLVPRWUDQVFXUULGRVPiVGHVHLVPHVHVGHVGHOD~OWLPDIHFKDGHGHULYDFLyQOD,VDSUHWHQGUiODIDFXOWDGGH
FDPELDUDOSUHVWDGRUGiQGROHDYLVRRSRUWXQRDOD¿OLDGRLQYRFDQGRSDUDHOORPRGL¿FDFLRQHVGHOD5HG
35(67$&,21(6 12 &8%,(57$6 325 /$ &2%(5785$ $',&,21$/ 3$5$ (1)(50('$'(6
CATASTRÓFICAS
/DV VLJXLHQWHV SUHVWDFLRQHV VH H[FOX\HQ GH HVWD &REHUWXUD $GLFLRQDO SDUD (QIHUPHGDGHV &DWDVWUy¿FDV
•
/DVSUHVWDFLRQHVGHULYDGDVGHSUREOHPDVGHVDOXGTXHUH~QDQODVFRQGLFLRQHVH[LJLGDVSDUDVHUFXELHUWDV
• SRUHO5pJLPHQ*HQHUDOGH*DUDQWtDVHQ6DOXG*(6
• /DVH[FOXVLRQHVHVWDEOHFLGDVHQHO&RQWUDWRGH6DOXG
/DV SDWRORJtDV GHULYDGDV GH FRPSOLFDFLRQHV \ VHFXHODV GH ORV WUDWDPLHQWRV FRVPpWLFRV R FRQ ¿QHV GH
• HPEHOOHFLPLHQWR
• 7UDWDPLHQWRVKRVSLWDODULRVGHSDWRORJtDVSVLTXLiWULFDVDGLFFLRQHVDGURJDVRDOFRKROLVPR
• 7UDWDPLHQWRVGHLQIHUWLOLGDGRHVWHULOLGDG
7UDWDPLHQWRTXLU~UJLFRGHOD2EHVLGDG0yUELGDVXVFRPSOLFDFLRQHV\VHFXHODVVDOYRORLQGLFDGRHQHO
• QXPHUDOGHHVWHDUWtFXOR
&XDOTXLHUWUDWDPLHQWRSRVWHULRUDXQWUDWDPLHQWRGHREHVLGDGWDQWRTXLU~UJLFRFRPRQRTXLU~UJLFR
TXHWHQJDHOFDUiFWHUGHFRVPpWLFRWDOHVFRPRDEGRPLQRSODVWtDXRWUDFRUUHFFLyQGHULYDGDGHODEDMDGH
• SHVR
• 7UDWDPLHQWRVRGRQWROyJLFRV
3UHVWDFLRQHV PpGLFDV IiUPDFRV \ WpFQLFDV TXH WHQJDQ HO FDUiFWHU GH H[SHULPHQWDO SDUD OD SDWRORJtD HQ
• WUDWDPLHQWR R TXH QR HVWpQ DYDODGDV SRU ODV VRFLHGDGHV FLHQWt¿FDV FKLOHQDV FRUUHVSRQGLHQWHV
/RVPHGLFDPHQWRVHLQVXPRVTXHQRHVWpQUHJLVWUDGRVSRUHO,QVWLWXWRGH6DOXG3~EOLFD,63GHDFXHUGR
• DODQRUPDWLYDYLJHQWHHQHOSDtV
• /DDWHQFLyQGRPLFLOLDULDHQWRGDVVXVIRUPDV
• /D KRVSLWDOL]DFLyQ GRPLFLOLDULD VDOYR OR LQGLFDGR HQ HO QXPHUDO GH HVWH DUWtFXOR
• 7RGDV DTXHOODV SUHVWDFLRQHV TXH QR HVWpQ GHWDOODGDV HQ HO DUDQFHO GHO 3ODQ GH 6DOXG &RPSOHPHQWDULR
&LUXJtDV SURJUDPDGDV UHDOL]DGDV IXHUD GH OD 5HG \ VXV FRPSOLFDFLRQHV PLHQWUDV QR VH LQFRUSRUH D OD
• 5HG&$(&
3UHVWDFLRQHV RWRUJDGDV HQ HVWDEOHFLPLHQWRV R LQVWLWXFLRQHV XELFDGDV IXHUD GHO WHUULWRULR QDFLRQDO \ WRGDV
• DTXHOODVSUHVWDFLRQHVTXHVHUHDOLFHQIXHUDGHOD5HG
/DV SUHVWDFLRQHV \ PHGLFDPHQWRV GH FDUiFWHU DPEXODWRULR QR FRGL¿FDGDV HQ HO DUDQFHO GHO FRQWUDWR GH
• VDOXGVDOYRORVHxDODGRHQHOSiUUDIRWHUFHURGHO$UWtFXOR,GHHVWHGRFXPHQWR
/DV SUHVWDFLRQHV KRPRORJDGDV HQWHQGLHQGR SRU KRPRORJDFLyQ HO UHHPSOD]R GH SUHVWDFLRQHV SRU RWUDV
QRFRGL¿FDGDVHQHODUDQFHOGHOFRQWUDWRGHVDOXG
(VWH EHQH¿FLR DGLFLRQDO SDUD HQIHUPHGDGHV FDWDVWUy¿FDV QR VH DSOLFD GXUDQWH ORV SOD]RV VHxDODGRV HQ HO
DUWtFXOR OHWUD J SDUD HO FDVR GH HQIHUPHGDGHV SUHH[LVWHQWHV GHFODUDGDV \ HQ HO DUWtFXOR GH ODV
SDWRORJtDVSUHH[LVWHQWHVQRGHFODUDGDVDPERVGHO')/1GHGH6DOXG
'(/7e50,12'(/$&2%(5785$$',&,21$/5(63(&72'(81$'(7(50,1$'$(1)(50('$'
CATASTRÓFICA
/DFREHUWXUDDGLFLRQDOSDUDXQDGHWHUPLQDGDHQIHUPHGDGFDWDVWUy¿FDWHUPLQD
22
D &XDQGRHOEHQH¿FLDULRFRPSOHWHHOSHUtRGRDQXDOFRQWDELOL]DGRGHVGHHOPRPHQWRHQTXHVHHPSLH]D
DDFXPXODUHOGHGXFLEOHHVWRHVGHVGHHOSULPHUFRSDJROD,QVWLWXFLyQGHEHUiFRPXQLFDUSRUFRUUHR
FHUWL¿FDGRWDOFLUFXQVWDQFLD(QWDOFDVRHOEHQH¿FLDULRSRGUiVROLFLWDUODUHQRYDFLyQGHOEHQH¿FLRGHQWUR
GHORVGtDVKiELOHVVLJXLHQWHVDODIHFKDGHHQYtRGHGLFKDFRPXQLFDFLyQ\OD,VDSUHHYDOXDUiGHQWUR
GHOSOD]RGHGtDVKiELOHVFRQWDGRGHVGHODVROLFLWXGVLFRUUHVSRQGHRQRPRGL¿FDUDOJXQDFLUFXQVWDQFLD
HVSHFt¿FDFRPRSRUHMHPSORHOSUHVWDGRUGHVLJQDGR8QDYH]HPLWLGRHOSURQXQFLDPLHQWRGHOD,VDSUH
\DFHSWDGDODGHULYDFLyQ\VXVFRQGLFLRQHVGHQWURGHORVVLJXLHQWHVGtDVKiELOHVVHFRPHQ]DUiD
DFXPXODUHOGHGXFLEOHHOTXHFRQVLGHUDUiORVFRSDJRVJHQHUDGRVGXUDQWHHOSURFHVRGHUHQRYDFLyQ
(QFDVRGHQRREVHUYDUVHHVWRVSOD]RVSRUHOEHQH¿FLDULRQRKDEUiOXJDUDODDFXPXODFLyQGHGHGXFLEOH
GXUDQWHHVHSHUtRGR
E &XDQGR XQ PpGLFR GH OD 5HG RWRUJD OD RUGHQ GH DOWD PpGLFD DO SDFLHQWH (Q FDVR GH H[LVWLU
FRPSOLFDFLRQHV SRVWHULRUHV GHULYDGDV GH OD SDWRORJtD WUDWDGD FRPR FDWDVWUy¿FD HO EHQH¿FLDULR SRGUi
UHLQFRUSRUDUVHQXHYDPHQWHDOD5HGHQODVPLVPDVFRQGLFLRQHVRULJLQDOHVGHQWURGHOPLVPRSHUtRGR
DQXDO
F &XDQGRHOEHQH¿FLDULRGHFLGDYROXQWDULDPHQWHUHWLUDUVHGHOVLVWHPDGHOD5HG
G &XDQGRHOEHQH¿FLDULRQRFXPSODODSUHVFULSFLyQPpGLFDLQGLFDGDSRUORVSUHVWDGRUHVGHOD5HG
H &XDQGRHOFRQWUDWRGHVDOXGSUHYLVLRQDOWHUPLQHSRUFXDOTXLHUFDXVD
3$*2'(/'('8&,%/(
(OGHGXFLEOHTXHVHPHQFLRQDHQODOHWUDHGHOQ~PHURGHHVWHDUWtFXORVHUiVLHPSUHGHFDUJRGHOD¿OLDGR
3RUOR WDQWRpVWHVHUi UHVSRQVDEOH GH HIHFWXDU HO SDJR GHO PLVPR HQ IRUPDGLUHFWD DO SUHVWDGRU PpGLFR R
LQVWLWXFLRQDOFRUUHVSRQGLHQWH
6LQ SHUMXLFLR GH OR DQWHULRU HO D¿OLDGR SRGUi UHFXUULU D OD ,VDSUH SUHYLR FXPSOLPLHQWR GH ORV UHTXLVLWRV D TXH
VH DOXGH HQ HO $QH[R 1 R D XQ WHUFHUR WDOHV FRPR &DMDV GH &RPSHQVDFLyQ %DQFRV H ,QVWLWXFLRQHV
)LQDQFLHUDV D ¿Q GH REWHQHU HO ¿QDQFLDPLHQWR GHO PRQWR D SDJDU SRU FRQFHSWR GHO GHGXFLEOH
/D,VDSUHQRVHSRGUiQHJDUDRWRUJDUHO¿QDQFLDPLHQWRVROLFLWDGRVLHOD¿OLDGRFXPSOHORVUHTXLVLWRVLQGLFDGRV
HQHO$QH[RUHIHULGR(QWRGRFDVRSDUDTXHOD,VDSUH¿QDQFLHHOGHGXFLEOHTXHGHEHSDJDUHOD¿OLDGRpVWH
GHEHUiVXVFULELUSUHYLDPHQWHXQSDJDUp$QH[R1DIDYRUGHOD,VDSUH\XQPDQGDWR$QH[R1TXH
IDFXOWH D HVWD ~OWLPD D FRPSOHWDU GLFKR GRFXPHQWR SRU HO VDOGR DGHXGDGR D ¿Q GH JDUDQWL]DU HO UHHPEROVR
tQWHJURGHGLFKR¿QDQFLDPLHQWR
3DUD ORV HIHFWRV GHO SDJR GHO FUpGLWR RWRUJDGR ODV SDUWHV VXVFULELUiQ XQ FRQYHQLR $QH[R 1 HQ HO FXDO
VH FRQYHQGUiQ ODV FRQGLFLRQHV GH RWRUJDPLHQWR \ HQ HO TXH HO D¿OLDGR VH FRPSURPHWD D UHHPEROVDU D OD
,VDSUH HO PRQWR ¿QDQFLDGR SRU pVWD \D VHD PHGLDQWH SDJR FRQWDGR R HO XVR GHO VDOGR DFXPXODGR HQ VX
FXHQWD FRUULHQWH GH H[FHGHQWHV GH FRWL]DFLyQ R D FXHQWD GH VXV H[FHVRV GHVFXHQWR HQ FXRWDV SRU SODQLOOD
GHVXUHPXQHUDFLyQRSHQVLyQPHQVXDO$QH[R1GHVFXHQWRHQFXRWDVGHVXFXHQWDFRUULHQWHEDQFDULD
R WDUMHWD GH FUpGLWR $QH[R 1 R ELHQ PHGLDQWH FXDOTXLHU RWUR PHGLR GH SDJR TXH FRQVLHQWD OD ,VDSUH
3DUD HO FDVR TXH HO D¿OLDGR VH QHJDUH D VXVFULELU XQ FRQYHQLR GH SDJR R VL KDELpQGRVH VXVFULWR GLFKR
FRQYHQLR OD ,VDSUH QR KXELHUH SHUFLELGR SDJR GXUDQWH GRV PHVHV FRQVHFXWLYRV R WUHV PHVHV HQ IRUPD
DOWHUQDGDSRUFDXVDLPSXWDEOHDOFRWL]DQWHRELHQVLKDELpQGRVHHIHFWXDGRWRGRVORVGHVFXHQWRVDFRUGDGRV
HQHOFRQYHQLRGHSDJRD~QSHUVLVWLHUHXQVDOGRLQVROXWRGHOFUpGLWROD,VDSUHHVWDUiIDFXOWDGDSDUDSHUVHJXLU
HOFREURGHGLFKRVDOGRPHGLDQWHODHMHFXFLyQGHOSDJDUpPHQFLRQDGR
'(/75$7$0,(17248,5Ò5*,&2'(/$2%(6,'$'0Ï5%,'$
6H RWRUJDUi OD FREHUWXUD GHO EHQH¿FLR GHVFULWR HQ HVWH GRFXPHQWR FXDQGR HO GLDJQyVWLFR FRUUHVSRQGD D
REHVLGDG PyUELGD \ HQ FDVR GH XQ WUDWDPLHQWR TXLU~UJLFR H[FHSWR LQVWDODFLyQ GH EDOyQ LQWUDJiVWULFR VL VH
FXPSOHQWRGRVORVUHTXLVLWRVGHVFULWRVDFRQWLQXDFLyQ
(OEHQH¿FLDULRGHEHWHQHUHQOD,VDSUHXQDYLJHQFLDVXSHULRUDPHVHV
(OEHQH¿FLDULRGHEHUiUHJLVWUDUXQtQGLFHGHPDVDFRUSRUDO,0&LJXDORVXSHULRUD
&HUWL¿FDUHOKDEHUIUDFDVDGRHQXQWUDWDPLHQWRPpGLFRGHODREHVLGDGHMHFXWDGRSRUHTXLSRPXOWLGLVFLSOLQDULR
SRUORPHQRVXQDxR
-8/ 13
&RQWDU FRQ XQD DXWRUL]DFLyQ GDGR SRU XQ SVLTXLDWUD GHVLJQDGR SRU OD ,VDSUH TXH QR FRQWUDLQGLTXH HVWH
MAY
WLSRGHFLUXJtD
6yOR VL OD FLUXJtD VH UHDOL]D HQ HO HVWDEOHFLPLHQWR KRVSLWDODULR TXH OD ,6$35( GHWHUPLQH HQ OD 5('
'(/$+263,7$/,=$&,Ï1'20,&,/,$5,$&$(&
(VWDFREHUWXUDSURFHGHUiUHVSHFWRGHOD+RVSLWDOL]DFLyQ'RPLFLOLDULDSUHYLDVROLFLWXGDOD,VDSUH\GHULYDFLyQ
SRU SDUWH GH pVWD D XQ SUHVWDGRU GHVLJQDGR SRU HOOD 3DUD HVWH HIHFWR GHEH GDU FXPSOLPLHQWR D WRGDV ODV
VLJXLHQWHVFRQGLFLRQHV
6H GHEH WUDWDU GH XQ SDFLHQWH TXH HVWH KRVSLWDOL]DGR VRPHWLGR D XQ WUDWDPLHQWR TXH UHTXLHUD
SUHVHQFLDGHOPpGLFRWUDWDQWH
23
(O PpGLFR WUDWDQWH GHEH VHU GLVWLQWR GHO PpGLFR VXSHUYLVRU GH OD HPSUHVD TXH GD HO VHUYLFLR GH
KRVSLWDOL]DFLyQGRPLFLOLDULD
'HEHWUDWDUVHGHSDFLHQWHVVLQ$OWDVyORVHWUDWDGHWUDVODGRGHVGHXQSUHVWDGRUGHOD5HGFRQFRQWLQXLGDG
GHSUHVWDFLRQHVFRPRXQDVXVWLWXFLyQGHXQDKRVSLWDOL]DFLyQGHQLYHOLQWHUPHGLR\RLQWHQVLYR\TXHOD
KRVSLWDOL]DFLyQ QR VH MXVWL¿TXH H[FOXVLYDPHQWH SRU OD DGPLQLVWUDFLyQ GH PHGLFDPHQWRV
'HEHWUDWDUVHGHSDWRORJtDVTXHMXVWL¿TXHQODKRVSLWDOL]DFLyQGRPLFLOLDULD
/DLQGLFDFLyQGHODKRVSLWDOL]DFLyQGRPLFLOLDULD\VXGXUDFLyQGHEHVHUHIHFWXDGDSRUHOPpGLFRWUDWDQWH
/D ,VDSUH GHULYDUi D XQ VHUYLFLR GH KRVSLWDOL]DFLyQ GRPLFLOLDULD VHxDODQGR OD GXUDFLyQ GH OD PLVPD \
FRQVLGHUDQGRSDUDHOORODLQGLFDFLyQGHOPpGLFRWUDWDQWHGHOD5('
/DHPSUHVDTXHSUHVWHHOVHUYLFLRGHKRVSLWDOL]DFLyQGRPLFLOLDULDGHEHUiHVWDUDFUHGLWDGD\FXPSOLUFRQ
ODVGLVSRVLFLRQHVOHJDOHV\UHJODPHQWDULDVGHRUGHQVDQLWDULRTXHVHDQSHUWLQHQWHVDGHPiVGHFRQWDU
FRQGLUHFFLyQPpGLFDUHVSRQVDEOH\OOHYDU¿FKDFOtQLFDGHOSDFLHQWH
/D,VDSUHHVWiIDFXOWDGDSDUDHYDOXDUSHULyGLFDPHQWHHOFXPSOLPLHQWRGHODVFRQGLFLRQHVTXHDPHULWDQ
OD+RVSLWDOL]DFLyQ'RPLFLOLDULDSDUDHIHFWRVGHUHLQJUHVRDOKRVSLWDODOWDRVXWpUPLQRSRUQRUHYHVWLU
\D ODV FRQGLFLRQHV TXH UHTXLHUH OD +RVSLWDOL]DFLyQ 'RPLFLOLDULD VHxDODGDV SUHFHGHQWHPHQWH
6H H[FOX\HQ ORV WUDWDPLHQWRV GH HQIHUPHGDGHV FUyQLFDV \ WUDWDPLHQWRV GH DQWLELyWLFRV
'(/$9,*(1&,$'(/$&2%(5785$$',&,21$/
/DSUHVHQWHFREHUWXUDDGLFLRQDOUHHPSOD]DHQWRGDVVXVSDUWHVODVFRQGLFLRQHVGHHVWHEHQH¿FLRFRQWHPSODGDV
HQOD&LUFXODU1GHODxRGHOD6XSHULQWHQGHQFLDGH,VDSUHV
(O D¿OLDGR \ VXV EHQH¿FLDULRV WHQGUiQ GHUHFKR D HVWD &REHUWXUD$GLFLRQDO SDUD (QIHUPHGDGHV &DWDVWUy¿FDV
±&$(&±DFRQWDUGHOGHMXOLRGHRGHVGHHOSULPHUGtDGHOPHVVXEVLJXLHQWHDODIHFKDGHVXVFULSFLyQ
GHOFRQWUDWRGHVDOXGHQVXFDVR
([FHSFLRQDOPHQWH HO EHQH¿FLDULR TXH DO GH -XQLR GH VH HQFXHQWUH DFXPXODQGR HO GHGXFLEOH R
JR]DQGR GHO EHQH¿FLR FRQWHPSODGR HQ OD FREHUWXUD FRQWHQLGD HQ OD &LUFXODU 1 FLWDGD OD PDQWHQGUi
KDVWD HO FXPSOLPLHQWR GH VX SHUtRGR ELHQDO \ HQ DGHODQWH UHJLUi OD FREHUWXUD HVWDEOHFLGD HQ HVWH
GRFXPHQWR
$57Ë&8/2,,&REHUWXUDHVSHFLDOFDWDVWUy¿FDSDUDODVJDUDQWtDVH[SOtFLWDVHQVDOXG*(6&$(&
/DV*DUDQWtDV([SOtFLWDVHQ6DOXG±*(6±FRQWHPSODQXQOLVWDGRHVSHFt¿FRGHSUHVWDFLRQHVWD[DWLYRSDUDFDGD
SUREOHPDGHVDOXGFRQGLFLRQHV\GLDJQyVWLFRVFRPSUHQGLGRVHQHO5pJLPHQGH*DUDQWtDV([SOtFLWDVHQ6DOXG
TXHHVWDUiDGLVSRVLFLyQGHOD¿OLDGRFXDQGRpVWHORVUHTXLHUD/DJDUDQWtDGHFREHUWXUD¿QDQFLHUDH[SUHVDPHQWH
VHxDODGDHQ')/1GH\VXVUHJODPHQWRVFRUUHVSRQGLHQWHVULJHVyORSDUDHOOLVWDGRDQWHVUHIHULGR
/D FREHUWXUD HVSHFLDO *(6&$(& VH DSOLFD VyOR SDUD ODV SUHVWDFLRQHV QR FRQWHQLGDV HQ HO OLVWDGR DQWHV
UHIHULGR SHUR FRQVLGHUDGRV HQ ORV SURWRFRORV SDUD OD VROXFLyQ GH ORV SUREOHPDV GH VDOXG GH¿QLGRV SRU HO
0LQLVWHULRGH6DOXG
7UDWiQGRVH GH 3UREOHPDV GH 6DOXG FRQWHPSODGRV HQ GLFKD *(6 HO EHQH¿FLDULR SRGUi RSWDU SRU DWHQGHUVH
EDMR ODV FRQGLFLRQHV GH OD *(6 R GH VX 3ODQ GH 6DOXG &RPSOHPHQWDULR VHJ~Q VH LQGLFD D FRQWLQXDFLyQ
1) Si opta por la atención en GES

