CARE PROCEDURE

• The affiliated clinics will provide emergency care with the sole presentation of the DNI and/or UDEP student credential, then you must regularize the care by presenting the form: Accident Report Form.
• If you continue treatment after the first consultation, we recommend carrying the form: Rímac Accident Report Form, which can be obtained at:
  • PIURA CAMPUS: Student Assistance Office. Office V6 on the First Floor Building A (Confucius).
  • LIMA CAMPUS: Medical Service (1st floor block I).

ATTENTION TELEPHONES

PIURA CAMPUS: Student Assistance Office. Esmeralda Calderón Silva.

Telephone: 073-284500 annex 7230. Cell: 969440756. Email: esmeralda.calderon@udep.edu.pe

LIMA CAMPUS: Medical service.

Telephone: 01-2139600 annex 2211. Email: medicalservice@udep.edu.pe

          Contact:  Claudia Duran – Responsible Executive. E-mail: Claudia.duran@marsh.com . Cell phone: 965 403 305.

RIMAC Central Emergency and Assistance Insurance: (01) 4111111 annex 0

Important note:

• The insurance covers accidents indicated in the Benefits Plan and that have been reported and attended to within the first 48 hours of the event occurring. If it were an accident caused by events as a result of a Strike, civil commotion, malicious damage, vandalism and terrorism, and earthquake and/or tremor and/or landslides and/or other natural phenomenon, the period is 24 hours. After this time, there is no coverage of any kind.
• If there is any reason of force majeure that prevents the care of an insured in the Health Provider Network and the insured has to assume the expenses, they must present the supporting documentation of the case, to manage the respective reimbursement, according to the conditions of the Policy. and the documents indicated in Refunds.

DOCUMENTATION REQUIRED IN CASE OF REFUNDS

• Accident Report Sheet duly completed by the Educational Center and the treating Doctor, detailing the circumstances of the accident and the reasons for not having used the Health Provider Network.
• In the case of traffic accidents and/or in cases of quarrels, fights and others in which the insured and third parties participate, even in the case of legitimate defense or for bodily injuries caused by third parties, the INSURED must present a copy of the complaint. police investigation carried out before the competent authorities after the incident occurred
  made.
• Receipt for professional fees in the name of the patient, with the canceled stamp.
• Original pharmacy invoices and/or special exams in the name of Rímac Seguros y Reaseguros (RUC 20100041953), original prescriptions, doctor's orders for exams and the results obtained. If you have x-rays, they must be attached with the radiographic reports.
• Only the first emergency care after the insured's accident will be recognized as reimbursement, which could not be treated in the Health Provider Network. Subsequent care must be attended to within the Health Provider Network.
• No care will be recognized as reimbursement under the dental and ophthalmological coverage for an accident, nor expenses for rehabilitation or expenses subsequent to the first care of the insured after the accident.
• The maximum period for submitting medical expenses for an accident covered by the insurance is 30 calendar days from the date of the accident. After this period no expenses will be recognized.
• Reimbursement will be recognized based on the maximum rate “C” (SEGUS) of the Association of Clinics of Peru affiliated with the COMPANY. Consultations up to a maximum of one hundred new soles (S/. 100.00). (SEGUS) of the Association of Peruvian Clinics affiliated with the COMPANY.

RISKS NOT COVERED AND EXCLUSIONS OF THE POLICY

Excluded from the coverage of this Policy are injuries or accidents that the Insured suffers as a result of, in relation to, or as a result of:

1. Any physical or mental illness and the consequences of medical or surgical treatments that are not caused by accidents under this Policy.
2. Pre-existing injuries or illnesses at the time of contracting this Policy. Illnesses and/or congenital defects and expenses derived from related causes.
3. The so-called "Medical Accidents", those being the following: strokes, congestions, syncope, vertigo, acute edema, myocardial infarctions, thrombosis and epileptic seizures; as well as cases of negligence or medical malpractice. Accidents caused by the repercussion or consequence of events, episodes or crises of these “Medical Accidents” are also excluded from coverage.
4. The consequences of hernias and intestinal entanglements, sunstroke, systematic poisoning and poisoning, food poisoning or those caused by adverse reactions to medications that would have resulted from taking them for reasons not related to accidental cause diagnoses covered by this Policy. Discarding or treating infectious diseases transmitted by insects when they are vectors of diseases such as: malaria, yellow fever, dengue, bartonellosis and leishmaniasis.
5. Medical complications of pregnancy or childbirth. However, in the event that an accident produces medical complications that lead to an abortion, the expenses thereof, including uterine curettage as a result of this, will be covered by this Policy. On the other hand, in the event that an accident causes birth to be natural or by cesarean section, the expenses incurred will not be covered by this Insurance.
6. Accidents that occur when the INSURED is under the influence of alcohol and/or drugs (regardless of their degree of presence in the blood) or in a state of sleepwalking. Accidents related to, caused or derived from the use, ingestion or consumption of alcoholic beverages, drugs, narcotics, narcotics or drugs with hallucinogenic effects are considered within this exclusion. For the purposes of this exclusion, it is understood that the INSURED is in a state of alcohol or intoxication, and therefore subject to this exclusion, when the blood test taken immediately after the accident gives a result greater than 0.5gr/LT. If the sample for ethyl dosage is not taken immediately after the accident, to calculate the level of alcohol in the blood at the time of the accident, a decrease per hour of 0.15gr./Lt will be considered from the time of the accident until the sample is taken. of the sample. In the case of drugs, narcotics and narcotics, any positive grade of a toxicological examination will be considered.
7. Death penalty or active participation in any criminal act or in acts that violate laws or regulations; in an arranged duel, in fights or quarrels, except in those cases in which legitimate defense is proven; military service; as well as active participation in strikes, riots, civil commotion, malicious damage, vandalism and terrorism.
8. Suicide, self-mutilation or self-harm.
9. For a criminal act against the INSURED committed as author or accomplice by the beneficiary or heir, leaving safe the right to receive the Insured Sum of the remaining beneficiaries or heirs, if any, as well as their right to increase.
10. War, invasion or war operations (whether or not there is a declaration of war), hostile acts by sovereign entities or the government, civil war, rebellion, revolution, insurrection, civil commotion that assumes the proportions of an uprising, military power or usurped or martial law or confiscation by order of a Government or public authority.
11. Nuclear detonation, reaction, nuclear radiation or radioactive contamination; regardless of the way in which the nuclear detonation, reaction, nuclear radiation or radioactive contamination was caused, as well as the emission of ionizing radiation or from the combustion of said fuel.
12. Accidents that occur in the practice of activities or sports, being the following: driving automobiles or competitive vehicles as well as direct or indirect participation in automobile, motorcycle, scooter, bicycle, motocross, downhill, and similar racing, direct or indirect participation in competitions or horse riding practices, mountaineering or climbing, hunting, underwater or deep sea fishing, hang gliding, parapeting, bungee jumping, parachuting, scuba diving, scuba diving, climbing, skiing, kayaking, mountaineering, rafting, rappelling, snowboarding, trekking, sky-surfing, skateboarding, mountain biking or mountain biking, and risky sports, according to the definition included in this Policy, and which are not declared, by means of a simple letter, by the Insured to the Company at the time of registration. in the Safe Present.
13. Acts that violate current laws or regulations.
14. Driving cars, motorcycles, scooters, tricycles, quad bikes, nautical motorcycles and any other motorized vehicle in breach of current regulations applicable to drivers, passengers or motorized vehicles, on public roads or not, including those of the Armed Forces, for trips eventual, unless otherwise indicated in the Benefit Plan.
15. The use as a passenger or driver of any usual means of public transportation of people, whether land, lake, river, sea or air in vehicles owned by commercial companies or not, that do not have regular and fixed itineraries, unless otherwise indicated. in the Benefits Plan.
16. The use as a passenger of private or non-public airplanes and/or helicopters, including those of the Armed Forces, for eventual trips, unless otherwise indicated in the