D&REHUWXUD6LRSWDSRUODDWHQFLyQVHJ~QODV*DUDQWtDV([SOtFLWDVHQ6DOXG±*(6±SRGUiDFFHGHUDGHPiV
D HVWD FREHUWXUD HVSHFLDO SDUD DTXHOODV SUHVWDFLRQHV QR FXELHUWDV SRU *(6 LQFOXLGDV HQ OD VROXFLyQ GHO
SUREOHPDGHVDOXGVHJ~QSURWRFRORVPpGLFRVGH¿QLGRV\SXEOLFDGRVSRUHO0LQLVWHULRGH6DOXG\TXHFXHQWDQ
FRQODFREHUWXUDGHO3ODQGH6DOXG&RPSOHPHQWDULR(VWRVSURWRFRORVVHUiQSXHVWRVDGLVSRVLFLyQGHOD¿OLDGR
FXDQGRpVWHORUHTXLHUD/D,VDSUHLQWHJUDUiHQVXVFRQYHQLRVFRQORVSUHVWDGRUHVGHOD5HGGLFKRVSURWRFRORV
(Q WRGR FDVR UHVSHFWR GH ODV SUHVWDFLRQHV QR DMXVWDGDV D SURWRFROR OD ,VDSUH RWRUJDUi VyOR OD FREHUWXUD
SUHYLVWDSDUDHOODVHQHO3ODQGH6DOXG&RPSOHPHQWDULRSDFWDGR
(VWD FREHUWXUD HVSHFLDO GH HQIHUPHGDGHV FDWDVWUy¿FDV GHQRPLQDGD *(6&$(& ULJH FRQ ODV PLVPDV
FRQGLFLRQHV GH¿QLGDV SDUD &$(& HQ OR TXH FRUUHVSRQGD \ TXH VH HVWDEOHFHQ HQ HO $UWtFXOR , GH HVWH
GRFXPHQWRVDOYRORVLJXLHQWH
, 7RGDUHIHUHQFLDDHQIHUPHGDGFDWDVWUy¿FDGHEHHQWHQGHUVHUHIHULGDDORVGLDJQyVWLFRVFRPSUHQGLGRV
HQ*(6
,, 7RGDUHIHUHQFLDD5HG&$(&GHEHHQWHQGHUVHUHIHULGDD5HG*(6&$(&
,,, /DVFRQGLFLRQHVGHDFFHVRDHVWHEHQH¿FLRVHHVWDEOHFHQDFRQWLQXDFLyQHQODOHWUDE
,9 6HDERQDUiSDUDODDFXPXODFLyQGHOGHGXFLEOHGHOD&REHUWXUD(VSHFLDOSDUDODV*DUDQWtDV([SOtFLWDV
HQ6DOXG*(6&$(&ORDFXPXODGRFRPRFRSDJRHQODVDWHQFLRQHV*(6SRUXQPLVPRGLDJQyVWLFR\
EHQH¿FLDULR
9 /DDWHQFLyQGHEHKDEHUVHLQLFLDGRHQODFREHUWXUD*(6
24
E &RQGLFLRQHV GH DFFHVR DO EHQH¿FLR *(6&$(& (O EHQH¿FLDULR SRGUi DFFHGHU D OD FREHUWXUD HVSHFLDO
FDWDVWUy¿FD*(6&$(&SDUDDTXHOODVFRQGLFLRQHVGHVDOXG\HQIHUPHGDGHV*(6GHDFXHUGRDORVLJXLHQWH
, (VWDUXWLOL]DQGRODPRGDOLGDGGHDWHQFLyQ*(6HQOD,VDSUH
,, /DVSUHVWDFLRQHV*(6&$(&VHHQWUHJDUiQDWUDYpVGHXQDUHG*(6FRQIRUPHDORVHxDODGRHQ')/
1GH5HGTXHSXHGHVHUGLVWLQWDDODGHOD&$(&
,,, /DVSUHVWDFLRQHVFXELHUWDVSRUHVWHEHQH¿FLRVRQDTXHOODVTXHDSDUHFHQHQORVSURWRFRORVUHIHUHQFLDOHV
GHO0LQLVWHULRGH6DOXG\IRUPDQSDUWHGHORVDUDQFHOHVGHOD,VDSUH
,9 +DEHU FXPSOLGR FRQ HO SURFHGLPLHQWR GH LQJUHVR D OD 5HG *(6 GH DFXHUGR D ORV SURFHGLPLHQWRV \
FRQGLFLRQHVHVWLSXODGRVSRUOD,VDSUH
2) Si no opta por la atención en GES
6yORWHQGUiODFREHUWXUDGHVX3ODQGH6DOXG&RPSOHPHQWDULRTXHGDQGRH[FOXLGRGHODFREHUWXUDDGLFLRQDO
\HVSHFLDOGH¿QLGDVHQORV$UWtFXORV,\,,GHHVWHGRFXPHQWR
3) Vigencia inicial de la cobertura adicional GES-CAEC
(OD¿OLDGR\VXVEHQH¿FLDULRVWHQGUiQGHUHFKRDHVWD&REHUWXUD(VSHFLDO&DWDVWUy¿FDSDUDODV*DUDQWtDV([SOtFLWDV
HQ6DOXG*(6&$(&DFRQWDUGHOGHMXOLRGHRGHVGHHOSULPHUGtDGHOPHVVXEVLJXLHQWHDODIHFKDGH
VXVFULSFLyQGHOFRQWUDWRGHVDOXGRGHODLQFRUSRUDFLyQGHOEHQH¿FLDULRHQVXFDVR
$57Ë&8/2,,,'HODSHUPDQHQFLDGHODVFREHUWXUDVDGLFLRQDOHV
$~QFXDQGRFXDOTXLHUDGHORVGRFXPHQWRVLQWHJUDQWHVGHOFRQWUDWRGHVDOXGVHPRGL¿TXHDIXWXURSRUPXWXR
DFXHUGRGHODVSDUWHVRPHGLDQWHODIDFXOWDGGHUHYLVLyQGHORVPLVPRVTXHUHJXODHO$UWtFXORGHO')/
1 GH GH 6DOXG OD ,VDSUH VH FRPSURPHWH D PDQWHQHU ODV FREHUWXUDV DGLFLRQDOHV LQGLFDGDV HQ ORV
$UWtFXORV,\,,HQORVWpUPLQRVGH¿QLGRVVDOYRTXHPHGLHFDPELRHQODVQRUPDWLYDVUHIHULGDVDORVEHQH¿FLRV
PtQLPRVOHJDOHVFDPELRVGHFRWL]DFLyQOHJDOGHVDOXGRFDPELRVHQHOUpJLPHQGHJDUDQWtDVHQVDOXG\ODV
*DUDQWtDV([SOtFLWDVHQ6DOXG
$57Ë&8/2,9)LVFDOL]DFLyQ\DUELWUDMH
/D &REHUWXUD DGLFLRQDO SDUD (QIHUPHGDGHV GH &DWDVWUy¿FD &$(& \ OD &REHUWXUD (VSHFLDO &DWDVWUy¿FD SDUD
ODV *DUDQWtDV ([SOtFLWDV HQ 6DOXG *(6&$(& TXHGDQ VRPHWLGDV D ODV PLVPDV QRUPDV GH ¿VFDOL]DFLyQ \
DUELWUDMHTXHVHHVWDEOHFHQHQ')/1(1GH6DOXG
-8/ 13
MAY
25
LISTADO DE ANEXOS
1 3(7,&,Ï1'(/%(1(),&,2<'(5,9$&,Ï1$/$5('
1 5(48,6,726 3$5$ $&&('(5 $/ ),1$1&,$0,(172 '(/ '('8&,%/( 325 /$ ,6$35(
1 0$1'$72
1 3$*$5e
1 &219(1,2'(3$*2
1 $8725,=$&,Ï1'('(6&8(172
1 0$1'$72$8725,=$&,Ï1'(&$5*2
$1(;21
PETICIÓN DEL BENEFICIO Y DERIVACIÓN A LA RED
(OD¿OLDGRRTXLHQORUHSUHVHQWHGHEHUiFRQFXUULUDOD,VDSUH
'HEHUiOOHQDU\¿UPDUHOIRUPXODULR1LQFOXLGRHQHVWHDQH[RHOFXDOVHUiHODERUDGRSRUFDGD,VDSUH
\ FRQWHQGUi FRPR PtQLPR ORV DQWHFHGHQWHV GHO IRUPXODULR 1 SURSXHVWR GHQRPLQDGR 62/,&,78' '(
INCORPORACIÓN A LA RED CERRADA DE COBERTURA ADICIONAL PARA ENFERMEDADES
&$7$675Ï),&$6&$(&<*(6&$(&
'HVGH HO PRPHQWR TXH OD ,VDSUH UHFLEH OD VROLFLWXG WHQGUi GRV \ WUHV GtDV KiELOHV VHJ~Q VH WUDWH
GH SDFLHQWHV TXH VH HQFXHQWUHQ KRVSLWDOL]DGRV R DTXHOORV TXH UHTXLHUDQ DWHQFLRQHV SURJUDPDGDV
UHVSHFWLYDPHQWH SDUD GH¿QLU VL UHFKD]D R DFHSWD OD VROLFLWXG \ HQ HVWH ~OWLPR FDVR GHVLJQDU HO SUHVWDGRU
GHOD5HG
/D ,VDSUH SRQGUi D GLVSRVLFLyQ GHO D¿OLDGR R VX UHSUHVHQWDQWH OD GHULYDFLyQ UHVSHFWLYD )RUPXODULR 1
HQHOOXJDUGRQGHIXHVROLFLWDGRHOEHQH¿FLRHQORVSOD]RVHVWDEOHFLGRVHQHOSXQWR
(O D¿OLDGR R VX UHSUHVHQWDQWH GHEHUi IRUPDOL]DU OD DFHSWDFLyQ GH OD GHULYDFLyQ HVWDPSDQGR VX ¿UPD HQ HO
)RUPXODULR (Q FRQVHFXHQFLD DQWH OD DXVHQFLD GH GLFKD ¿UPD VH FRQVLGHUDUi UHFKD]DGD OD GHULYDFLyQ
VLWXDFLyQ TXH VHUi LQIRUPDGD SRU FDUWD FHUWL¿FDGD DO D¿OLDGR SDVDGRV GtDV KiELOHV FRQWDGRV GHVGH ORV
SOD]RVHVWDEOHFLGRVHQHOSXQWR

)RUPXODULR1
SOLICITUD DE INCORPORACIÓN A LA RED CERRADA DE LA COBERTURA

$',&,21$/3$5$(1)(50('$'(6&$7$675Ï),&$6&$(&R*(6&$(&
16ROLFLWXG BBBBBBBBBBBBBBBBBBB
/XJDUGH(PLVLyQ BBBBBBBBBBBBBBBBBBB
$17(&('(17(67,78/$52%(1(),&,$5,2 )HFKD6ROLFLWXG BBBBBBBBBBBBBBBBBB
1RPEUHGHO3DFLHQWHBBBBBBBBBBBBBBBBBBBBBBBBBBBB(GDGBBBBBB 587SDFLHQWH BBBBBBBBBB

1RPEUHGHO7LWXODU BBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBB5XWWLWXODUBBBBBBBBBBBBBBBB
'RPLFLOLRBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBB&LXGDGBBBBBBBBBBBBBBBB
7HOpIRQR&DVDBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBB 7HOpIRQR2IBBBBBBBBBBBBBBBB
(PDLO BBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBB&HOBBBBBBBBBBBBBBBB
3ODQGH6DOXGBBBBBBBB$FUHGBBBBBBBBBB5HGBBBBBBBBBBBBB)HFKD'LDJQyVWLFRBBBBBBBBBBBBBBBB
'LDJQyVWLFR*(6BBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBB
'LDJQyVWLFR&$(& BBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBB
/XJDUSULPHUDDWHQFLyQBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBB
7UDWDPLHQWRDVHJXLU BBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBB
0pGLFR7UDWDQWH BBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBB (VSHFLDOLGDGBBBBBBBBB
,QVWLWXFLyQ BBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBB
+RVSLWDOL]DGR6ËBBBBBB 'HVGHBBBBBBBBBBBBB +DVWDBBBBBBBBBB
12BBBBBB
,QVWLWXFLyQBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBB
)XH7UDVODGDGR 6ËBBBBBB 'HVGH\+DVWDBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBB
12BBBBBB
0RQWR'HGXFLEOH BBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBB
,GHQWL¿FDFLyQGHO5HSUHVHQWDQWHR)DPLOLDU5HVSRQVDEOH
1RPEUHBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBB
587BBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBB 5HODFLyQBBBBBBBBBBBBBBBBB
7HOpIRQRFDVDBBBBBBBBBBBBBBBBBBBBBBBBBBBB7HOpIRQR 2I BBBBBBBBBBBBBBBBBBB &HOBBBBBBBB
IMPORTANTE
&ROPHQD *ROGHQ &URVV 6$ LQIRUPD D XVWHG TXH HO EHQH¿FLR VROLFLWDGR FRPHQ]DUi D UHJLU VyOR
FXDQGR LQJUHVH D OD 5(' \ ¿UPH OD DFHSWDFLyQ GH OD 'HULYDFLyQ D OD 5HG &HUUDGD GH $WHQFLRQHV
&$(& R *(6&$(& GRFXPHQWR TXH HVWDUi D VX GLVSRVLFLyQ R GH VX IDPLOLDU UHVSRQVDEOH D PiV
WDUGDU HO GtD VXEVLJXLHQWH KiELO D OD IHFKD GH HVWD VROLFLWXG HQ FXDOTXLHUD GH QXHVWUDV VXFXUVDOHV
(OWLWXODURVXUHSUHVDQWDQWHGHEHUiIRUPDOL]DUODDFHSWDFLyQGHODGHULYDFLyQPHGLDQWHOD¿UPDHVWDPSDGD
HQHO)RUPXODULR1(QFRQVHFXHQFLDDQWHODDXVHQFLDGHGLFKD¿UPDVHFRQVLGHUDUiUHFKD]DGD
ODGHULYDFLyQ
7RPpFRQRFLPLHQWRBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBB
)LUPD\5875HSUHVHQWDQWH 1RPEUH587\)LUPD
-8/ 13
Isapre Colmena Golden Cross

MAY
ADMINISTRACIÓN DE SALUD
)HFKDGH5HFHSFLyQBBBBBBBBBBBB
BBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBB

Firma
Enfermera +RUDGH5HFHSFLyQBBBBBBBBBBBB
Isapre Colmena Golden Cross
BBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBB
/D SHUVRQD TXH ¿UPD UHFRQRFH KDEHU VLGR LQIRUPDGD GHELGDPHQWH GH ODV &RQGLFLRQHV GH OD &REHUWXUD
$GLFLRQDOSDUD(QIHUPHGDGHV&DWDVWUy¿FDVHQ&KLOH

)RUPXODULR1
'(5,9$&,Ï1$ /$ 5(' &(55$'$ '($7(1&,21(6 3$5$ (1)(50('$'(6 &$7$675Ï),&$6 &$(&
,VDSUH&ROPHQD*ROGHQ&URVV6$FRPXQLFDTXHHOSDFLHQWHGHEHSUHVHQWDUVHFRQHVWHGRFXPHQWRHQXQRGH
ORV FHQWURV GH OD 5(' TXH VH LQGLFDQ D FRQWLQXDFLyQ HVWDEOHFLPLHQWR TXH OH GHVLJQDUi XQ 0pGLFR WUDWDQWH
VLpVWHQRHVWiH[SUHVDPHQWHVHxDODGRHQHOSUHVHQWHGRFXPHQWR
/D SUHVHQWH GHULYDFLyQ WHQGUi XQD GXUDFLyQ GH VHLV PHVHV FRQWDGRV GHVGH OD IHFKD GH DFHSWDFLyQ GH HVWH
GRFXPHQWRSRVWHULRUDORFXDOOD,VDSUHHIHFWXDUiXQDHYDOXDFLyQFX\RUHVXOWDGRVHFRPXQLFDUiDOSDFLHQWH
HQFDVRGHPRGL¿FDUOD3RVWHULRUPHQWHOD,VDSUHSRGUiPRGL¿FDUODVFRQGLFLRQHVGHGHULYDFLyQVLWXDFLyQTXH
GHEHUiVHUFRPXQLFDGDSRUFRUUHRFHUWL¿FDGR
(VWDEOHFLPLHQWR
'LUHFFLyQ
+DELWDFLyQ
0pGLFR
(VSHFLDOLGDG
587GHO0pGLFR
2EVHUYDFLRQHV
1RPEUHGHO3DFLHQWH 5XW
1RPEUHGHO7LWXODU 5XW
'LDJQyVWLFR&,(
7UDWDPLHQWRLQGLFDGR
)HFKD6ROLFLWXG&$(& 0RQWR'HGXFLEOH
)HFKDGHULYDFLyQ )HFKD,QLFLR%HQH¿FLR
PRESTACIONES NO INCLUIDAS EN LA COBERTURA ADICIONAL PARA ENFERMEDADES

&$7$675Ï),&$6&$(&1,(1*(6&$(&
/DVSUHVWDFLRQHVGHULYDGDVGHSUREOHPDVGHVDOXGTXHUH~QDQODVFRQGLFLRQHVH[LJLGDVSDUDVHUFXELHUWDV
SRUHO5pJLPHQ*HQHUDOGH*DUDQWtDVHQ6DOXG*(6
/DVH[FOXVLRQHVHVWDEOHFLGDVHQHO&RQWUDWRGH6DOXG
/DVSDWRORJtDVGHULYDGDVGHFRPSOLFDFLRQHV\VHFXHODVGHORVWUDWDPLHQWRVFRVPpWLFRVRFRQ¿QHVGH
HPEHOOHFLPLHQWR
7UDWDPLHQWRVKRVSLWDODULRVGHSDWRORJtDVSVLTXLiWULFDVDGLFFLRQHVDGURJDVRDOFRKROLVPR
7UDWDPLHQWRVGHLQIHUWLOLGDGRHVWHULOLGDG
7UDWDPLHQWRTXLU~UJLFRGHOD2EHVLGDG0yUELGDVXVFRPSOLFDFLRQHV\VHFXHODVVDOYRORLQGLFDGRHQHO
QXPHUDOVDOYRORLQGLFDGRHQHOQXPHUDOGHO$UWtFXOR
&XDOTXLHU WUDWDPLHQWR SRVWHULRU D XQ WUDWDPLHQWR GH REHVLGDG WDQWR TXLU~UJLFR FRPR QR TXLU~UJLFR
TXHWHQJDHOFDUiFWHUGHFRVPpWLFRWDOHVFRPRDEGRPLQRSODVWtDXRWUDFRUUHFFLyQGHULYDGDGHODEDMD
GHSHVR
7UDWDPLHQWRVRGRQWROyJLFRV
3UHVWDFLRQHV PpGLFDVIiUPDFRV\WpFQLFDVTXHWHQJDQHOFDUiFWHUGHH[SHULPHQWDO SDUDODSDWRORJtD

HQ WUDWDPLHQWR R TXH QR HVWpQ DYDODGDV SRU ODV VRFLHGDGHV FLHQWt¿FDV FKLOHQDV FRUUHVSRQGLHQWHV

/RVPHGLFDPHQWRVHLQVXPRVTXHQRHVWpQUHJLVWUDGRVSRUHO,QVWLWXWRGH6DOXG3~EOLFR,63GHDFXHUGR
DODQRUPDWLYDYLJHQWHGHOSDtV
/DDWHQFLyQGRPLFLOLDULDHQWRGDVVXVIRUPDV
/DKRVSLWDOL]DFLyQGRPLFLOLDULDVDOYRORLQGLFDGRHQHOQXPHUDOGHODUWtFXOR
7RGDVDTXHOODVSUHVWDFLRQHVTXHQRHVWpQGHWDOODGDVHQHODUDQFHOGHOSODQFRPSOHPHQWDULR
&LUXJtDVSURJUDPDGDVUHDOL]DGDVIXHUDGHOD5HG\VXVFRPSOLFDFLRQHVPLHQWUDVQRVHLQFRUSRUHDOD
Red CAEC
3UHVWDFLRQHVRWRUJDGDVHQHVWDEOHFLPLHQWRVRLQVWLWXFLRQHVXELFDGDVIXHUDGHOWHUULWRULRQDFLRQDO\WRGDV
DTXHOODVSUHVWDFLRQHVTXHVHUHDOLFHQIXHUDGHOD5HG
/DVSUHVWDFLRQHV\PHGLFDPHQWRVGHFDUiFWHUDPEXODWRULRQRFRGL¿FDGDVHQHODUDQFHOGHOFRQWUDWRGH
VDOXGVDOYRORVHxDODGRHQHOSiUUDIRWHUFHURGHO$UWtFXOR,GHHVWHGRFXPHQWR
/DVSUHVWDFLRQHVKRPRORJDGDVHQWHQGLHQGRSRUKRPRORJDFLyQHOUHHPSOD]RGHSUHVWDFLRQHVSRURWUDV
QRFRGL¿FDGDVHQHODUDQFHOGHOFRQWUDWRGHVDOXG
(VWH EHQH¿FLR DGLFLRQDO SDUD HQIHUPHGDGHV &DWDVWUy¿FDV QR VH DSOLFD GXUDQWH ORV SOD]RV VHxDODGRV HQ HO
$UWtFXOR OHWUD J SDUD HO FDVR GH HQIHUPHGDGHV SUHH[LVWHQWHV GHFODUDGDV \ HQ HO DUWtFXOR GH ODV
SDWRORJtDVSUHH[LVWHQWHVQRGHFODUDGDVDPERVGHO')/1GHGH6DOXG
(VWHGRFXPHQWRGHGHULYDFLyQDFUHGLWDTXHHOSDFLHQWHLQGLYLGXDOL]DGRHVD¿OLDGRD,VDSUH&ROPHQD*ROGHQ&URVV
6$ \ VH HQFXHQWUD LQFRUSRUDGR D OD 5HG GH (QIHUPHGDGHV &DWDVWUy¿FDV SRU OR TXH HV GH VX
UHVSRQVDELOLGDGHOSDJRGHOPRQWRGHVXGHGXFLEOH
DERIVACIÓN A LA RED ACEPTO INGRESO A LA RED
Firma de Familiar Responsable

)LUPD5HVSRQVDEOH&ROPHQD*ROGHQ&URVV6$
1RPEUH 1RPEUH
)HFKD 5XW
+RUD )HFKD
5(&+$=2,1*5(62$/$5('
Firma de Familiar Responsable
1RPEUH
5XW
-8/ 13
MAY
)HFKD
0RWLYR
&RQVWDQFLD
&RQIHFKDBBBBBBBBBBBB+RUDBBBBBBBBBBBBB,QIRUPpDBBBBBBBBBBBBBBBBBBBBBBBBBBBBB587BBBBBBBBBBBBBBBB
ODGHULYDFLyQHIHFWXDGDSDUDODVDWHQFLRQHVSRUOD&REHUWXUD$GLFLRQDOSDUD(QIHUPHGDGHV&DWDVWUy¿FDVGHOSDFLHQWH
LQGLYLGXDOL]DGRQHJiQGRVHD¿UPDUWDQWRODDFHSWDFLyQFRPRHOUHFKD]RGHOLQJUHVRDHVHEHQH¿FLR

$QH[R1
MANDATO
(Q BBBBBBBBBBBBBBBBBB D BBB GH BBBBBBBBBBBBBBBBBB GHO BBBBBBB 'RQ D

BBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBB HQ DGHODQWH HO ³0DQGDQWH´ &pGXOD 1DFLRQDO GH ,GHQWLGDG
1 BBBBBBBBBBBBBBBB GRPLFLOLDGR HQ HVWD FLXGDG HQ FDOOH BBBBBBBBBBBBBBB 1 BBBBBBB H[SRQH
4XHFRQHOREMHWRGHGRFXPHQWDUHQWtWXORHMHFXWLYR\IDFLOLWDUHOFREURGHODWRWDOLGDGRHOVDOGRGHOGHGXFLEOH
TXH HO 0DQGDQWH DGHXGH D BBBBBBBBBBBBBBBBBBBBB HQ DGHODQWH LQGLVWLQWDPHQWH OD ³,VDSUH´ HQ FDVR GH
RFXUUHQFLDGHDOJXQRVGHORVHYHQWRVVHxDODGRVHQHOSiUUDIRTXLQWRGHODUWtFXORGHODV&RQGLFLRQHVGHOD
&REHUWXUD$GLFLRQDOSDUD(QIHUPHGDGHV&DWDVWUy¿FDVHQDGHODQWHOD³&REHUWXUD´TXHHO0DQGDQWHFRQWUDWy
FRQ OD ,VDSUH HO 0DQGDQWH VXVFULEH VLQ iQLPR GH QRYDU XQ SDJDUp D OD RUGHQ GH OD ,VDSUH FRQ DOJXQDV
PHQFLRQHV HQ EODQFR RWRUJDQGR SRU HVWH DFWR HO 0DQGDQWH D OD ,VDSUH \ D VXV VXFHVRUHV R HQGRVDWDULRV
XQ PDQGDWR HVSHFLDO SDUD TXH HQ VX QRPEUH \ UHSUHVHQWDFLyQ SURFHGD D LQFRUSRUDU DO SDJDUp
PHQFLRQDGR DQWHV GH VX FREUR OD IHFKD GH H[SHGLFLyQ HO PRQWR GH FDSLWDO DGHXGDGR \ OD IHFKD
GHYHQFLPLHQWR
/D ,VDSUH GH FRQIRUPLGDG D OR GLVSXHVWR HQ HO$UWtFXOR GH OD /H\ 1 VREUH /HWUD GH &DPELR \
3DJDUp GHEHUi LQFRUSRUDU ODV PHQFLRQHV IDOWDQWHV DO FLWDGR SDJDUp FRQ DUUHJOR D ODV VLJXLHQWHV
LQVWUXFFLRQHV
/D ,VDSUH SRGUi OOHQDU HO SDJDUp HQ FXDOTXLHUD GH ORV VLJXLHQWHV FDVRV L VL HO 0DQGDQWH VH QHJDUH
DVXVFULELUXQFRQYHQLRGHSDJRXQDYH]TXHOD,VDSUHOHKXELHUH¿QDQFLDGRHOSDJRGHOGHGXFLEOHGHDFXHUGR
DORVWpUPLQRVGHOQXPHUDQGRGHO$UWtFXOR,GHOD&REHUWXUDLLVLKDELpQGRVHVXVFULWRGLFKRFRQYHQLRGH
SDJR OD ,VDSUH SRU FDXVD LPSXWDEOH DO FRWL]DQWH QR KXELHUH SHUFLELGR SDJR GXUDQWH PHVHV FRQVHFXWLYRV
R PHVHV HQ IRUPD DOWHUQDGD R LLL VL KDELpQGRVH HIHFWXDGR ORV GHVFXHQWRV DFRUGDGRV HQ HO FRQYHQLR GH
SDJRD~QSHUVLVWLHUHXQVDOGRLQVROXWRGHOGHGXFLEOH
/DIHFKDGHH[SHGLFLyQGHOSDJDUpFRUUHVSRQGHUiDOGtDHQTXHVHFRPSOHWHHOPLVPRVHJ~QORVHxDODGR
HQHO1
/D,VDSUHSURFHGHUiDHQWHUDUHOFRUUHVSRQGLHQWHLPSXHVWRGHWLPEUHV\HVWDPSLOODVTXHJUDYDHOSDJDUp
GHQWURGHORVSOD]RVHVWDEOHFLGRVHQHO'/GH(OFRVWRGHOLPSXHVWRTXHGHEDSDJDUVHFRQRFDVLyQ
GHOOOHQDGRGHOSDJDUpVHUiGHFDUJRH[FOXVLYRGHO0DQGDQWH
/DIHFKDGHOYHQFLPLHQWRGHOSDJDUpVHUiHOGtDKiELOVLJXLHQWHDOGHVXH[SHGLFLyQ
(OFDSLWDODGHXGDGRVHUiHOVDOGRGHOGHGXFLEOHPHQFLRQDGRTXHVHDGHXGHDODIHFKDGHH[SHGLFLyQFRQ
VX FRUUHVSRQGLHQWH UHDMXVWH PiV ORV LQWHUHVHV FRUULHQWHV JDVWRV GH FREUDQ]D \ HO PRQWR GHO LPSXHVWR
GH WLPEUHV \ HVWDPSLOODV TXH FRUUHVSRQGD VHJ~Q OLTXLGDFLyQ TXH DO HIHFWR SUDFWLTXH OD ,VDSUH
/D ,VDSUH TXHGD H[SUHVDPHQWH IDFXOWDGD SDUD DXWRUL]DU DQWH 1RWDULR 3~EOLFR OD ¿UPD GHO VXVFULSWRU XQD
YH]FRPSOHWDGRVORVEODQFRVGHO3DJDUp
(O0DQGDQWHUHOHYDH[SUHVDPHQWHDOD,VDSUHGHODREOLJDFLyQGHUHQGLUFXHQWD
7RGRV ORV JDVWRV GHUHFKRV QRWDULDOHV LPSXHVWRV \ GHVHPEROVRV TXH WHQJDQ VX RULJHQ HQ ODV
SUHVHQWHV LQVWUXFFLRQHV \ HQ HO PHQFLRQDGR SDJDUp VHUiQ GH FDUJR H[FOXVLYR GHO 0DQGDQWH
/D ,VDSUH QR UHFLELUi UHPXQHUDFLyQ DOJXQD SRU OD HMHFXFLyQ GH ODV JHVWLRQHV HQFRPHQGDGDV HQ HO
SUHVHQWHPDQGDWR
(OSUHVHQWHPDQGDWRWHUPLQDUiDOPLVPRWLHPSRTXHWHUPLQHHO&RQWUDWRGH6DOXG3UHYLVLRQDOH[LVWHQWH
HQWUH HO 0DQGDQWH \ OD ,VDSUH D PHQRV TXH D WDO IHFKD HO 0DQGDQWH DGHXGH D OD ,VDSUH WRGR R SDUWH GHO
GHGXFLEOH \D PHQFLRQDGR HQ FX\R FDVR HO SUHVHQWH PDQGDWR VH H[WLQJXLUi VyOR XQD YH] TXH HO 0DQGDQWH
SDJXHHQIRUPDtQWHJUDDOD,VDSUHHOVDOGRGHOGHGXFLEOHDGHXGDGR
/DV SUHVHQWHV LQVWUXFFLRQHV GH OOHQDGR VH RWRUJDQ FRQ FDUiFWHU GH LUUHYRFDEOHV HQ ORV WpUPLQRV GHO
$UWtFXORGHO&yGLJRGH&RPHUFLR
Firma del Mandante

30
$QH[R1
PAGARÉ
(A la Vista – Pesos Reajustabilidad Unidad de Fomento)

&DSLWDO$GHXGDGR8)BBBBBBBBBBBB
9HQFLPLHQWR$ODYLVWD
'HER \ SURPHWR SDJDU LQFRQGLFLRQDOPHQWH D OD YLVWD \ D OD RUGHQ GH BBBBBBBBBBBBBBBBBBBB OD ,VDSUH
OD VXPD HTXLYDOHQWH HQ SHVRV PRQHGD FRUULHQWH QDFLRQDO GH FXUVR OHJDO GH BBBBBBBBB 8) BBBBBBBBB
Unidades de Fomento).
(O FDSLWDO DGHXGDGR VH GHWHUPLQDUi \ SDJDUi HQ SHVRV PRQHGD FRUULHQWH QDFLRQDO GH FXUVR OHJDO VHJ~Q HO
YDORUTXHOD8QLGDGGH)RPHQWRWHQJDDOGtDGHOUHVSHFWLYRSDJRHIHFWLYRVDOYRVLHOSDJRVHKLFLHUHGHVSXpV
GHODIHFKDHVWLSXODGD\HQpVWDHOYDORUGHOD8QLGDGGH)RPHQWRKXELHVHVLGRVXSHULRUSXHVHQWDOHYHQWR
VHXWLOL]DUiHVWH~OWLPRYDORU
6HHQWLHQGHSRU8QLGDGGH)RPHQWRDTXHOVLVWHPDGHUHDMXVWHDXWRUL]DGRSRUHO%DQFR&HQWUDOGH&KLOHGH
DFXHUGRDORHVWDEOHFLGRHQHO1GHODUWtFXORGHOD/H\RODTXHHQHOIXWXURODUHHPSODFH\VHD
GHWHUPLQDGDVREUHODVPLVPDVEDVHV
(OSDJRGHWRGDFDQWLGDGDGHXGDGDHQYLUWXGGHHVWHSDJDUpVHHIHFWXDUiDQWHVGHODVKRUDV30GHO
GtDGHOSDJRFRUUHVSRQGLHQWHHQODVR¿FLQDVGHOD,VDSUHXELFDGDVHQBBBBBBBBBBBBBBBBBB1BBBBBBBBB
FRPXQDGHBBBBBBBBBBBBBBBBFLXGDGGHBBBBBBBBBBBBBBBBB
(QFDVRGHPRUDRVLPSOHUHWDUGRHQHOSDJRGHHVWHSDJDUpVHGHYHQJDUiGHVGHODIHFKDGHODPRUDRGHO
VLPSOH UHWDUGR \ KDVWD OD IHFKD GHO SDJR tQWHJUR \ HIHFWLYR XQ LQWHUpV SHQDO LJXDO DO Pi[LPR FRQYHQFLRQDO
TXHODOH\SHUPLWDHVWLSXODUDODIHFKDGHODPRUDRGHOVLPSOHUHWDUGRSDUDRSHUDFLRQHVGHFUpGLWRGHGLQHUR
HQ PRQHGD QDFLRQDO UHDMXVWDEOHV LQWHUpV TXH VH FDOFXODUi \ SDJDUi VREUH HO VDOGR DGHXGDGR GHELGDPHQWH
UHDMXVWDGR/RVLQWHUHVHVTXHQRIXHUHQSDJDGRVVHFDSLWDOL]DUiQFDGDGtDV\VLQQHFHVLGDGGHGHPDQGD
MXGLFLDOGHYHQJDUiQQXHYRVLQWHUHVHVORVTXHVHFDOFXODUiQ\SDJDUiQDXQDWDVDLJXDODODGHOLQWHUpVSHQDO
DQWHVUHIHULGR/DREOLJDFLyQGHSDJDUHVWHGRFXPHQWRHVLQGLYLVLEOH6,13527(6723DUDWRGRVORVHIHFWRV
GH HVWH SDJDUp HO VXVFULSWRU ¿MD VX GRPLFLOLR HQ OD FLXGDG \ FRPXQD GH BBBBBBBBBBBBBBBBBB \ VH VRPHWH
D OD FRPSHWHQFLD GH VXV 7ULEXQDOHV GH -XVWLFLD (O ,PSXHVWR GH 7LPEUHV \ (VWDPSLOODV TXH JUDYD D HVWH
GRFXPHQWRVHHQWHUDHQGLQHURHQ7HVRUHUtDVHJ~Q'/$UW1
(QBBBBBBBBBBBBBBBBDBBBBBBBBBGHBBBBBBBBBGHODxRBBBBBBBB
Suscriptor
1RPEUHR5D]yQ6RFLDOGHO6XVFULSWRUBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBB
5871BBBBBBBBBBBBBBBBBBBBBBB
'RPLFLOLRBBBBBBBBBBBBBBBBBBBBBBB
AUTORIZACIÓN NOTARIALXVRH[FOXVLYRQRWDULR

$XWRUL]ROD¿UPDSXHVWDHQHVWHGRFXPHQWRSRUGRQDBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBB
MAY 13
&,1BBBBBBBBBBBBBBBBBBBBFRPR6XVFULSWRU
(QBBBBBBBBBBBBBBBDBBBBBBBGHBBBBBBBBBBBBBGHODxRBBBBBBBBB
NOTARIO

$QH[R1
CONVENIO DE PAGO
(QBBBBBBBBBBBBBBBBBBBBBBB D BBBBBBBBBB GH BBBBBBBBBBBBBBBBBBBB GHO BBBBBBB HQWUH 'RQ D

BBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBB HQ DGHODQWH HO ³&RWL]DQWH´ &pGXOD 1DFLRQDO GH
,GHQWLGDG 1 BBBBBBBBBBBBBBBBBBBBBB SRU XQD SDUWH \ SRU OD RWUD BBBBBBBBBBBBBBBBBBBBBBBB HQ
DGHODQWH OD ³,VDSUH´ 5RO ÒQLFR 7ULEXWDULR 1BBBBBBBBBBBBB UHSUHVHQWDGD SRU GRQD
BBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBB &pGXOD 1DFLRQDO GH ,GHQWLGDG 1BBBBBBBBBBBBBBBB VH
KDFRQYHQLGRORVLJXLHQWH
35,0(52 &RQ IHFKD BBBBBBBBBBBBBBBBB HO &RWL]DQWH VXVFULELy FRQ OD ,VDSUH XQD &REHUWXUD $GLFLRQDO
SDUD (QIHUPHGDGHV &DWDVWUy¿FDV HQ DGHODQWH OD ³&REHUWXUD´ VHJ~Q ODV FRQGLFLRQHV HVWDEOHFLGDV SDUD OD
PLVPDHQHO&RQWUDWRGH6DOXG
6(*81'2 &RPR FRQVHFXHQFLD GHO XVR GH OD PHQFLRQDGD FREHUWXUD HO &RWL]DQWH DGHXGD DFWXDOPHQWH D
OD ,VDSUH OD FDQWLGDG GH BBBBBBBBBBBBBBBB 8QLGDGHV GH )RPHQWR FRUUHVSRQGLHQWHV DO GHGXFLEOH GH VX
FDUJR \ TXH IXH ¿QDQFLDGR SRU OD ,VDSUH GH FRQIRUPLGDG D OR HVWDEOHFLGR HQ HO QXPHUDQGR GHO DUWtFXOR ,
GHODV&RQGLFLRQHVGHOD&REHUWXUD$GLFLRQDOSDUD(QIHUPHGDGHV&DWDVWUy¿FDV
7(5&(523RUHOSUHVHQWHLQVWUXPHQWR\FRQHOREMHWRGHDVHJXUDUHOWRWDOUHHPEROVRDOD,VDSUHGHOPRQWR
LQGLFDGR HQ OD FOiXVXOD SUHFHGHQWH HO &RWL]DQWH VH FRPSURPHWH D SDJDU D OD ,VDSUH OD PHQFLRQDGD VXPD
PHGLDQWH
D(OSDJRHQHVWHPLVPRDFWRGHODVXPDGHBBBBBBBBBBBBBBB8QLGDGHVGH)RPHQWRHQVXHTXLYDOHQWH
HQ SHVRV DO GtD GH KR\ PHGLDQWH HO GHVFXHQWR GH GLFKD VXPD GHO VDOGR DFXPXODGR HQ OD &XHQWD &RUULHQWH
GH([FHGHQWHVTXHHO&RWL]DQWHPDQWLHQHHQOD,VDSUHHQORVWpUPLQRVGHODUWtFXORGHO')/1GH
GH6DOXG\
E (O VDOGR DVFHQGHQWH D BBBBBBBBBBBBBBBB 8QLGDGHV GH )RPHQWR PHGLDQWH OD DOWHUQDWLYD HOHJLGD SRU
HO&RWL]DQWH\TXHVHLQGLFDDFRQWLQXDFLyQ
'HVFXHQWR SRU SODQLOOD GH VX UHPXQHUDFLyQ R GH VX SHQVLyQ PHQVXDO HQ BBBB FXRWDV PHQVXDOHV GH
BBBBBBBBBBBBB8QLGDGHVGH)RPHQWRSDUDFX\RVHIHFWRVHO&RWL]DQWHVXVFULEHOD$XWRUL]DFLyQGHO'HVFXHQWR
FRUUHVSRQGLHQWHSRULQVWUXPHQWRSDUDOHORFRQHVWDPLVPDIHFKD
'HVFXHQWR HQ &XHQWD &RUULHQWH 1 BBBBBBBBBBBBBBB GHO %DQFR BBBBBBBBBBBBBBBBBB FX\R WLWXODU HV HO
&RWL]DQWH GH BBBB FXRWDV PHQVXDOHV GH BBBBBB 8QLGDGHV GH )RPHQWR SDUD FX\RV HIHFWRV HO &RWL]DQWH
VXVFULEH HO 0DQGDWR GH $XWRUL]DFLyQ GH &DUJR FRUUHVSRQGLHQWH SRU LQVWUXPHQWR SDUDOHOR FRQ HVWD PLVPD
IHFKDDXWRUL]DQGRDODYH]HQIRUPDLUUHYRFDEOHDOD,VDSUHSDUDLQIRUPDUDODLQVWLWXFLyQEDQFDULDVHxDODGD
HQODRSRUWXQLGDGFRUUHVSRQGLHQWHHOPRQWRGHODVFXRWDVDGHVFRQWDU
&DUJR HQ 7DUMHWD GH &UpGLWR BBBBBBBBBBBBB 1 BBBBBBBBBBBBBBB FX\R WLWXODU HV HO &RWL]DQWH GH BBBB
FXRWDV PHQVXDOHV GH BBBBBB 8QLGDGHV GH )RPHQWR SDUD FX\RV HIHFWRV HO &RWL]DQWH VXVFULEH HO 0DQGDWR
GH $XWRUL]DFLyQ GH &DUJR FRUUHVSRQGLHQWH SRU LQVWUXPHQWR SDUDOHOR FRQ HVWD PLVPD IHFKD DXWRUL]DQGR D
OD YH] HQ IRUPD LUUHYRFDEOH D OD ,VDSUH SDUD LQIRUPDU D OD DGPLQLVWUDGRUD GH WDUMHWD GH FUpGLWR
HQODRSRUWXQLGDGFRUUHVSRQGLHQWHHOPRQWRGHODVFXRWDVDGHVFRQWDU
&XDOTXLHUDRWUDTXHOD,VDSUHHVWLPHFRQYHQLHQWH
&8$572 (Q HO HYHQWR TXH OD ,VDSUH SRU FDXVD LPSXWDEOH DO FRWL]DQWH QR KXELHUH SHUFLELGR SDJR GXUDQWH
PHVHV FRQVHFXWLYRV R PHVHV HQ IRUPD DOWHUQDGD R ELHQ VL KDELpQGRVH HIHFWXDGR WRGRV ORV GHVFXHQWRV
DFRUGDGRV HQ HVWH FRQYHQLR D~Q SHUVLVWLHUH XQ VDOGR LQVROXWR GHO GHGXFLEOH OD ,VDSUH HVWDUi IDFXOWDGD SDUD
SHUVHJXLU HO FREUR GH GLFKR VDOGR PHGLDQWH OD HMHFXFLyQ GHO SDJDUp VXVFULWR SRU HO &RWL]DQWH \ TXH VH
PHQFLRQDHQHOQXPHUDQGRGHODUWtFXOR,GHODV&RQGLFLRQHVSDUDOD&REHUWXUD$GLFLRQDOSDUD(QIHUPHGDGHV
&DWDVWUy¿FDV
48,172 6L XQD YH] WHUPLQDGR HO &RQWUDWR GH 6DOXG 3UHYLVLRQDO VH HIHFWXDUD XQ SDJR FRQ FDUJR DO VDOGR
DGHXGDGR PHGLDQWH DOJXQD GH ODV DOWHUQDWLYDV LQGLFDGDV HQ OD FOiXVXOD WHUFHUD VH GHMD FRQVWDQFLD TXH HOOR
QR LPSOLFDUi HQ FDVR DOJXQR OD UHKDELOLWDFLyQ GH OD &REHUWXUD $GLFLRQDO SDUD (QIHUPHGDGHV &DWDVWUy¿FDV
Cotizante Isapre
32
$QH[R1
$8725,=$&,Ï1'('(6&8(172
(Q BBBBBBBBBBBBBBBBBB D BBBBBB GH BBBBBBBBBBBBBBBBB GHO BBBBBBB 'RQD

BBBBBBBBBBBBBBBBBBBBBBBBBB HQ DGHODQWH HO ³7UDEDMDGRU´ 3HQVLRQDGR &pGXOD 1DFLRQDO GH ,GHQWLGDG
1BBBBBBBBBBBBBBBBBBGHFODUD
4XHSRUHOSUHVHQWHLQVWUXPHQWRYHQJRHQDXWRUL]DUDPLHPSOHDGRUHQWLGDGSDJDGRUDGHODSHQVLyQSDUD

TXH GH PL OLTXLGDFLyQ GH UHPXQHUDFLRQHV GH OD SHQVLyQ GHO PHV GH BBBBBBBBBBBBBB GHO DxR BBBBBBBB
FRPRWDPELpQGHODGHORVBBBBBBBBBPHVHVVLJXLHQWHVVHGHVFXHQWHODFDQWLGDGGHBBBBBBBBBBB8QLGDGHV
GH)RPHQWR\SDJXHGLFKDFDQWLGDGDBBBBBBBBBBBBBBBBHQDGHODQWHOD³,VDSUH´SRUFRQFHSWRGHUHHPEROVR
GHOGHGXFLEOHGHOD&REHUWXUD$GLFLRQDOSDUD(QIHUPHGDGHV&DWDVWUy¿FDVTXHKHFRQWUDWDGRFRQGLFKD,VDSUH
(QFDVRGHTXHODFDQWLGDGPHQVXDODGHVFRQWDUDUULEDVHxDODGDVXPDGDDORVRWURVGHVFXHQWRVSUHYLDPHQWH
DXWRUL]DGRVSRUPt\TXHVHDQGLVWLQWRVDORVPHQFLRQDGRVHQHOLQFLVRSULPHURGHODUWtFXORGHO&yGLJR
GHO WUDEDMR H[FHGD GHO GH PL UHPXQHUDFLyQ WRWDO DXWRUL]R D TXH OD VXPD D GHVFRQWDU VH UHGX]FD HQ
HO PRQWR H[DFWR HQ TXH H[FHGD GHO UHIHULGR OtPLWH \ HO VDOGR VH DFXPXOH HQ XQD R PiV IUDFFLRQHV TXH QR
H[FHGDQ GHO UHIHULGR \ VH GHVFXHQWHQ D SDUWLU GHO ~OWLPR PHV LQGLFDGR HQ HO SiUUDIR SUHFHGHQWH KDVWD
VXWRWDOH[WLQFLyQ
(Q FDVR TXH HO GHVFXHQWR VH UHDOLFH GH PL SHQVLyQ HO SRUFHQWDMH D GHVFRQWDU QR SRGUi H[FHGHU GHO OtPLWH
VHxDODGRHQODUHJXODFLyQGHOUpJLPHQSUHYLVLRQDOFRUUHVSRQGLHQWH
Empleador Trabajador
(Entidad Pagadora de la Pensión) (Pensionado)
127$(VWDDXWRUL]DFLyQVHGHEHUiFRPSOHWDUFRQORVGDWRVTXHFRUUHVSRQGDVHJ~QVHWUDWHGHXQD¿OLDGR
GHSHQGLHQWHRSHQVLRQDGR
-8/ 13
MAY
33
$QH[R1
0$1'$72$8725,=$&,Ï1'(&$5*2
&8(17$&255,(17(%$1&$5,$7$5-(7$'(&5e',72
(QBBBBBBBBBBBBBBBBBBBBBBBBDBBBBBBBBBBBBBBBGHBBBBBBBBBBBBBBBBBGHOBBBBBBBBBBBBBB'RQD
BBBBBBBBBBBBBBBBBBBBBBBBBBBBBB HQ DGHODQWH HO ³0DQGDQWH´ &pGXOD 1DFLRQDO GH ,GHQWLGDG 1
BBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBB DXWRUL]D DO %DQFR$GPLQLVWUDGRUD GH 7DUMHWDV GH &UpGLWR
BBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBB HQ DGHODQWH HO ³0DQGDWDULR´ D SDJDU GH VX &XHQWD
&RUULHQWH7DUMHWD GH &UpGLWR 1BBBBBBBBBBBBBBBBBBBBBBBBBBB D BBBBBBBBBBBBBBBBBBBBBB HQ DGHODQWH
OD³,VDSUH´ODVFXRWDVFRUUHVSRQGLHQWHVDOGHGXFLEOHGHOD&REHUWXUD$GLFLRQDOSDUD(QIHUPHGDGHV&DWDVWUy¿FDV
HQDGHODQWHOD³&REHUWXUD´GHDFXHUGRDODVFRQGLFLRQHVTXHDFRQWLQXDFLyQVHLQGLFD
35,0(52 (O SDJR GH ORV PRQWRV TXH OD ,VDSUH LQIRUPH PHQVXDOPHQWH DO 0DQGDWDULR VH HIHFWXDUi FRQ
FDUJRDODFXHQWDFRUULHQWHLQGLYLGXDOL]DGDOtQHDGHFUpGLWRGHVREUHJLURRFXHQWDYLVWDVLODKXELHUHTXHHO
0DQGDQWH SRVHD HQ GLFKD LQVWLWXFLyQ \ HQ OD PHGLGD HQ TXH H[LVWDQ IRQGRV VX¿FLHQWHV \ GLVSRQLEOHV SDUD
FXEULUOR
6(*81'2(OSDJR GHODV FXRWDVVHHIHFWXDUi GHQWUR GH ORV SULPHURV GtDV KiELOHV GH ORV PHVHV HQ TXH
FRUUHVSRQGD SDJDUODV VHJ~Q LQIRUPDUi OD ,VDSUH DO 0DQGDWDULR 6L WDOHV SDJRV QR VH SXGLHUDQ HIHFWXDU SRU
FXDOTXLHU FDXVD HO 0DQGDWDULR TXHGD OLEHUDGR GH WRGD UHVSRQVDELOLGDG GHELHQGR HO 0DQGDQWH SDJDUODV D
OD ,VDSUH VHJ~Q OR GLVSXHVWR HQ OD &REHUWXUD (Q HO HYHQWR TXH DOJXQDV FXRWDV SRU FXDOTXLHU FDXVD QR
KD\DQVLGRFDUJDGDVSRUHO0DQGDWDULRRKDELHQGRVLGRFDUJDGDVKD\DQVLGRUHFKD]DGDVHO0DQGDQWH
IDFXOWDDOD,VDSUHSDUDFDUJDUODVHQRWUDVIHFKDVGXUDQWHHOUHVSHFWLYRPHVRELHQDOPHVVLJXLHQWHFRQ
VXVUHDMXVWHVHLQWHUHVHVMXQWRFRQODFXRWDFRUUHVSRQGLHQWHDGLFKRPHV
7(5&(526LDOJXQDFXRWDSRUFXDOTXLHUUD]yQQRIXHUDSDJDGDHO0DQGDWDULRQRWHQGUiUHVSRQVDELOLGDG
DOJXQDDXQTXHGHGLFKDFLUFXQVWDQFLDUHVXOWHRSXGLHVHUHVXOWDUODWHUPLQDFLyQGHOD&REHUWXUD
&8$572(VWDDXWRUL]DFLyQUHJLUiKDVWDTXHHO0DQGDQWHODUHYRTXHSRUHVFULWRDOD,VDSUHTXLHQLQIRUPDUi
DO0DQGDWDULRGHHVWDUHYRFDFLyQ
)LUPD7LWXODU&XHQWD&RUULHQWH%DQFDULD7DUMHWDGH&UpGLWR
34
*(6$8*(
CONDICIONES PARA ACCEDER A LA COBERTURA DE LAS GARANTÍAS

EXPLÍCITAS EN SALUD
5HJXODGRSRU&LUFXODUHV,)1,)1,)1H,)1
3RUHOSUHVHQWHLQVWUXPHQWRSRQHPRVHQVXFRQRFLPLHQWRODV&RQGLFLRQHVGHOD&REHUWXUDGHODV*DUDQWtDV
([SOtFLWDV HQ 6DOXG GH FRQIRUPLGDG D OR SUHVFULWR HQ OD /H\ \ DO 'HFUHWR YLJHQWH GH ORV 0LQLVWHULRV
GH6DOXG\+DFLHQGDTXHHVWDEOHFHORV3UREOHPDVGH6DOXG\*DUDQWtDV([SOtFLWDVGH6DOXG
35,0(52*(1(5$/,'$'(6
(O 5pJLPHQ *HQHUDO GH *DUDQWtDV FRQWLHQH *DUDQWtDV ([SOtFLWDV HQ 6DOXG UHODWLYDV D DFFHVR FDOLGDG
SURWHFFLyQ ¿QDQFLHUD \ RSRUWXQLGDG FRQ TXH GHEHQ VHU RWRUJDGDV ODV SUHVWDFLRQHV DVRFLDGDV D XQ FRQMXQWR
SULRUL]DGR GH SURJUDPDV HQIHUPHGDGHV R FRQGLFLRQHV GH VDOXG TXH VHxDOH HO GHFUHWR FRUUHVSRQGLHQWH
(VWDV *DUDQWtDV ([SOtFLWDV HQ 6DOXG VRQ FRQVWLWXWLYDV GH '(5(&+26 SDUD ODV SHUVRQDV
EHQH¿FLDULDV $VLPLVPR HVWDV JDUDQWtDV SXHGHQ VHU GLIHUHQWHV SDUD XQD PLVPD SUHVWDFLyQ FRQIRUPH D
FULWHULRV JHQHUDOHV WDOHV FRPR HQIHUPHGDG VH[R JUXSR GH HGDG X RWUDV YDULDEOHV REMHWLYDV TXH VHDQ
SHUWLQHQWHV
6(*81'2&2%(5785$
/DV HQIHUPHGDGHV FRQGLFLRQHV GH VDOXG \ SUHVWDFLRQHV TXH QR VH HQFXHQWUHQ LQFRUSRUDGDV GHQWUR GH
ODV *DUDQWtDV ([SOtFLWDV HQ 6DOXG *(6 PDQWHQGUiQ VL FRUUHVSRQGH ODV FRQGLFLRQHV \ FREHUWXUD GH
ORV UHVSHFWLYRV 3ODQHV GH 6DOXG &RPSOHPHQWDULRV TXH WHQJDQ ORV D¿OLDGRV DO PRPHQWR GH UHTXHULU WDOHV
DWHQFLRQHV /DV SHUVRQDV D¿OLDGDV \ EHQH¿FLDULDV WLHQHQ HQ WRGR FDVR HO GHUHFKR GH DFRJHUVH D ODV
FRQGLFLRQHV GH ODV *(6 FXDQGR FRUUHVSRQGD R PDQWHQHU OD FREHUWXUD \ FRQGLFLRQHV GH VX 3ODQ GH
6DOXG&RPSOHPHQWDULRYLJHQWH
7(5&(52/,67$'2'(35(67$&,21(6
8Q 'HFUHWR 6XSUHPR GH ORV 0LQLVWHULRV GH 6DOXG \ +DFLHQGD ¿MD HO FRQMXQWR GH 3UREOHPDV GH 6DOXG \
*DUDQWtDV ([SOtFLWDV HQ 6DOXG (O OLVWDGR GH ORV SUREOHPDV GH 6DOXG ¿MDGRV SRU HO 'HFUHWR DFWXDOPHQWH
YLJHQWHVHSUHVHQWDDO¿QDOGHOSUHVHQWHDQH[R
&8$572*$5$17Ë$6(;3/Ë&,7$6(16$/8'
3DUDORVHIHFWRVSUHYLVWRVHQODOH\HQUHODFLyQDO5pJLPHQVHHQWHQGHUiSRU
Garantía Explícita de Acceso:2EOLJDFLyQGHODV,VDSUHVGHDVHJXUDUHORWRUJDPLHQWRGHODVSUHVWDFLRQHVGH

VDOXGJDUDQWL]DGDVHQHO5pJLPHQHQODIRUPD\FRQGLFLRQHVTXHGHWHUPLQHHOGHFUHWRFRUUHVSRQGLHQWH
Garantía Explícita de Calidad: Otorgamiento de estas prestaciones de salud garantizadas por un prestador
UHJLVWUDGR R DFUHGLWDGR GH DFXHUGR DO ')/ 1 GH GH 6DOXG HQ OD IRUPD \ FRQGLFLRQHV
GHWHUPLQDGDV HQ HO GHFUHWR FRUUHVSRQGLHQWH FXDQGR HVWp YLJHQWH HQ HVWD PDWHULD 3UHYLR D HVWR ODV
,VDSUHV RWRUJDUiQ HVWRV EHQH¿FLRV HQ OD UHG TXH SDUD WDO HIHFWR KD\DQ LQIRUPDGR D OD 6XSHULQWHQGHQFLD
GH6DOXG
Garantía Explícita de Oportunidad: 3OD]R Pi[LPR SDUD HO RWRUJDPLHQWR GH ODV SUHVWDFLRQHV GH
MAY 13
VDOXGJDUDQWL]DGDVHQODIRUPD\FRQGLFLRQHVTXHGHWHUPLQHHOGHFUHWRFRUUHVSRQGLHQWH'LFKRSOD]RFRQVLGHUDUi
D OR PHQRV HO WLHPSR HQ TXH OD SUHVWDFLyQ GHEHUi VHU RWRUJDGD SRU HO SUHVWDGRU GH VDOXG GHVLJQDGR HQ
SULPHU OXJDU HO WLHPSR SDUD VHU DWHQGLGR SRU XQ SUHVWDGRU GLVWLQWR GHVLJQDGR SRU OD ,VDSUH
FXDQGR QR KXELHUH VLGR DWHQGLGR SRU HO SULPHUR \ HQ GHIHFWR GH ORV DQWHULRUHV HO WLHPSR HQ TXH HO
SUHVWDGRU GHVLJQDGR SRU OD 6XSHULQWHQGHQFLD GH 6DOXG GHED RWRUJDU OD SUHVWDFLyQ FRQ FDUJR D OD ,VDSUH
1R VH HQWHQGHUi TXH KD\ LQFXPSOLPLHQWR GH OD JDUDQWtD HQ ORV FDVRV GH IXHU]D PD\RU FDVR IRUWXLWR R
TXH VH GHULYHQ GH FDXVDV LPSXWDEOHV D OD SHUVRQD D¿OLDGD R EHQH¿FLDULD OR TXH GHEHUi VHU
GHELGDPHQWHDFUHGLWDGRSRUOD,VDSUH
35
Garantía Explícita de Protección Financiera: /D FRQWULEXFLyQ R FRSDJR TXH GHEHUi HIHFWXDU HO R OD D¿OLDGD
SRU SUHVWDFLyQ R JUXSR GH SUHVWDFLRQHV OD TXH GHEHUi VHU GH XQ GHO YDORU GHWHUPLQDGR HQ HO DUDQFHO
GH UHIHUHQFLD GHO 5pJLPHQ D GLVSRVLFLyQ GH ODV SHUVRQDV D¿OLDGDV \ EHQH¿FLDULDV HQ ODV R¿FLQDV GH OD
,VDSUH/RDQWHULRUVLQSHUMXLFLRGHORHVWDEOHFLGRHQHODUWtFXORGHHVWHGRFXPHQWR
48,1729,*(1&,$
3RU UHJOD JHQHUDO ORV EHQH¿FLRV GH ODV *DUDQWtDV ([SOtFLWDV HQ 6DOXG *(6 WHQGUiQ XQD YLJHQFLD GH
WUHVDxRV6LQRVHPRGL¿FDUHQDOH[SLUDUHOSOD]RVHxDODGRHQYLUWXGGHXQ'HFUHWR6XSUHPRGHO0LQLVWHULR
GH6DOXGVHHQWHQGHUiQSURUURJDGDVSRURWURVWUHVDxRV
6(;72)250$/,'$'(6<&21',&,21(6'($7(1&,Ï1<'($&&(62
3DUD WHQHU GHUHFKR D ODV *DUDQWtDV ([SOtFLWDV HQ 6DOXG *(6 ODV SHUVRQDV D¿OLDGDV \ EHQH¿FLDULDV
GH ,VDSUHV D TXLHQHV VH OHV KD\D GLDJQRVWLFDGR DOJXQD GH ODV HQIHUPHGDGHV R FRQGLFLRQHV GH VDOXG
FXELHUWDV SRU GLFKDV *DUDQWtDV ([SOtFLWDV GHEHUiQ DWHQGHUVH FRQ HO SUHVWDGRU GH VDOXG TXH SDUD HO FDVR
HVSHFt¿FR GHWHUPLQH OD ,VDSUH 1R REVWDQWH OR DQWHULRU ORV \ ODV EHQH¿FLDULDV SRGUiQ RSWDU SRU DWHQGHUVH
FRQIRUPH D VX SODQ FRPSOHPHQWDULR YLJHQWH FRQ OD ,QVWLWXFLyQ HQ FX\R FDVR QR UHJLUiQ ODV *DUDQWtDV
([SOtFLWDVGHTXHWUDWDHVWHGRFXPHQWR
3DUD RWRUJDU ODV SUHVWDFLRQHV JDUDQWL]DGDV H[SOtFLWDPHQWH ORV SUHVWDGRUHV GHEHUiQ HVWDU UHJLVWUDGRV
R DFUHGLWDGRV HQ OD 6XSHULQWHQGHQFLD GH 6DOXG GH DFXHUGR D OR TXH VH HVWDEOHFH HQ OD *DUDQWtD ([SOtFLWD
GH&DOLGDG1RREVWDQWHPLHQWUDVWDO*DUDQWtDQRVHDH[LJLEOHORVSUHVWDGRUHVVyORGHEHUiQVHULQIRUPDGRV
DOD6XSHULQWHQGHQFLD
'LFKDV SUHVWDFLRQHV VH RWRUJDUiQ H[FOXVLYDPHQWH D WUDYpV GH HVWDEOHFLPLHQWRV XELFDGRV HQ HO WHUULWRULR
QDFLRQDO
8QD YH] GHVLJQDGR HO SUHVWDGRU SRU OD ,VDSUH OD SHUVRQD D¿OLDGD R EHQH¿FLDULD R VX UHSUHVHQWDQWH
GHEHUi LQGLFDU H[SUHVDPHQWH \ SRU HVFULWR VX GHFLVLyQ GH WUDWDUVH D WUDYpV GH GLFKR SUHVWDGRU R GHVLVWLU
GH OD DWHQFLyQ JDUDQWL]DGD HQ FX\R FDVR VH HQWLHQGH TXH RSWD SRU VX 3ODQ GH 6DOXG &RPSOHPHQWDULR
\QRUHJLUiQODVJDUDQWtDVH[SOtFLWDV
/DV *DUDQWtDV ([SOtFLWDV VH DSOLFDUiQ VyOR D ODV SUHVWDFLRQHV GH¿QLGDV HQ HO DUDQFHO FRUUHVSRQGLHQWH
/DV GHPiV SUHVWDFLRQHV QR FRQWHQLGDV HQ HO UHIHULGR$UDQFHO QR REVWDQWH VH RWRUJXHQ HQ HVWDEOHFLPLHQWRV
GHVLJQDGRVSRUOD,VDSUHWHQGUiQODFREHUWXUDGHO3ODQGH6DOXG&RPSOHPHQWDULRRODFREHUWXUD*(6&$(&VL
FRUUHVSRQGLHUH
/RV SUHVWDGRUHV GH VDOXG GHEHUiQ LQIRUPDU D ODV SHUVRQDV D¿OLDGDV D ODV ,VDSUHV TXH WLHQHQ GHUHFKR
D ODV *DUDQWtDV ([SOtFLWDV HQ 6DOXG HQ OD IRUPD RSRUWXQLGDG \ FRQGLFLRQHV TXH HVWDEOHFH HO 5HJODPHQWR
(Q FDVR GH LQFXPSOLPLHQWR HO R OD DIHFWDGD R TXLHQ OR UHSUHVHQWH SRGUi UHFODPDU DQWH OD 6XSHULQWHQGHQFLD
GH 6DOXG OD TXH SRGUi VDQFLRQDU D ORV SUHVWDGRUHV FRQ DPRQHVWDFLyQ R HQ FDVR GH IDOWD UHLWHUDGD FRQ
VXVSHQVLyQGHKDVWDGtDVSDUDRWRUJDUODV*DUDQWtDV([SOtFLWDVHQ6DOXGVLQSHUMXLFLRGHRWUDVVDQFLRQHV
TXHFRQWHPSOHQORVUHJODPHQWRV
6e37,0235(&,2
(O SUHFLR GH ORV EHQH¿FLRV GH ODV *DUDQWtDV ([SOtFLWDV HQ 6DOXG *(6 \ OD XQLGDG HQ TXH VH SDFWD VHUi
HO PLVPR SDUD WRGDV ODV SHUVRQDV EHQH¿FLDULDV GH OD ,VDSUH \ HV LQGHSHQGLHQWH GHO SUHFLR GHO 3ODQ GH
6DOXG &RPSOHPHQWDULR (O SUHFLR SRGUi VHU PRGL¿FDGR FDGD YH] TXH VH PRGL¿TXH HO GHFUHWR TXH HVWDEOHFH
ORV3UREOHPDVGH6DOXG\*DUDQWtDVHQ6DOXG

2&7$92*$5$17Ë$6(;3/Ë&,7$6(16$/8''(/5e*,0(148(5,*(1$&217$5'(/'(
2&78%5('(
(O'HFUHWR6XSUHPR1GHUHFWL¿FDGRSRUHO'61GHORV0LQLVWHULRVGH+DFLHQGD\6DOXGDSUREy
ODVVLJXLHQWHV*DUDQWtDV([SOtFLWDVHQ6DOXGGHO5pJLPHQTXHULJHQDFRQWDUGHOGHRFWXEUHGH
3DUD WHQHU GHUHFKR D HVWD FREHUWXUD ¿QDQFLHUD DGLFLRQDO HO PRQWR GH ORV FRSDJRV GHEHUi VXSHUDU
XQ GHGXFLEOH HQWHQGLpQGRVH SRU WDO OD VXPD GH ORV FRSDJRV TXH VH DFXPXODUiQ SRU FDGD HYHQWR
3DUDHOFDVRGHODVSHUVRQDVD¿OLDGDVD,VDSUHVHVWHGHGXFLEOHHTXLYDOGUiDFRWL]DFLRQHVPHQVXDOHV
OHJDOHV R SDFWDGDV VHJ~Q FRUUHVSRQGD SRU FDGD SDWRORJtD DVRFLDGD D ODV *DUDQWtDV ([SOtFLWDV HQ 6DOXG
TXH OH RFXUUD DO R OD D¿OLDGD R D VXV EHQH¿FLDULRV \ EHQH¿FLDULDV 'LFKR GHGXFLEOH QR SRGUi H[FHGHU GH
8QLGDGHVGH)RPHQWR
(Q FDVR GH H[LVWLU PiV GH XQ HYHQWR TXH DIHFWH DO R OD D¿OLDGD R D XQR R PiV EHQH¿FLDULRV R
EHQH¿FLDULDV HQ XQ SHUtRGR GH PHVHV FRQWDGRV GHVGH TXH VH GHYHQJD HO SULPHU FRSDJR GHO SULPHU
HYHQWR HO GHGXFLEOH VHUi GH FRWL]DFLRQHV PHQVXDOHV 'LFKR GHGXFLEOH QR SRGUi H[FHGHU GH
8QLGDGHVGH)RPHQWR
(O GHGXFLEOH GHEHUi VHU DFXPXODGR HQ XQ SHUtRGR Pi[LPR GH GRFH PHVHV \ VH FRPSXWDUi GHVGH OD
IHFKD HQ TXH OD SHUVRQD EHQH¿FLDULD UHJLVWUH HO SULPHU FRSDJR GHYHQJDGR 6L DO FDER GH ORV GRFH PHVHV
QR VH DOFDQ]DUH D FRPSOHWDU HO GHGXFLEOH ORV FRSDJRV QR VH DFXPXODUiQ SDUD HO VLJXLHQWH SHUtRGR
UHLQLFLiQGRVHHOFyPSXWRGHOGHGXFLEOHSRURWURVPHVHV\DVtVXFHVLYDPHQWH
3DUD ORV HIHFWRV GHO FyPSXWR GHO GHGXFLEOH QR VH FRQWDELOL]DUiQ ORV FRSDJRV TXH WHQJDQ RULJHQ HQ
SUHVWDFLRQHV QR FXELHUWDV SRU ODV *DUDQWtDV ([SOtFLWDV HQ 6DOXG R TXH HVWDQGR FXELHUWDV KD\DQ VLGR
RWRUJDGDV SRU SUHVWDGRUHV GLVWLQWRV D ORV GHVLJQDGRV SRU ODV ,VDSUHV VLQ SHUMXLFLR GH ORV SUHVWDGRUHV
GHVLJQDGRVSRUOD6XSHULQWHQGHQFLDGH6DOXGFXDQGRFRUUHVSRQGLHUD
1RREVWDQWHORLQGLFDGRDQWHULRUPHQWHVyORSDUDORVHIHFWRVGHODDFXPXODFLyQGHOGHGXFLEOHWUDWiQGRVH
GHXQDFRQGLFLyQGHVDOXGJDUDQWL]DGDH[SOtFLWDPHQWHTXHLPSOLTXHXUJHQFLDYLWDORVHFXHODIXQFLRQDOJUDYH\
TXHHQFRQVHFXHQFLDUHTXLHUDKRVSLWDOL]DFLyQLQPHGLDWDHLPSRVWHUJDEOHHQXQHVWDEOHFLPLHQWRGLIHUHQWHDO
GHVLJQDGRSRUOD,VDSUHVHFRPSXWDUiQORVFRSDJRVGHYHQJDGRVHQGLFKRHVWDEOHFLPLHQWRGHDFXHUGRDOSODQ
FRQWUDWDGRKDVWDTXHHORODSDFLHQWHVHHQFXHQWUHHQFRQGLFLRQHVGHVHUWUDVODGDGR
(O R OD PpGLFR WUDWDQWH GHO HVWDEOHFLPLHQWR VHUi TXLHQ GHWHUPLQH HO PRPHQWR D SDUWLU GHO FXDO HO R OD
SDFLHQWHVHHQFXHQWUDHQFRQGLFLRQHVGHVHUWUDVODGDGR
6L HO R OD SDFLHQWH VXV IDPLOLDUHV R UHSUHVHQWDQWH RSWDQ SRU OD PDQWHQFLyQ HQ HO HVWDEOHFLPLHQWR ORV
FRSDJRV TXH VH GHYHQJXHQ D SDUWLU GH HVH PRPHQWR QR VH FRQVLGHUDUiQ SDUD HO FyPSXWR GHO GHGXFLEOH
/RPLVPRRFXUULUiVLHORODSDFLHQWHVXVIDPLOLDUHVRUHSUHVHQWDQWHRSWDQSRUHOWUDVODGRDXQHVWDEOHFLPLHQWR
TXHQRHVGHORVGHVLJQDGRVSRUOD,VDSUH
6L HO R OD SDFLHQWH VXV IDPLOLDUHV R UHSUHVHQWDQWH RSWDQ SRU HO WUDVODGR D XQ HVWDEOHFLPLHQWR GHVLJQDGR
SRU OD ,VDSUH VH LQLFLDUi R UHLQLFLDUi D SDUWLU GH HVH PRPHQWR HO FyPSXWR GH ORV FRSDJRV SDUD HO FiOFXOR
GHOGHGXFLEOH
-8/ 13
MAY

GES
(O'HFUHWR6XSUHPR1GHUHFWL¿FDGRSRUHO'HFUHWR6XSUHPR1GHORV0LQLVWHULRVGH
+DFLHQGD\6DOXGDSUREyODVVLJXLHQWHV
GARANTÍAS EXPLÍCITAS EN SALUD DEL RÉGIMEN QUE RIGEN A

&217$5'(/'(2&78%5('(
(1)(50('$'5(1$/&5Ï1,&$(7$3$<
$FFHVR7RGREHQH¿FLDULR
• &RQFRQ¿UPDFLyQGLDJQyVWLFDWHQGUiDFFHVRDWUDWDPLHQWRFRQIRUPHDORGLVSXHVWRHQODV1RUPD
GHFDUiFWHU7pFQLFR0pGLFR\$GPLQLVWUDWLYRSDUDHOFXPSOLPLHQWRGHODV*DUDQWtDV([SOtFLWDVHQ
6DOXGDODVTXHKDFHUHIHUHQFLDHVWH'HFUHWRHQVX$UWtFXOR
• (QWUDWDPLHQWRWHQGUiDFFHVRDFRQWLQXDUOR
• &RQ(QIHUPHGDG5HQDO&UyQLFDGHFXUVRSURJUHVLYRHLUUHYHUVLEOHWHQGUiDFFHVRDFRQIHFFLyQGH
ItVWXOD DUWHULRYHQRVD R LQVWDODFLyQ GH FDWpWHU SHULWRQHDO VHJ~Q LQGLFDFLyQ GHO HVSHFLDOLVWD H
LQGHSHQGLHQWHGHVXYHORFLGDGGHILOWUDFLyQJORPHUXODU
• 7UDVSODQWDGRWHQGUiDFFHVRDQXHYRWUDVSODQWHVHJ~QLQGLFDFLyQPpGLFD
• 7UDVSODQWDGRWHQGUiDFFHVRDSUR¿OD[LV\WUDWDPLHQWRGHFLWRPHJDORYLUXVVHJ~QLQGLFDFLyQ
PpGLFD
• 7UDVSODQWDGRWHQGUiDFFHVRDWHUDSLDGHUHFKD]RVHJ~QLQGLFDFLyQPpGLFD
• &RQ(QIHUPHGDG5HQDO&UyQLFDHWDSDVHJ~QLQGLFDFLyQPpGLFDWHQGUiDFFHVRDHVWXGLRSUHWUDVSODQWH
HLQJUHVRDOLVWDGHHVSHUDGHWUDVSODQWHVLFXPSOHFRQFULWHULRVGHLQFOXVLyQGH¿QLGRVHQOD1RUPDGH
FDUiFWHU7pFQLFR0pGLFR\$GPLQLVWUDWLYRDXQTXHQRKD\DUHTXHULGRGLiOLVLV
&$5',23$7Ë$6&21*e1,7$623(5$%/(6(10(125(6'($f26
$FFHVR7RGREHQH¿FLDULRPHQRUGHDxRV
• &RQVRVSHFKDWHQGUiDFFHVRDFRQ¿UPDFLyQGLDJQyVWLFD
• &RQFRQ¿UPDFLyQGLDJQyVWLFDWHQGUiDFFHVRDWUDWDPLHQWR,QFOX\HUHLQWHUYHQFLRQHV
• &RQUHTXHULPLHQWRGHUHFDPELRGH0DUFDSDVRRFDPELRGHJHQHUDGRU\RHOHFWURGRVHJ~Q
FRUUHVSRQGDWHQGUiDFFHVRDWUDWDPLHQWR\VHJXLPLHQWR
• 6HH[FOX\H7UDVSODQWHFDUGtDFR
&È1&(5&(59,&287(5,12
$FFHVR7RGDPXMHUEHQH¿FLDULD
• (QWUH\DxRVWHQGUiDFFHVRDUHDOL]DFLyQGH3$3FDGDDxRV
• &RQFRQ¿UPDFLyQGLDJQyVWLFDWHQGUiDFFHVRDWUDWDPLHQWR\VHJXLPLHQWR
• &RQUHFLGLYDWHQGUiDFFHVRDFRQ¿UPDFLyQGLDJQyVWLFDWUDWDPLHQWR\VHJXLPLHQWR
$/,9,2'(/'2/25325&È1&(5$9$1=$'2<&8,'$'263$/,$7,926325&È1&(5$9$1=$'2
&RQFRQ¿UPDFLyQGLDJQyVWLFDWHQGUiDFFHVRDWUDWDPLHQWR
,1)$572$*8'2'(/0,2&$5',2
$FFHVR7RGREHQH¿FLDULRTXHGHVGHHOGHMXOLRGHSUHVHQWH
• 'RORUWRUiFLFRQRWUDXPiWLFR\RVtQWRPDVGH,QIDUWR$JXGRGHO0LRFDUGLRWHQGUiDFFHVRD
FRQ¿UPDFLyQGLDJQyVWLFD
• &RQFRQ¿UPDFLyQGLDJQyVWLFDGH,QIDUWR$JXGRGHO0LRFDUGLRWHQGUiDFFHVRDWUDWDPLHQWR
PpGLFR\SUHYHQFLyQVHFXQGDULD
• %\SDVVFRURQDULRRDQJLRSODVWtDFRURQDULDSHUFXWiQHDWHQGUiDFFHVRDSUHYHQFLyQVHFXQGDULD
',$%(7(60(//,7867,32
• &RQFRQ¿UPDFLyQGLDJQyVWLFDWHQGUiDFFHVRDWUDWDPLHQWR
• ,QFOX\HWUDWDPLHQWRGHSLHGLDEpWLFR
• &RQGHVFRPSHQVDFLyQWHQGUiDFFHVRDWUDWDPLHQWRGHXUJHQFLD\KRVSLWDOL]DFLyQVHJ~QLQGLFDFLyQ
PpGLFD
• (QWUDWDPLHQWRWHQGUiDFFHVRDFRQWLQXDUOR
',$%(7(60(//,7867,32
&RQVRVSHFKDWHQGUiDFFHVRDFRQ¿UPDFLyQGLDJQyVWLF

&RQFRQ¿UPDFLyQGLDJQyVWLFDWHQGUiDFFHVRDWUDWDPLHQWR,QFOX\HWUDWDPLHQWRSLHGLDEpWLFR
(QWUDWDPLHQWRWHQGUiDFFHVRDFRQWLQXDUOR
&È1&(5'(0$0$(13(5621$6'($f26<0È6
$FFHVR7RGDREHQH¿FLDULDRGHDxRV\PiV
&RQVRVSHFKDWHQGUiDFFHVRDFRQ¿UPDFLyQGLDJQyVWLFD
&RQFRQ¿UPDFLyQGLDJQyVWLFDWHQGUiDFFHVRDWUDWDPLHQWR\VHJXLPLHQWR
&RQUHFLGLYDWHQGUiDFFHVRDFRQ¿UPDFLyQGLDJQyVWLFDWUDWDPLHQWR\VHJXLPLHQWR
',65$),$6(63,1$/(6
$FFHVR7RGREHQH¿FLDULRQDFLGRDFRQWDUGHOGHMXOLRGH
&RQFRQ¿UPDFLyQGLDJQyVWLFDWHQGUiDFFHVRDWUDWDPLHQWR,QFOX\HUHLQWHUYHQFLRQHV
&RQWUDWDPLHQWRWHQGUiDFFHVRDVHJXLPLHQWR
$FFHVR7RGREHQH¿FLDULRLQGHSHQGLHQWHGHIHFKDGHQDFLPLHQWR
&RQ FRQ¿UPDFLyQ GLDJQyVWLFD GH GLVUD¿D RFXOWD \ PpGXOD DQFODGD R PHQLQJLWLV D UHSHWLFLyQ
WHQGUiDFFHVRDWUDWDPLHQWR,QFOX\HUHLQWHUYHQFLRQHV
75$7$0,(17248,5Ò5*,&2'((6&2/,26,6(10(125(6'($f26
$FFHVR7RGR EHQH¿FLDULR PHQRU GH DxRV FRQ FRQ¿UPDFLyQ GLDJQyVWLFD H LQGLFDFLyQ GH WUDWDPLHQWR
TXLU~UJLFRGH(VFROLRVLVWHQGUiDFFHVRDWUDWDPLHQWRVLHPSUHTXHFXPSODORVFULWHULRVGHLQFOXVLyQGH¿QLGRV
HQ,D1RUPDGHFDUiFWHU7pFQLFR0pGLFR\$GPLQLVWUDWLYR
75$7$0,(17248,5Ò5*,&2'(&$7$5$7$6
&RQFRQ¿UPDFLyQGLDJQyVWLFDWHQGUiDFFHVRDWUDWDPLHQWRVLHPSUHTXHFXPSODFRQHO
VLJXLHQWHFULWHULRGHLQFOXVLyQ
$JXGH]DYLVXDOLJXDORLQIHULRUDFRQFRUUHFFLyQySWLFD
(1'235Ï7(6,6 727$/ '( &$'(5$ (1 3(5621$6 '( $f26 < 0È6 &21 $57526,6 '(
CADERA CON LIMITACIÓN FUNCIONAL SEVERA
$FFHVR7RGREHQH¿FLDULRGHDxRV\PiV
&RQFRQ¿UPDFLyQGLDJQyVWLFDGHDUWURVLVGHFDGHUDFRQOLPLWDFLyQIXQFLRQDOVHYHUDVHJ~QOR
HVWDEOHFLGRHQOD1RUPDGHFDUiFWHU7pFQLFR\$GPLQLVWUDWLYRTXHUHTXLHUDHQGRSUyWHVLVWRWDO
WHQGUiDFFHVRDWUDWDPLHQWR
&RQLQGLFDFLyQPpGLFDWHQGUiDFFHVRDUHFDPELRGHHQGRSUyWHVLVWRWDO
),685$/$%,23$/$7,1$
$FFHVR7RGREHQH¿FLDULRQDFLGRGHVGHHOGHMXOLRGHFRQ¿VXUDODELRSDODWLQDHVWpRQR
DVRFLDGD D PDOIRUPDFLRQHV FUDQHRIDFLDOHV WHQGUi DFFHVR D FRQ¿UPDFLyQ GLDJQyVWLFD \
WUDWDPLHQWRLQFOX\HQGRUHKDELOLWDFLyQHQPHQRUHVGHDxRV
&È1&(5(13(5621$60(125(6'($f26
&RQFRQ¿UPDFLyQGLDJQyVWLFDWHQGUiDFFHVRDWUDWDPLHQWR\VHJXLPLHQWR(QORVFDVRVGH
/HXFHPLDV\/LQIRPDVLQFOX\HWUDVSODQWHGHPpGXODyVHDVHJ~QLQGLFDFLyQPpGLFD
,JXDODFFHVRWHQGUiDTXHODOTXHVHOHKD\DVRVSHFKDGRDQWHVGHORVDxRVD~QFXDQGR
ODFRQ¿UPDFLyQVHSURGX]FDGHVSXpVGHHVWDHGDG
/RVEHQH¿FLDULRVPHQRUHVGHDxRVTXHUHFLGLYHQ\TXHKD\DQWHQLGRVRVSHFKD
DQWHVGHORVDxRVWHQGUiQDFFHVRDFRQ¿UPDFLyQGLDJQyVWLFDWUDWDPLHQWR\VHJXLPLHQWR
MAY 13
-8/
(648,=2)5(1,$
$FFHVR7RGREHQH¿FLDULRFRQVRVSHFKDGHHVTXL]RIUHQLDHQTXLHQHVVHPDQL¿HVWDQSRUSULPHUDYH]
ORVVtQWRPDVDSDUWLUGHOGHMXOLRGH
&RQVRVSHFKDWHQGUiDFFHVRDHYDOXDFLyQGLDJQyVWLFDFRQ¿UPDFLyQGLDJQyVWLFD\WUDWDPLHQWR
LQLFLDOSRUGtDV
&RQFRQ¿UPDFLyQGLDJQyVWLFDFRQWLQXDUiWUDWDPLHQWR
&È1&(5'(7(67Ë&8/2(13(5621$6'($f26<0È6
&RQUHFLGLYDWHQGUiDFFHVRDGLDJQyVWLFRWUDWDPLHQWR\VHJXLPLHQWR

/,1)20$6(13(5621$6'($f26<0È6
&RQUHFLGLYDWHQGUiDFFHVRDGLDJQyVWLFRWUDWDPLHQWR\VHJXLPLHQWR
6Ë1'520('(/$,10812'(),&,(1&,$$'48,5,'$9,+6,'$
$FFHVR7RGR%HQH¿FLDULR
&RQVRVSHFKDFOtQLFDWHQGUiDFFHVRDFRQ¿UPDFLyQGLDJQyVWLFD
&RQFRQ¿UPDFLyQGLDJQyVWLFD\RLQGLFDFLyQPpGLFDWHQGUiDFFHVRDH[iPHQHVWUDWDPLHQWR\
VHJXLPLHQWR
(PEDUD]DGD9,+\UHFLpQQDFLGRKLMRGHPDGUH9,+WHQGUiQDFFHVRDSURWRFRORSDUD
3UHYHQFLyQGH7UDQVPLVLyQ9HUWLFDO
(QWUDWDPLHQWRWHQGUiDFFHVRDFRQWLQXDUORHQODPHGLGDTXHKD\DFXPSOLGRFRQORVFULWHULRVGH
LQLFLRRFDPELRGHWHUDSLDDQWLUUHWURYLUDOYLJHQWH
,1)(&&,Ï15(63,5$725,$$*8'$,5$'(0$1(-2$0%8/$725,2(10(125(6'($f26

$FFHVR 7RGR EHQH¿FLDULR PHQRU GH DxRV FRQ FRQ¿UPDFLyQ GLDJQyVWLFD GH ,5$ GH PDQHMR
DPEXODWRULRWHQGUiDFFHVRDWUDWDPLHQWR
1(8021Ë$$'48,5,'$(1/$&2081,'$''(0$1(-2$0%8/$725,2(13(5621$6'(
$f26<0È6
&RQ VRVSHFKD GH 1$& WHQGUi DFFHVR D FRQ¿UPDFLyQ GLDJQyVWLFD FOtQLFRUDGLROyJLFD
\WUDWDPLHQWRIDUPDFROyJLFRGXUDQWHODVSULPHUDVKRUDV
7UDWDPLHQWRNLQHVLROyJLFRVHJ~QLQGLFDFLyQPpGLFD
&RQFRQ¿UPDFLyQGLDJQyVWLFDFRQWLQXDUiWUDWDPLHQWR
+,3(57(16,Ï1$57(5,$/35,0$5,$2(6(1&,$/(13(5621$6'($f26<0È6
$FFHVRDPRQLWRUHRFRQWLQXRGHSUHVLyQDUWHULDOVHJ~QLQGLFDFLyQPpGLFD
(3,/(36,$125()5$&7$5,$(13(5621$6'(6'($f2<0(125(6'($f26
$FFHVR7RGREHQH¿FLDULRGHVGHXQDxR\PHQRUGHDxRV
&RQVRVSHFKDDSDUWLUGHOGHMXOLRGHWHQGUiDFFHVRDHYDOXDFLyQLQLFLDOGXUDQWHGtDV
\FRQ¿UPDFLyQGLDJQyVWLFD
(QWUDWDPLHQWRWHQGUiDFFHVRFRQWLQXDUOR
6$/8'25$/,17(*5$/3$5$1,f26<1,f$6'($f26
$FFHVR%HQH¿FLDULRGHDxRV(ODFFHVRDWUDWDPLHQWRGHEHUHDOL]DUVHPLHQWUDVHOEHQH¿FLDULRWHQJD
VHLVDxRVHODOWDVHRWRUJDXQDYH]HUXSFLRQDGRVORVSULPHURVPRODUHVGH¿QLWLYRVORVTXHGHEHQKDEHU
VLGRHYDOXDGRVVHJ~QFULWHULRGHULHVJR\RSUHVHQFLDGHGDxRUHFLELHQGRHOWUDWDPLHQWRDFRUGHDOGLDJQyVWLFR
UHDOL]DGR
35(9(1&,Ï1'(3$57235(0$7852
$FFHVR7RGDEHQH¿FLDULDHPEDUD]DGD
&RQFRQ¿UPDFLyQWHQGUiDFFHVRDWUDWDPLHQWR\FRQWUROSRVWHULRU
75$6725126'(*(1(5$&,Ï1'(/,038/62<&21'8&&,Ï1(13(5621$6'($f26<
0È648(5(48,(5(10$5&$3$62
&RQUHTXHULPLHQWRGHUHFDPELRGH0DUFDSDVRRFDPELRGHJHQHUDGRU\RHOHFWURGRVHJ~Q
FRUUHVSRQGDWHQGUiDFFHVRDWUDWDPLHQWR\VHJXLPLHQWR
40
&2/(&,67(&720Ë$35(9(17,9$'(/&È1&(5'(9(6Ë&8/$(13(5621$6'($$f26
$FFHVR7RGREHQH¿FLDULRHQWUH\DxRV
&È1&(5*È675,&2
$FFHVR%HQH¿FLDULRPHQRUGHDxRV
&RQFRQ¿UPDFLyQGLDJQyVWLFDGH&iQFHUWHQGUiDFFHVRDWUDWDPLHQWR\VHJXLPLHQWR
$FFHVR%HQH¿FLDULRGHDxRV\PiV
4XHFXPSODFRQFULWHULRVGHLQFOXVLyQFRQWHQLGRVHQODV1RUPDV7pFQLFR0pGLFR\$GPLQLVWUDWLYR
&RQVRVSHFKDWHQGUiDFFHVRDDWHQFLyQSRUHVSHFLDOLVWD
&RQLQGLFDFLyQGHHVSHFLDOLVWDWHQGUiDFFHVRDFRQ¿UPDFLyQGLDJQyVWLFD
&RQGLDJQyVWLFRFRQ¿UPDGRWHQGUiDFFHVRDWUDWDPLHQWR
&È1&(5'(35Ï67$7$(13(5621$6'($f26<0È6
&RQUHFLGLYDWHQGUiDFFHVRDWUDWDPLHQWR\VHJXLPLHQWR
9,&,26'(5()5$&&,Ï1(13(5621$6'($f26<0È6
6yORFRQSUHVELFLDWHQGUiDFFHVRDOHQWHVVLQFRQ¿UPDFLyQGLDJQyVWLFD
&RQVRVSHFKDGHPLRStDDVWLJPDWLVPRRKLSHUPHWULRStDWHQGUiDFFHVRDFRQ¿UPDFLyQGLDJQyVWLFD
&RQFRQ¿UPDFLyQGLDJQyVWLFDWHQGUiDFFHVRDOHQWHV
(675$%,602(13(5621$60(125(6'($f26
/RV EHQH¿FLDULRV PD\RUHV GH DxRV \ TXH KD\DQ WHQLGR VRVSHFKD D SDUWLU GHO GH -XOLR GH
VLHQGRPHQRUGHDxRVWHQGUiQDFFHVRDFRQ¿UPDFLyQ\WUDWDPLHQWR
5(7,123$7Ë$',$%e7,&$
$FFHVR7RGREHQH¿FLDULRGLDEpWLFR
'(635(1',0,(172'(5(7,1$5(*0$7Ï*(121275$80È7,&2
+(02),/,$
&RQVRVSHFKDWHQGUiDFFHVRDFRQ¿UPDFLyQGLDJQyVWLFD\WUDWDPLHQWR
'(35(6,Ï1(13(5621$6'($f26<0È6
-8/ 13
MAY
75$7$0,(172 48,5Ò5*,&2 '( /$ +,3(53/$6,$ %(1,*1$ '( /$ 35Ï67$7$ (1 3(5621$6
6,1720È7,&$6
Ï57(6,62$<8'$67e&1,&$63$5$3(5621$6'($f26<0È6
$FFHVR7RGREHQH¿FLDULRGHDxRV\PiVTXHFXPSODFRQORVFULWHULRVGHLQFOXVLyQFRQWHQLGRVHQ
ODV1RUPDV7pFQLFR0pGLFR\$GPLQLVWUDWLYRWHQGUiDFFHVRDyUWHVLVFRUUHVSRQGLHQWH\
VHVLRQHVGHNLQHVLRORJtDVHJ~QLQGLFDFLyQPpGLFD

$7$48(&(5(%529$6&8/$5,648e0,&2(13(5621$6'($f26<0È6
$FFHVR7RGREHQH¿FLDULRGHDxRVRPiV
&RQFRQ¿UPDFLyQGLDJQyVWLFDWHQGUiDFFHVRDWUDWDPLHQWRLQFOX\HKRVSLWDOL]DFLyQVHJ~Q
LQGLFDFLyQPpGLFDHQSUHVWDGRUFRQFDSDFLGDGUHVROXWLYD
&RQWUDWDWDPLHQWRWHQGUiDFFHVRDUHKDELOLWDFLyQ\VHJXLPLHQWR
(1)(50('$'38/021$52%6758&7,9$&5Ï1,&$'(75$7$0,(172$0%8/$725,2
$FFHVR7RGREHQH¿FLDULRFRQVtQWRPDVREVWUXFWLYRV
&RQFRQ¿UPDFLyQGLDJQyVWLFDWHQGUiDFFHVRDFRQWLQXDUWUDWDPLHQWR
(QWUDWDPLHQWRWHQGUiDFFHVRDFRQWLQXDUORLQFOX\HQGRH[DFHUEDFLRQHV
$60$%52148,$/02'(5$'$<*5$9((13(5621$60(125(6'($f26
$FFHVR7RGREHQH¿FLDULRVLQWRPiWLFR
6Ë1'520('(',),&8/7$'5(63,5$725,$(1(/5(&,e11$&,'2
$FFHVR7RGREHQH¿FLDULRUHFLpQQDFLGR
&RQVRVSHFKDWHQGUiDFFHVRDFRQ¿UPDFLyQGLDJQyVWLFD\WUDWDPLHQWR
&RQFRQ¿UPDFLyQGLDJQyVWLFDWHQGUiDFFHVRDFRQWLQXDUWUDWDPLHQWR
75$7$0,(172 0e',&2 (1 3(5621$6 '( $f26 < 0È6 &21 $57526,6 '( &$'(5$ <2
52',//$/(9(202'(5$'$
&RQFRQ¿UPDFLyQGLDJQyVWLFDGH$UWURVLVGH5RGLOODOHYHRPRGHUDGDWHQGUiDFFHVRD
WUDWDPLHQWRPpGLFR
&RQFRQ¿UPDFLyQGLDJQyVWLFDGH$UWURVLVGH&DGHUDOHYHRPRGHUDGDWHQGUiDFFHVRD
WUDWDPLHQWRPpGLFR
+(0255$*,$68%$5$&12,'($6(&81'$5,$$583785$'($1(85,60$6&(5(%5$/(6
&RQVRVSHFKDGHKHPRUUDJLDVXEDUDFQRLGHDSRUDQHXULVPDFHUHEUDOURWRWHQGUiDFFHVR
DFRQ¿UPDFLyQGLDJQyVWLFD\WUDWDPLHQWR
&RQWUDWDPLHQWRWHQGUiDFFHVRDUHKDELOLWDFLyQ\VHJXLPLHQWR
78025(635,0$5,26'(/6,67(0$1(59,262&(175$/(13(5621$6'($f2620È6
&RQWUDWDPLHQWRWHQGUiDFFHVRDFRQWLQXDUOR
75$7$0,(17248,5Ò5*,&2'(+(51,$'(/1Ò&/(238/3262/80%$5
&RQFRQ¿UPDFLyQGHLQGLFDFLyQTXLU~UJLFDWHQGUiDFFHVRDFLUXJtDVLFXPSOHFRQORVFULWHULRVGH
LQFOXVLyQHVWDEOHFLGRVHQOD1RUPDGHFDUiFWHU7pFQLFR0pGLFR\$GPLQLVWUDWLYR
/(8&(0,$(13(5621$6'($f26<0È6
&RQVRVSHFKDWHQGUiDFFHVRDFRQ¿UPDFLyQGLDJQyVWLFD\HVWXGLRGH/HXFHPLD
&RQUHFLGLYDWHQGUiDFFHVRDFRQ¿UPDFLyQGLDJQyVWLFDWUDWDPLHQWR\VHJXLPLHQWR
85*(1&,$2'2172/Ï*,&$$0%8/$725,$
(QORVFDVRVGHVRVSHFKDGH$EVFHVRVGHHVSDFLRVDQDWyPLFRVGHOWHUULWRULR%XFR0i[LOR
)DFLDO\)OHJPRQ2UR&pUYLFR)DFLDOGHRULJHQRGRQWROyJLFRWHQGUiDFFHVRDWUDWDPLHQWRLQLFLDOHQ
XUJHQFLD
(QORVGHPiVFDVRVFRQFRQ¿UPDFLyQGLDJQyVWLFDWHQGUiDFFHVRDWUDWDPLHQWR
42
6$/8'25$/,17(*5$/'(/$'8/72'($f26
$FFHVR7RGREHQH¿FLDULRGHDxRVGHHGDGWHQGUiDFFHVRDWUDWDPLHQWR/DVROLFLWXGGHDWHQFLyQ
RGRQWROyJLFDGHEHUHDOL]DUVHPLHQWUDVHOEHQH¿FLDULRWHQJDDxRV(ODOWDVHRWRUJDFXDQGR
VHKDFRPSOHWDGRORVSURFHGLPLHQWRVGHSURPRFLyQSUHYHQFLyQUHFXSHUDFLyQ\UHKDELOLWDFLyQ
TXHUHTXLHUDHOLQGLYLGXR
32/,75$80$7,=$'2*5$9(
• &RQFRQ¿UPDFLyQGLDJQyVWLFDWHQGUiDFFHVRDWUDWDPLHQWRVLFXPSOHFRQORVVLJXLHQWHV
FULWHULRVGHLQFOXVLyQ
3DFLHQWHFRQOHVLRQHVGHRULJHQWUDXPiWLFRTXHDEDUTXHQGRVRPiVGHORVVLJXLHQWHV
VLVWHPDVQHUYLRVRUHVSLUDWRULRFLUFXODWRULRP~VFXORHVTXHOpWLFRGLJHVWLYRRXULQDULR\TXH
DOPHQRVXQRGHHOORVLPSOLTXHULHVJRGHPXHUWH
75$80$7,602&5È1(2(1&()È/,&202'(5$'22*5$9(
&RQVRVSHFKDWLHQHDFFHVRDFRQ¿UPDFLyQGLDJQyVWLFD
75$80$2&8/$5*5$9(
),%526,648Ë67,&$
&RQFRQ¿UPDFLyQGLDJQyVWLFDWHQGUiDFFHVRDHWDSL¿FDFLyQ\WUDWDPLHQWR
(QWUDWDPLHQWRWHQGUiGHUHFKRDFRQWLQXDUOR
$575,7,65(80$72,'($
&216802 3(5-8',&,$/ 2 '(3(1'(1&,$ '( 5,(6*2 %$-2 $ 02'(5$'2 '( $/&2+2/ <
'52*$6(13(5621$60(125(6'($f26
&RQFRQ¿UPDFLyQGLDJQyVWLFDGHFRQVXPRSHUMXGLFLDORGHSHQGLHQWHGHULHVJREDMR
DPRGHUDGRWHQGUiDFFHVRDWUDWDPLHQWR\VHJXLPLHQWR
(QFDVRGHUHFDtGDWHQGUiDFFHVRDWUDWDPLHQWR\VHJXLPLHQWR
$1$/*(6,$'(/3$572
$FFHVR7RGDEHQH¿FLDULDHQWUDEDMRGHSDUWRTXHXQDYH]LQIRUPDGDDFHSWH\FRQLQGLFDFLyQPpGLFD
7HQGUiDFFHVRDDQDOJHVLDIDUPDFROyJLFD
*5$148(0$'2
7HQGUiDFFHVRDWUDWDPLHQWR\VHJXLPLHQWRVLHPSUHTXHFXPSODFRQORVFULWHULRVGHLQFOXVLyQ
GH¿QLGRVHQOD1RUPD7pFQLFR0pGLFR\$GPLQLVWUDWLYR
+,32$&86,$ %,/$7(5$/ (1 3(5621$6 '( $f26 < 0È6 48( 5(48,(5(1 862 '(
-8/ 13
AUDÍFONO
MAY
&RQFRQ¿UPDFLyQGLDJQyVWLFDHLQGLFDFLyQPpGLFDGHDXGtIRQRWHQGUiDFFHVRD
WUDWDPLHQWR\VHJXLPLHQWR
5(7,123$7Ë$'(/35(0$7852
$FFHVR7RGREHQH¿FLDULRSUHPDWXURGHPHQRVGHJUDPRVRPHQRUGHVHPDQDVGHJHVWDFLyQ
DOQDFHU
7HQGUiQDFFHVRDVFUHHQLQJFRQIRQGRGHRMR
&RQFRQ¿UPDFLyQGLDJQyVWLFDWHQGUiDFFHVRDWUDWDPLHQWR\VHJXLPLHQWRVHJ~QLQGLFDFLyQ
PpGLFD
43
',63/$6,$%521&238/021$5'(/35(0$7852
$FFHVR 7RGR EHQH¿FLDULR SUHPDWXUR GH PHQRV GH JUDPRV DO QDFHU R PHQRUHV GH
VHPDQDVGHJHVWDFLyQ
&RQFRQ¿UPDFLyQGLDJQyVWLFDWHQGUiDFFHVRDWUDWDPLHQWR\VHJXLPLHQWR$FFHVRD
2[LJHQRWHUDSLDGRPLFLOLDULDVHJ~QUHVXOWDGRGH6DWXURPHWUtDFRQWLQXD
+,32$&86,$1(8526(1625,$/%,/$7(5$/'(/35(0$7852
$FFHVR 7RGR EHQH¿FLDULR SUHPDWXUR QDFLGR D FRQWDU GHO GH MXOLR GH FRQ PHQRV GH
JUDPRVDOQDFHURPHQRUGHVHPDQDVGHJHVWDFLyQ
7HQGUiDFFHVRDVFUHHQLQJDXGLWLYR
&RQVFUHHQLQJDOWHUDGRWHQGUiDFFHVRDFRQ¿UPDFLyQGLDJQyVWLFD
(3,/(36,$125()5$&7$5,$(13(5621$6'($f26<0È6
$60$%52148,$/(13(5621$6'($f26<0È6
(1)(50('$''(3$5.,1621
$575,7,6,',23È7,&$-89(1,/
&RQFRQ¿UPDFLyQGLDJQyVWLFDDQWHVGHORVDxRVWHQGUiDFFHVRDWUDWDPLHQWR
35(9(1&,Ï16(&81'$5,$,168),&,(1&,$5(1$/&5Ï1,&$7(50,1$/
4XHFXPSODFRQORVFULWHULRVGHLQFOXVLyQGHFOHDUDQFHGHFUHDWLQLQDPOPLQ\R
PLFURDOEXPLQXULDFRQRVLQDOWHUDFLRQHVGHOVHGLPHQWRXULQDULRWHQGUiDFFHVRDWUDWDPLHQWR
',63/$6,$/8;$17('(&$'(5$6
$FFHVR
7RGREHQH¿FLDULRGXUDQWHHOWHUFHUPHVGHYLGDWHQGUiDFFHVRDUDGLRJUDItDGHFDGHUDV
7RGREHQH¿FLDULRUHFLpQQDFLGRRODFWDQWHPHQRUGHDxR
&RQVRVSHFKDGHUDGLRJUDItDGHFDGHUDVRHFRWRPRJUDItDDOWHUDGDWHQGUiDFFHVRDFRQ¿UPDFLyQ
GLDJQyVWLFD
&RQFRQ¿UPDFLyQGLDJQyVWLFDGHGLVSODVLDOX[DQWHGHFDGHUDWHQGUiDFFHVRDWUDWDPLHQWR
RUWRSpGLFR
6$/8'25$/,17(*5$/'(/$(0%$5$=$'$
$FFHVR7RGDPXMHU
&RQFRQ¿UPDFLyQGHVXFRQGLFLyQGHHPEDUD]RWHQGUiDFFHVRDWUDWDPLHQWRGHQWDO
LQWHJUDO
(6&/(526,60Ò/7,3/(5(0,7(17(5(&855(17(
&RQVRVSHFKDTXHFXPSODFRQORVFULWHULRVGHLQFOXVLyQVHxDODGRVHQOD1RUPD7pFQLFR
0pGLFR\$GPLQLVWUDWLYRWHQGUiDFFHVRDFRQ¿UPDFLyQGLDJQyVWLFD
&RQFRQ¿UPDFLyQGLDJQyVWLFDWHQGUiDFFHVRDWUDWDPLHQWRVHJ~QFULWHULRVHVWDEOHFLGRVHQOD
1RUPD7pFQLFR0pGLFR\$GPLQLVWUDWLYR
(QWUDWDPLHQWRWHQGUiDFFHVRDFRQWLQXDUOR,QFOX\HH[DFHUEDFLRQHVRUHDJXGL]DFLRQHV
44
+(3$7,7,6&5Ï1,&$3259,586+(3$7,7,6%
&RQVRVSHFKDWHQGUiDFFHVRDHYDOXDFLyQLQLFLDO\WUDWDPLHQWR
+(3$7,7,6&5Ï1,&$3259,586+(3$7,7,6&
&È1&(5&2/255(&7$/(13(5621$6'($f26<0È6
&È1&(5'(29$5,2(3,7(/,$/
&RQFRQ¿UPDFLyQGLDJQyVWLFDWHQGUiDFFHVRDHWDSL¿FDFLyQWUDWDPLHQWR\VHJXLPLHQWR
&È1&(59(6,&$/(13(5621$6'($f26<0È6
&RQFRQ¿UPDFLyQGLDJQyVWLFDWHQGUiDFFHVRDWUDWDPLHQWR\HWDSL¿FDFLyQ
267(26$5&20$(13(5621$6'($f26<0È6
&RQFRQ¿UPDFLyQGLDJQyVWLFDWHQGUiDFFHVRDHWDSL¿FDFLyQWUDWDPLHQWR\VHJXLPLHQWR
75$7$0,(17248,5Ò5*,&2'(/(6,21(6&5Ï1,&$6'(/$9È/98/$$Ï57,&$(13(5621$6
'($f26<0È6
&RQFRQ¿UPDFLyQGHLQGLFDFLyQTXLU~UJLFDWHQGUiDFFHVRDFLUXJtDVHJXLPLHQWR\WUDWDPLHQWR
DQWLFRDJXODQWHVHJ~QLQGLFDFLyQPpGLFD
(QWUDWDPLHQWRDQWLFRDJXODQWHWHQGUiDFFHVRDFRQWLQXDUOR
75$672512%,32/$5(13(5621$6'($f26<0È6
&RQFRQ¿UPDFLyQGLDJQyVWLFDSRUHVSHFLDOLVWDWHQGUiDFFHVRDWUDWDPLHQWR
+,327,52,',602(13(5621$6'($f26<0È6
-8/ 13
75$7$0,(172'(+,32$&86,$02'(5$'$6(9(5$<352)81'$(13(5621$60(125(6'($f26
MAY
$FFHVR7RGREHQH¿FLDULRQDFLGRDFRQWDUGHOGHHQHURGH
&RQFRQ¿UPDFLyQGLDJQyVWLFDSRUHVSHFLDOLVWDVHJ~QFULWHULRVHVWDEOHFLGRVHQOD1RUPDGH
FDUiFWHU7pFQLFR0pGLFR\$GPLQLVWUDWLYRWHQGUiDFFHVRDWUDWDPLHQWR
/8386(5,7(0$72626,67e0,&2
45
75$7$0,(17248,5Ò5*,&2'(/(6,21(6&5Ï1,&$6'(/$69È/98/$50,75$/<75,&Ò63,'(
(13(5621$6'($f26<0È6
&RQFRQ¿UPDFLyQGHLQGLFDFLyQTXLU~UJLFDWHQGUiDFFHVRDFLUXJtDVHJXLPLHQWR\WUDWDPLHQWR
DQWLFRDJXODQWHVHJ~QLQGLFDFLyQPpGLFD
(QWUDWDPLHQWRDQWLFRDJXODQWHWHQGUiDFFHVRDFRQWLQXDUOR
75$7$0,(172'((55$',&$&,Ï1'(/+(/,&2%$&7(53</25,
$FFHVR7RGREHQH¿FLDULRTXHFXPSODFRQORVFULWHULRVGHLQFOXVLyQLQFRUSRUDGRVHQOD1RUPDGH
FDUiFWHU7pFQLFR0pGLFR\$GPLQLVWUDWLYRWHQGUiDFFHVRDWUDWDPLHQWR
&È1&(5'(38/0Ï1(13(5621$6'($f26<0È6
(QWUDWDPLHQWRWHQGUiDFFHVRDVHJXLPLHQWR
&È1&(5'(7,52,'(6',)(5(1&,$'2<0('8/$5(13(5621$6'($f26<0È6
&È1&(55(1$/(13(5621$6'($f26<0È6
&RQUHFLGLYDWHQGUiDFFHVRDWUDWDPLHQWR
0,(/20$0Ò/7,3/((13(5621$6'($f26<0È6
(1)(50('$''($/=+(,0(5<275$6'(0(1&,$6
(OD¿OLDGRGHEHUiLQIRUPDUVHHQVX,VDSUHDWUDYpVGHORVPHGLRVTXHpVWDGLVSRQJDUHVSHFWRGHORVDOFDQFHV
FRQGLFLRQHV FREHUWXUDV \ SUHVWDFLRQHV DVRFLDGRV D HVWDV FRQGLFLRQHV GH VDOXG JDUDQWL]DGDV

PPI
CONDICIONES PARTICULARES PLAN PREVENTIVO DE ISAPRES – PPI

3RUHOSUHVHQWHLQVWUXPHQWRVHSRQHHQVXFRQRFLPLHQWRORVEHQH¿FLRV\IXQFLRQDPLHQWRGHO3ODQ3UHYHQWLYR
GH,VDSUHV33,
(O33,LQFOX\HODWRWDOLGDGGHODVSUHVWDFLRQHVSURFHGLPLHQWRVH[iPHQHVLQWHUYHQFLRQHV\PpWRGRVLQFOXLGRV
HQHO'61GHOGHORV0LQLVWHULRVGH6DOXG\+DFLHQGDHQOD5HVROXFLyQ([HQWD1GH
GHO0LQLVWHULRGH6DOXGTXHUHJXODHO([DPHQGH0HGLFLQD3UHYHQWLYD\HQODV1RUPDV7pFQLFDVGH&DUiFWHU
REOLJDWRULRTXHHO0LQLVWHULRGH6DOXGGLFWHFRQHOREMHWRGHXQLIRUPDUORVFULWHULRVGHHMHFXFLyQGHPHGLFLyQ\
YDOLGDFLyQGHORVH[iPHQHVSDUDHOJUXSRGHSREODFLyQTXHFRUUHVSRQGD
&RPSOHPHQWDULDPHQWHVHSUHVHQWDQRWUDVSUHVWDFLRQHVTXHODV,VDSUHVKDQLQFRUSRUDGRYROXQWDULDPHQWHSDUD
HQWUHJDUDVXVEHQH¿FLDULRV
35,0(52*(1(5$/,'$'(6
(O 3ODQ 3UHYHQWLYR GH ,VDSUHV 33, GHWDOOD ODV FREHUWXUDV UHIHULGDV D ODV ERQL¿FDFLRQHV FRQWHQLGDV HQ
GLFKR SODQ RUGHQDGDV GH DFXHUGR D OR VLJXLHQWH 3URJUDPD GHO 1LxR &RQWURO GHO (PEDUD]R \ 3URJUDPD
3HUVRQDVGHDxRV\PiV
6(*81'2&2%(5785$
/DV SUHVWDFLRQHV TXH QR VH HQFXHQWUHQ GHWDOODGDV HQ HO 3ODQ 3UHYHQWLYR GH ,VDSUHV 33, PDQWHQGUiQ
VL FRUUHVSRQGH ODV FRQGLFLRQHV \ FREHUWXUD GH ORV UHVSHFWLYRV 3ODQHV GH 6DOXG &RPSOHPHQWDULRV \ GH
*(6 TXH WHQJDQ ORV D¿OLDGRV DO PRPHQWR GH UHTXHULU WDOHV DWHQFLRQHV (O D¿OLDGR \ EHQH¿FLDULR GHFLGLUi
cuando solicitar las coberturas del PPI cuando corresponda de acuerdo a los procedimientos indicados
SRUOD,VDSUH/DFREHUWXUDVyORRSHUDUiVLHOEHQH¿FLDULRFXPSOHFRQHOSURFHGLPLHQWR\DGHPiVVHDWLHQGH
HQHOSUHVWDGRUUHIHULGRSRUOD,VDSUH
(Q OR TXH FRUUHVSRQGD D ODV SUHVWDFLRQHV FRQWHPSODGDV HQ *(6 HVWH 3ODQ 3UHYHQWLYR GH 6DOXG OR
FRPSOHPHQWD\DPSOtD
/D FREHUWXUD ¿QDQFLHUD SDUD HO 3ODQ 3UHYHQWLYR GH ,VDSUHV VHUi GH XQ GHO YDORU GH ODV SUHVWDFLRQHV
VLHPSUHTXHVHFXPSODQODVFRQGLFLRQHVGHVFULWDVHQHOSUHVHQWHGRFXPHQWR
7(5&(529,*(1&,$
/D YLJHQFLD GH ODV SUHVWDFLRQHV TXH FRUUHVSRQGHQ DO 3ODQ 3UHYHQWLYR GH ,VDSUHV 33, \ ORV EHQH¿FLRV
PtQLPRV HVWi VXMHWD D ODV GLVSRVLFLRQHV OHJDOHV \ UHJODPHQWDULDV UHVSHFWLYDV 1R REVWDQWH OD FREHUWXUD
GH DTXHOODV SUHVWDFLRQHV YROXQWDULDPHQWH LQFOXLGDV SRU ODV ,VDSUHV ± DGLFLRQDOHV D ODV GH¿QLGDV OHJDO \
UHJODPHQWDULDPHQWH±SRGUiVHUUHYLVDGDSXGLHQGRSRUDFXHUGRGHODV,VDSUHVDGVFULWDVH[FOXLURUHHPSOD]DU
GLFKDVSUHVWDFLRQHV
&8$572)250$/,'$'(6&21',&,21(6'($7(1&,Ï1<'($&&(62
3DUD WHQHU GHUHFKR D ODV FREHUWXUDV LQGLFDGDV HQ HO 3ODQ 3UHYHQWLYR GH ,VDSUHV 33, ORV D¿OLDGRV \
-8/ 13
EHQH¿FLDULRV GHEHUiQ DWHQGHUVH FRQ HO SUHVWDGRU GH VDOXG TXH SDUD FDGD FDVR HVSHFt¿FR GHWHUPLQH OD
MAY
,VDSUH(QFDVRFRQWUDULRQRSRGUiLQYRFDUHVWHEHQH¿FLR\QRSURFHGHUiODFREHUWXUDGHGLFKDVSUHVWDFLRQHV
'LFKDV SUHVWDFLRQHV VH RWRUJDUiQ H[FOXVLYDPHQWH D WUDYpV GH HVWDEOHFLPLHQWRV XELFDGRV HQ HO WHUULWRULR
QDFLRQDO \ UHIHULGR H[SOtFLWDPHQWH SRU OD ,VDSUH (O WUDVODGR GHO EHQH¿FLDULR DO SUHVWDGRU UHIHULGR HV GH
VXFDUJR\UHVSRQVDELOLGDG
8QD YH] GHVLJQDGR HO SUHVWDGRU HO D¿OLDGR R EHQH¿FLDULR GHEHUi LQGLFDU H[SUHVDPHQWH \ SRU HVFULWR
VXFRQIRUPLGDGFRQGLFKRSUHVWDGRU
/DVFREHUWXUDVGHO33,VHDSOLFDUiQVRODPHQWHDODVSUHVWDFLRQHVDVRFLDGDVDGLFKRSODQ
7RGDV ODV GHPiV SUHVWDFLRQHV QR REVWDQWH VH UHDOLFHQ HQ HO SUHVWDGRU LQGLFDGR SRU OD ,VDSUH WHQGUiQ
ODFREHUWXUDGHO3ODQ&RPSOHPHQWDULRGH6DOXG

48,17235(&,2
/D FREHUWXUD ¿QDQFLHUD SDUD HO 3ODQ 3UHYHQWLYR GH ,VDSUHV VHUi GH XQ GHO YDORU GH ODV SUHVWDFLRQHV
\ QR WLHQH FRVWR DGLFLRQDO DO 3ODQ GH 6DOXG &RPSOHPHQWDULR VLHPSUH TXH VH HQWUHJXHQ HQ ODV FRQGLFLRQHV
RSRUWXQLGDG\HQORVSUHVWDGRUHVUHIHULGRVSRUOD,VDSUH
6(;72%(1(),&,$5,26
/RV EHQH¿FLDULRV GH HVWD FREHUWXUD VHUiQ DTXHOORV LQGLFDGRV HQ HO ~OWLPR )81 GHO &RQWUDWR GH 6DOXG
SUHYLVLRQDOYLJHQWH
6e37,02352*5$0$635(9(17,926
(O 3ODQ 3UHYHQWLYR GH ,VDSUHV 33, HVWi RUJDQL]DGR HQ WUHV SURJUDPDV GH DFXHUGR DO JUXSR GH SREODFLyQ
TXH FRUUHVSRQGD 3URJUDPD GHO 1LxR &RQWURO GHO (PEDUD]R \ 3URJUDPD GH 3HUVRQDV GH DxRV \ PiV
7.1. PROGRAMA DEL NIÑO

(O SURJUDPD GHO QLxR WLHQH SRU SURSyVLWR DSR\DU XQ GHVDUUROOR LQWHJUDO DGHFXDGR \ D\XGDU D OD IRUPDFLyQ
GHKiELWRVVDOXGDEOHV/DVDFWLYLGDGHVFRPSUHQGLGDVHQHVWHSURJUDPDVRQ
&21752/ '(/ '(6$552//2 36,&202725 (67$'2 1875,&,21$/ 2%(6,'$' 5(*,6752

<&216(-(5Ë$'(,1081,=$&,Ï13$,
,QWHUYHQFLyQ &RQWURO SRU HQIHUPHUDV FRQ GHULYDFLyQ D QXWULFLRQLVWD FXDQGR HVWpQ DOWHUDGRV VXV SDUiPHWURV
GHSHVR\WDOOD
%HQH¿FLDULR5HFLpQQDFLGRKDVWDDxRV
&URQRJUDPDGHO&RQWUROGHO1LxR
5HFLpQQDFLGRSULPHURVGtDVGRVFRQWUROHVSRUPpGLFRSRUHQIHUPHUD

$ORVPHVHVGHHGDG
$ORVPHVHVGHHGDG
$ORVPHVHVGHHGDG
$ORVPHVHVGHHGDG
$ORVPHVHVGHHGDG
$ORVPHVHVGHHGDG
$ORVPHVHVGHHGDG
$ORVPHVHVGHHGDG
$ORVPHVHVGHHGDG
$ORVPHVHVGHHGDG
$ORVPHVHVGHHGDG
$ORVDxRVGHHGDGGRVFRQWUROHVSRUDxR
(Q FDGD FRQWURO VH FXPSOLUiQ ODV DFWLYLGDGHV GHWDOODGDV HQ HO $QH[R 1 ³2EMHWLYRV VHJ~Q FRQWURO´
RECIÉN NACIDOS
7.1.2 FENILCETONURIA
([DPHQ'HWHUPLQDFLyQGHIHQLODODQLQDHQVDQJUH
)UHFXHQFLD8QDYH]GHQWURGHORVGtDVGHVGHHOQDFLPLHQWR
%HQH¿FLDULR5HFLpQQDFLGR

7.1.3 HIPOTIROIDISMO CONGÉNITO
([DPHQ'HWHUPLQDFLyQGH76+HQVDQJUH
%HQH¿FLDULR5HFLpQ1DFLGR
7.1.4 DISPLASIA DEL DESARROLLO DE CADERAS

([DPHQ0DQLREUDGH2UWRODQLR%DUORZ
%HQH¿FLDULR5HFLpQQDFLGR
LACTANTES
7.1.5 DISPLASIA DEL DESARROLLO DE CADERAS

([DPHQ5DGLRJUDItDGH3HOYLV
)UHFXHQFLD8QDYH]DORVWUHVPHVHVGHHGDG
%HQH¿FLDULR/DFWDQWH
1,f26<1,f$6(175(<$f26
62%5(3(62<2%(6,'$'
([DPHQ0HGLFLyQGHOSHVR\WDOOD
)UHFXHQFLD8QDYH]HQHOSHUtRGR
%HQH¿FLDULR1LxRV\QLxDVGHDxRV
$0%/,23Ë$(675$%,602<'()(&726(1/$$*8'(=$9,68$/
([DPHQ$SOLFDFLyQGHODFDUWLOOD/($
7.1.8 DETECCIÓN DE MALOS HÁBITOS BUCALES

([DPHQ3HVTXLVDSUHFR]GHIDFWRUHVGHULHVJRSDUDSDWRORJtDVEXFDOHV
7.2 PROGRAMA CONTROL DEL EMBARAZO
(O SURJUDPD FRQWURODUi HO HPEDUD]R GH WDO IRUPD GH DSR\DU OD ODERU GHO SURIHVLRQDO PpGLFR UHFRPHQGDQGR
ORV H[iPHQHV UHTXHULGRV HQ FDGD HWDSD /DV DFWLYLGDGHV FRPSUHQGLGDV HQ HVWH SURJUDPD VRQ
&21752/0e',&2<'(0$7521$
,QWHUYHQFLyQGH0pGLFRDOLQLFLRGHOHPEDUD]RHUPHV\DOYRPHV
,QWHUYHQFLyQGH0DWURQD,QLFLRGHO&RQWUROSUHQDWDOGH0DWURQDDQWHVGHVHPDQDVGHDPHQRUUHD
PLGLHQGRSHVR\WDOODPHGLFLyQHVWDQGDUL]DGDGHODSUHVLyQDUWHULDO&XHVWLRQDULRGH$XWRGLDJQyVWLFR
VREUH5LHVJRVHQHO8VRGH$OFRKRO$8',7DSOLFDFLyQGHOLQVWUXPHQWR(VWUDWHJLD$¶VVHJ~Q*XtD
&OtQLFD\HIHFWXDQGRODVGHULYDFLRQHVSDUDODUHDOL]DFLyQGHORVVLJXLHQWHVH[iPHQHVLQFOX\HQGRJUXSR
\5KKHPRJORELQD\KHPDWRFULWR9'5/R535HQVDQJUHJOLFHPLDHQD\XQDVRULQDFRPSOHWD\
HFRJUDItDSUHFR]±DQWHVGHVHPDQDVGHJHVWDFLyQ±/XHJRODUHSHWLFLyQGHH[iPHQHVVHJ~QSDXWD
VHUtDLXQQXHYR9'5/DODVVHPDQDVLLXQDJOLFHPLDR37*HQWUHODV\VHPDQDV\LLLXQ
KHPDWRFULWR\KHPRJORELQDHQWUH\VHPDQDV&RQWURODUGLDEHWHVPHOOLWXVDPXMHUHVGXUDQWHHO
HPEDUD]RDQWHVGHODVVHPDQDVGHJHVWDFLyQ
)UHFXHQFLD7UHVYHFHVGHQWURGHOHPEDUD]R
%HQH¿FLDULR0XMHUHVHPEDUD]DGDV
-8/ 13
MAY
7.2.2 DIABETES MELLITUS GESTACIONAL

([DPHQ*OLFHPLDHQD\XQDV
)UHFXHQFLD(QHOSULPHUFRQWUROGHOHPEDUD]RLGHDOPHQWHDQWHVGHODVVHPDQDV
%HQH¿FLDULR(PEDUD]DGDV
7.2.3 INFECCIÓN POR VIRUS DE INMUNODEFICIENCIA HUMANA

([DPHQ7HVWGH(OLVDSDUD9,+HQVDQJUH'HEHUHDOL]DUVHFRQFRQVHMHUtDSUHYLDGHPDQHUDYROXQWDULD\FRQ
FRQVHQWLPLHQWRLQIRUPDGR/H\1&RQVHMHUtDSUHYLDDOH[DPHQ\FRQVHMHUtDSRVWH[DPHQHQ
ODVHPEDUD]DGDVFRQ9,+SRVLWLYR
%HQH¿FLDULR(PEDUD]DGDVTXHDFHSWHQUHDOL]DUVHHOH[DPHQ

7.2.4 SÍFILIS
([DPHQ9'5/9HQHUHDO'LVHDVH5HVHDUFK/DERUDWRU\R5355DSLG3ODVPD5HDJLQHQVDQJUH
7.2.5 INFECCIÓN URINARIA

([DPHQ8URFXOWLYR
62%5(3(62<2%(6,'$'
([DPHQ0HGLFLyQGHSHVR\WDOOD&RQVHMHUtDVREUHKiELWRVVDOXGDEOHVGHDOLPHQWDFLyQ\DFWLYLGDGItVLFD
7.2.7 HIPERTENSIÓN ARTERIAL

([DPHQ0HGLFLyQHVWDQGDUL]DGDGHODSUHVLyQDUWHULDO
7.2.8 BEBER PROBLEMA

([DPHQ&XHVWLRQDULRGHDXWRGLDJQyVWLFRVREUH5LHVJRVHQHO8VRGHO$OFRKRO$8',7\RYHUVLyQDFRU
WDGD&RQVHMHUtDVHJ~QHOWLSRGHFRQVXPRGHDOFRKROHQSHUVRQDVGHEDMRULHVJRHQULHVJR
SUREOHPDRGHSHQGHQFLD
7.2.9 TABAQUISMO
([DPHQ$SOLFDFLyQGHOLQVWUXPHQWR(VWUDWHJLD$VVHJ~QJXtDFOtQLFD&RQVHMHUtDEUHYH\UHIHULUD
WUDWDPLHQWRFRQHOSURIHVLRQDOTXHUHDOLFHHOFRQWUROGHOHPEDUD]R
%HQH¿FLDULRHPEDUD]DGDV
352*5$0$'(/$'8/72<(/'(/$'8/720$<25
(O SURJUDPD WLHQH SRU SURSyVLWR SURPRYHU KiELWRV VDOXGDEOHV GHWHFWDU DGLFFLRQHV GH DOFRKRO \ WDEDFR
&RQWURODU REHVLGDG KLSHUWHQVLyQ \ QLYHOHV GH FROHVWHURO \ HVWLPXODU XQD DOLPHQWDFLyQ DGHFXDGD SUHYLD D
OD FRQFHSFLyQ (Q FDGD FDVR VH HIHFWXDUi OD UHFRPHQGDFLyQ TXH FRUUHVSRQGD (O SURJUDPD UHVSHFWR GHO
DGXOWR PD\RU WLHQH SRU SURSyVLWR DSR\DU OD PDQWHQFLyQ GH OD DXWRYDOHQFLD SURPRYLHQGR KiELWRV VDOXGDEOHV
FRQWURODQGR VX FDSDFLGDG DXGLWLYD \ GH PRYLOLGDG /DV DFWLYLGDGHV FRPSUHQGLGDV HQ HVWH SURJUDPD VRQ
&RQWURO SRU PpGLFR HQIHUPHUD HQIHUPHUD PDWURQD PDWURQD QXWULFLRQLVWD X RWUR LQWHJUDQWH GHO HTXLSR GH
VDOXGGHELGDPHQWHFDSDFLWDGRVDOYRORH[SUHVDPHQWHLQGLFDGR
3(5621$6'($f26<0È6
35202&,Ï1'(/(-(5&,&,2
([DPHQ&RQVHMHUtD
)UHFXHQFLD8QDYH]DODxR
%HQH¿FLDULR3HUVRQDVGHDxRV\PiV
7.3.2 BEBEDOR PROBLEMA

([DPHQ&XHVWLRQDULRGH$XWRGLDJQyVWLFRVREUH5LHVJRVHQHO8VRGH$OFRKRO$8',7\RYHUVLyQDFRUWDGD
\FRQVHMHUtDUHVSHFWRGHWHUDSLD
)UHFXHQFLDYH]FDGDDxRV
%HQH¿FLDULR3HUVRQDVGH\PiVDxRV
7.3.3 TABAQUISMO
([DPHQ$SOLFDFLyQGHO,QVWUXPHQWR(VWUDWHJLD$¶VVHJ~Q*XtD&OtQLFD\FRQVHMHUtDEUHYH
50
62%5(3(62<2%(6,'$'
([DPHQ0HGLFLyQGH3HVR\7DOOD&iOFXORËQGLFHGH0DVD&RUSRUDO,0&\PHGLFLyQGHFLUFXQIHUHQFLD
GHFLQWXUD&&SDUDGHWHFWDUSHUVRQDVREHVDVFRQPD\RUULHVJRFDUGLRYDVFXODU&RQVHMHUtDHQ
DOLPHQWDFLyQVDOXGDEOHHLQFUHPHQWRGHODDFWLYLGDGItVLFD&RQVHMHUtDSRUSDUWHGH1XWULFLRQLVWD\
GHULYDFLyQ&$(&VLFRUUHVSRQGH
7.3.5 HIPERTENSIÓN ARTERIAL

([DPHQ0HGLFLyQHVWDQGDUL]DGDGHSUHVLyQDUWHULDO
7.3.6 DIABETES MELLITUS

([DPHQ*OLFHPLDHQD\XQDV
7.3.7 SÍFILIS
([DPHQ([DPHQGH9'5/R535HQVDQJUH
)UHFXHQFLDYH]FDGDDxRV%HQH¿FLDULRVFRQFRQGXFWDVRIDFWRUHVGHULHVJRXQDYH]DODxR
7.3.8 TUBERCULOSIS
([DPHQ%DFLORVFRStDDWRGDSHUVRQDFRQWRVSURGXFWLYDSRUPiVGHGtDVDOPRPHQWRGHOH[DPHQ
)UHFXHQFLDYH]FDGDDxRV\RWRGDSHUVRQDFRQWRVSURGXFWLYDSRUPiVGHGtDV
%HQH¿FLDULR3HUVRQDVPD\RUHVGHDxRVFRQVtQWRPDVUHVSLUDWRULRVSRUGtDVRPiV
08-(5(6'($$f26
6LQSHUMXLFLRGHODUHDOL]DFLyQGHORVH[iPHQHVLQGLFDGRVSDUDHOJUXSRGHDxRV\PiVGHEHUi
HIHFWXDUVHHQHVWHJUXSRGHSREODFLyQODSHVTXLVDGHODVLJXLHQWHFRQGLFLyQ
7.3.9 CÁNCER CERVICOUTERINO

([DPHQ3DSDQLFRODX3$3RFLWRORJtDH[IROLDWLYDFHUYLFDO
)UHFXHQFLD8QDYH]FDGDDxRV
%HQH¿FLDULR0XMHUHVGHDDxRV\HQWUH\DxRVFRQYLGDVH[XDODFWLYD
3(5621$6'(<0È6$f26
7.3.10 DISLIPIDEMIA
([DPHQ0HGLFLyQGHO&ROHVWHURO7RWDO&RQVHMHUtDSRUSDUWHGH1XWULFLRQLVWDVLFRUUHVSRQGH
%HQH¿FLDULR+RPEUHV\PXMHUHVGH\PiVDxRV
08-(5(6'(<+$67$$f26
7.3.11 CÁNCER DE MAMA

([DPHQ0DPRJUDItDVHQWRWDODFRQWDUGHORVDxRVGHYLGD\KDVWDORVDxRV
%HQH¿FLDULR0XMHUHVGH\KDVWDDxRV
-8/ 13
$'8/72'(<0È6$f26
MAY
7.3.12 EVALUACIÓN FUNCIONAL PARA UNA VIDA AUTOVALENTE (AUTONOMÍA FUNCIONAL)

([DPHQ&XHVWLRQDULRHVWDQGDUL]DGRHYDOXDFLyQIXQFLRQDOGHODGXOWRPD\RU()$0\FRQVHMHUtD
)UHFXHQFLD$QXDO
%HQH¿FLDULR%HQH¿FLDULRVPD\RUHVGHDxRV
(YDOXDFLyQGHODPRYLOLGDGFDSDFLGDGGHDOLPHQWDFLyQYLVLyQDXGLFLyQ\GHULYDFLyQD*(6VLFRUUHVSRQGH
0$<25(6'($f26
7.3.13 PREVENCION CARDIOVASCULAR EN POBLACIÓN DE RIESGO

,QWHUYHQFLyQ&RQVHMHUtDUHVSHFWRGHKiELWRVVDOXGDEOHVDOLPHQWDFLyQFRQVXPRGHiFLGRDFHWLOVDOLFtOLFR\RWURV
%HQH¿FLDULR0D\RUHVGHDxRV

08-(5(6(1('$')e57,/
35202&,Ï1&216802'(È&,'2)Ï/,&2),(552<&$/&,2
,QWHUYHQFLyQ&DPSDxDGHLQIRUPDFLyQDJUXSRVHVSHFt¿FRV
%HQH¿FLDULR0XMHUHVHQHGDGIpUWLO
2%-(7,9266(*Ò1&21752/
352*5$0$'(/1,f2
(Q HO SHUtRGR GH UHFLpQ QDFLGR IRPHQWDU OD ODFWDQFLD QDWXUDO HGXFDQGR D OD PDGUH UHVSHFWR GH OD
WpFQLFD GH DOLPHQWDFLyQ DFODUDQGR VXV GXGDV FRQWURODQGR OD HYROXFLyQ GHO SHVR \ OD WDOOD \ D OD YH]
GHFKHTXHDUORVUHVXOWDGRVGHORVH[iPHQHVWRPDGRVDOQDFHUSDUDGHWHFWDUIHQLOFHWRQXULDHKLSRWLURLGLVPR
FRQJpQLWR ± \ 9'5/ GH FRUGyQ ± $QWH OD GHWHFFLyQ GH DQRUPDOLGDGHV GH FXDOTXLHU QDWXUDOH]D VHUtD
UHIHULGRDVXSHGLDWUD
$ORVPHVHVVHUHDOL]DUtDHOFRQWUROGHSHVRWDOOD\FLUFXQIHUHQFLDFUDQHDQDHYDOXDFLyQGHOGHVDUUROOR
SVLFRPRWRU \ UHIHUHQFLD D YDFXQDFLyQ (YDOXDFLyQ GH DXGLFLyQ 6H GDUtD RUGHQ GH UHDOL]DFLyQ GH
UDGLRJUDItD GH SHOYLV SDUD ODFWDQWHV GH VH[R IHPHQLQR (YDOXDU SUHVHQFLD GH KHUQLDV \ GHULYDU HQ FDVR
GH VHU QHFHVDULR (GXFDFLyQ HQ DOLPHQWDFLyQ VDQD 3UHYHQFLyQ GHO 6tQGURPH ,QIDQWLO GH 0XHUWH 6~ELWD
±6,06±FX\RVIDFWRUHVGHULHVJRVRQHOFRQVXPRGHWDEDFRSRUSDUWHGHODHPEDUD]DGDSUHPDWXURV
RGHEDMRSHVRGHQDFLPLHQWRDWUDYpVGHHGXFDFLyQHVSHFt¿FD
$ ORV PHVHV VH UHDOL]DUtD XQD HYDOXDFLyQ GH SHVR WDOOD \ FLUFXQIHUHQFLD FUDQHDQD &KHTXHR GH
UHDOL]DFLyQ \ UHVXOWDGRV GH 5DGLRJUDItD GH SHOYLV GHULYDFLyQ DO SHGLDWUD HQ FDVR GH QHFHVLGDG \
HYDOXDFLyQ GH FXPSOLPLHQWR GH YDFXQDFLyQ \ GHULYDFLyQ D GRVLV GH ORV PHVHV (YDOXDFLyQ GH FLFDWUL]
%&* 5HDOL]DFLyQ GH HYDOXDFLyQ GH GHVDUUROOR SVLFRPRWRU \ GHULYDFLyQ VL GHWHFWD UHWUDVR R ULHVJR
(GXFDFLyQHQDOLPHQWDFLyQVDQD\SUHYHQFLyQGHDFFLGHQWHV
FXPSOLPLHQWR GH YDFXQDFLyQ \ GHULYDFLyQ D GRVLV GH ORV PHVHV (YDOXDFLyQ GHO GHVDUUROOR 3VLFRPRWRU
\ GH OD HUXSFLyQ GHQWDULD HGXFDFLyQ HQ DOLPHQWDFLyQ VDQD \ HQ SUHYHQFLyQ GH DFFLGHQWHV GRPpVWLFRV
$ ORV PHVHV VH UHDOL]DUtD XQD HYDOXDFLyQ GH SHVR WDOOD \ FLUFXQIHUHQFLD FUDQHDQD &KHTXHR
GH FXPSOLPLHQWR GH YDFXQDFLyQ \ GHULYDFLyQ D GRVLV PHVHV (YDOXDFLyQ GHO GHVDUUROOR 3VLFRPRWRU
GHVFDUWDU FULSWRUTXLGHD \ HGXFDFLyQ HQ DOLPHQWDFLyQ VDQD \ HQ SUHYHQFLyQ GH DFFLGHQWHV GRPpVWLFRV
FXPSOLPLHQWR GH YDFXQDFLyQ \ GHULYDFLyQ D GRVLV GH PHVHV 3UHYHQFLyQ GH VDOXG RUDO HGXFDFLyQ
HQDOLPHQWDFLyQVDQD\SUHYHQFLyQGHDFFLGHQWHVGRPpVWLFRV
$ ORV PHVHV VH UHDOL]DUtD XQD HYDOXDFLyQ GH SHVR WDOOD \ FLUFXQIHUHQFLD FUDQHDQD &KHTXHR
GH FXPSOLPLHQWR GH YDFXQDFLyQ 'HVFDUWDU OD SUHVHQFLD GH ¿PRVLV (GXFDFLyQ HQ DOLPHQWDFLyQ VDQD
\SUHYHQFLyQGHDFFLGHQWHV
$ ORV DxRV VH UHDOL]DUtD XQD HYDOXDFLyQ GH SHVR \ WDOOD &KHTXHR GH FXPSOLPLHQWR GH YDFXQDFLyQ
(GXFDFLyQ HQ DOLPHQWDFLyQ VDQD \ SUHYHQFLyQ GH DFFLGHQWHV \ PHGLFLyQ GH DJXGH]D YLVXDO
$ ORV DxRV VH UHDOL]DUtD XQD HYDOXDFLyQ GH SHVR \ WDOOD &RQWURO GH 3UHVLyQ $UWHULDO &KHTXHR
GHFXPSOLPLHQWRGHYDFXQDFLyQ'HULYDFLyQDGRVLVDxRV(GXFDFLyQHQDOLPHQWDFLyQVDQDSUHYHQFLyQ
GHDFFLGHQWHV\PHGLFLyQGHDJXGH]DYLVXDO
$ ORV DxRV VH UHDOL]DUtD XQD HYDOXDFLyQ GH SHVR \ WDOOD &RQWURO GH 3UHVLyQ $UWHULDO &KHTXHR GH
FXPSOLPLHQWR GH YDFXQDFLyQ (GXFDFLyQ HQ DOLPHQWDFLyQ VDQD \ SUHYHQFLyQ GH DFFLGHQWHV (YDOXDFLyQ
GHLQVHUFLyQHVFRODU(YDOXDFLyQGHDXGLFLyQ\DJXGH]DYLVXDO±WHVWGH6QHOOHQ±
$ORVDxRVVHUHDOL]DUtDXQDHYDOXDFLyQGHSHVR\WDOOD\GHVDUUROORSXEHUDO(GXFDFLyQHQPDGXUDFLyQ
VH[XDO (GXFDFLyQ HQ DOLPHQWDFLyQ VDQD \ SUHYHQFLyQ GH DFFLGHQWHV (GXFDFLyQ HQ SUHYHQFLyQ GH LQLFLR
GHOKiELWRWDEiTXLFR\FRQVXPRGHDOFRKRO\GURJDV(YDOXDFLyQGHDJXGH]DYLVXDO
(O SDFLHQWH VHUi UHIHULGR D XQ PpGLFR SHGLDWUD HQ FDVR GH GHWHFWDUVH DQRUPDOLGDG GHO GHVDUUROOR \R GH
UHVXOWDGRVGHH[iPHQHV6HGHEHRULHQWDUDODPDGUHDFHUFDGHOXJDUHVGHYDFXQDFLyQ6HUiQHFHVDULR
FRQWDU FRQ ORV UHJLVWURV SHUWLQHQWHV GH UHVXOWDGRV REWHQLGRV \ IUHFXHQFLDV GHWHUPLQDGDV GH FRQWUROHV
52
-8/ 13
MAY
www.colmena.cl Mesa Central 2 2959 4000

Golden Phone 2 2959 4040

Actualizacion Contrato de Salud

Cargado por

Información del documento

Derechos de autor

Formatos disponibles

Compartir este documento

Compartir o incrustar documentos

Opciones para compartir

¿Le pareció útil este documento?

¿Este contenido es inapropiado?

Copyright:

Formatos disponibles

Actualizacion Contrato de Salud

Cargado por

Copyright:

Formatos disponibles

Condiciones Generales Uniformes

para el Contrato de Salud Previsional

Contrato de Salud Previsional

BENEFICIARIOS DEL CONTRATO E INICIO DE VIGENCIA DE SUS BENEFICIOS

(O)RQGR1DFLRQDOGH6DOXG )RQDVD SRUVXSDUWHHVHOHQFDUJDGRGHDVHJXUDUODSURWHFFLyQ¿QDQFLHUDTXH

(O3ODQGH6DOXG&RPSOHPHQWDULRSXHGHVHULQGLYLGXDORJUXSDO WDPELpQGHQRPLQDGRVFROHFWLYRV /RVSODQHV

B) PAGO DE LAS ATENCIONES MÉDICAS Y ARANCEL DE PRESTACIONES

F 3URJUDPDGH$WHQFLyQ0pGLFDR3$0 Opera este sistema por las prestaciones otorgadas en forma

A) OBLIGACIONES DEL AFILIADO

D &REHUWXUDSDUDHQIHUPHGDGHVRFRQGLFLRQHVGHVDOXGSUHH[LVWHQWHVGHFODUDGDV Las prestaciones de salud

G2PLWLUGHO&RQWUDWRDDOJ~QIDPLOLDUEHQH¿FLDULRGHORVLQGLFDGRVHQODVOHWUDVE \F GHODUWtFXORGHO')/1

2) Incumplimiento de las obligaciones de la Isapre.

 )LUPDRKXHOODGLJLWDOGHOD¿OLDGR Firma Isapre

CONDICIONES DE LA COBERTURA ADICIONAL PARA ENFERMEDADES

1) Si opta por la atención en GES

2) Si no opta por la atención en GES

3) Vigencia inicial de la cobertura adicional GES-CAEC

PETICIÓN DEL BENEFICIO Y DERIVACIÓN A LA RED

SOLICITUD DE INCORPORACIÓN A LA RED CERRADA DE LA COBERTURA

1RPEUHGHO3DFLHQWHBBBBBBBBBBBBBBBBBBBBBBBBBBBB(GDGBBBBBB 587SDFLHQWH BBBBBBBBBB

Isapre Colmena Golden Cross

'(5,9$&,Ï1$ /$ 5(' &(55$'$ '($7(1&,21(6 3$5$ (1)(50('$'(6 &$7$675Ï),&$6 &$(&

PRESTACIONES NO INCLUIDAS EN LA COBERTURA ADICIONAL PARA ENFERMEDADES

 3UHVWDFLRQHV PpGLFDVIiUPDFRV\WpFQLFDVTXHWHQJDQHOFDUiFWHUGHH[SHULPHQWDO SDUDODSDWRORJtD

DERIVACIÓN A LA RED ACEPTO INGRESO A LA RED

Firma de Familiar Responsable

Firma de Familiar Responsable

(Q BBBBBBBBBBBBBBBBBB D BBB GH BBBBBBBBBBBBBBBBBB GHO BBBBBBB 'RQ D

Firma del Mandante

(A la Vista – Pesos Reajustabilidad Unidad de Fomento)

AUTORIZACIÓN NOTARIAL XVRH[FOXVLYRQRWDULR

(QBBBBBBBBBBBBBBBBBBBBBBB D BBBBBBBBBB GH BBBBBBBBBBBBBBBBBBBB GHO BBBBBBB HQWUH 'RQ D

(Q BBBBBBBBBBBBBBBBBB D BBBBBB GH BBBBBBBBBBBBBBBBB GHO BBBBBBB 'RQ D

4XHSRUHOSUHVHQWHLQVWUXPHQWRYHQJRHQDXWRUL]DUDPLHPSOHDGRU HQWLGDGSDJDGRUDGHODSHQVLyQ SDUD

(Entidad Pagadora de la Pensión) (Pensionado)

CONDICIONES PARA ACCEDER A LA COBERTURA DE LAS GARANTÍAS

Garantía Explícita de Acceso:2EOLJDFLyQGHODV,VDSUHVGHDVHJXUDUHORWRUJDPLHQWRGHODVSUHVWDFLRQHVGH

GARANTÍAS EXPLÍCITAS EN SALUD DEL RÉGIMEN QUE RIGEN A

,1)(&&,Ï15(63,5$725,$$*8'$ ,5$ '(0$1(-2$0%8/$725,2(10(125(6'($f26

CONDICIONES PARTICULARES PLAN PREVENTIVO DE ISAPRES – PPI

7.1. PROGRAMA DEL NIÑO

 &21752/ '(/ '(6$552//2 36,&202725 (67$'2 1875,&,21$/ 2%(6,'$' 5(*,6752

5HFLpQQDFLGR SULPHURVGtDV GRVFRQWUROHVSRUPpGLFRSRUHQIHUPHUD

7.1.4 DISPLASIA DEL DESARROLLO DE CADERAS

7.1.5 DISPLASIA DEL DESARROLLO DE CADERAS

7.1.8 DETECCIÓN DE MALOS HÁBITOS BUCALES

7.2 PROGRAMA CONTROL DEL EMBARAZO

7.2.2 DIABETES MELLITUS GESTACIONAL

7.2.3 INFECCIÓN POR VIRUS DE INMUNODEFICIENCIA HUMANA

7.2.5 INFECCIÓN URINARIA

7.2.7 HIPERTENSIÓN ARTERIAL

7.2.8 BEBER PROBLEMA

7.3.2 BEBEDOR PROBLEMA

7.3.5 HIPERTENSIÓN ARTERIAL

7.3.6 DIABETES MELLITUS

7.3.9 CÁNCER CERVICOUTERINO

7.3.11 CÁNCER DE MAMA

7.3.12 EVALUACIÓN FUNCIONAL PARA UNA VIDA AUTOVALENTE (AUTONOMÍA FUNCIONAL)

7.3.13 PREVENCION CARDIOVASCULAR EN POBLACIÓN DE RIESGO

www.colmena.cl Mesa Central 2 2959 4000

También podría gustarte

(O)RQGR1DFLRQDOGH6DOXG)RQDVDSRUVXSDUWHHVHOHQFDUJDGRGHDVHJXUDUODSURWHFFLyQ¿QDQFLHUDTXH

(O3ODQGH6DOXG&RPSOHPHQWDULRSXHGHVHULQGLYLGXDORJUXSDOWDPELpQGHQRPLQDGRVFROHFWLYRV/RVSODQHV

F3URJUDPDGH$WHQFLyQ0pGLFDR3$0 Opera este sistema por las prestaciones otorgadas en forma

D&REHUWXUDSDUDHQIHUPHGDGHVRFRQGLFLRQHVGHVDOXGSUHH[LVWHQWHVGHFODUDGDV Las prestaciones de salud

G2PLWLUGHO&RQWUDWRDDOJ~QIDPLOLDUEHQH¿FLDULRGHORVLQGLFDGRVHQODVOHWUDVE\FGHODUWtFXORGHO')/1

)LUPDRKXHOODGLJLWDOGHOD¿OLDGR Firma Isapre

1RPEUHGHO3DFLHQWHBBBBBBBBBBBBBBBBBBBBBBBBBBBB(GDGBBBBBB 587SDFLHQWH BBBBBBBBBB

3UHVWDFLRQHV PpGLFDVIiUPDFRV\WpFQLFDVTXHWHQJDQHOFDUiFWHUGHH[SHULPHQWDO SDUDODSDWRORJtD

(Q BBBBBBBBBBBBBBBBBB D BBB GH BBBBBBBBBBBBBBBBBB GHO BBBBBBB 'RQ D

AUTORIZACIÓN NOTARIALXVRH[FOXVLYRQRWDULR

(QBBBBBBBBBBBBBBBBBBBBBBB D BBBBBBBBBB GH BBBBBBBBBBBBBBBBBBBB GHO BBBBBBB HQWUH 'RQ D

(Q BBBBBBBBBBBBBBBBBB D BBBBBB GH BBBBBBBBBBBBBBBBB GHO BBBBBBB 'RQD

4XHSRUHOSUHVHQWHLQVWUXPHQWRYHQJRHQDXWRUL]DUDPLHPSOHDGRUHQWLGDGSDJDGRUDGHODSHQVLyQSDUD

,1)(&&,Ï15(63,5$725,$$*8'$,5$'(0$1(-2$0%8/$725,2(10(125(6'($f26

&21752/ '(/ '(6$552//2 36,&202725 (67$'2 1875,&,21$/ 2%(6,'$' 5(*,6752

5HFLpQQDFLGRSULPHURVGtDVGRVFRQWUROHVSRUPpGLFRSRUHQIHUPHUD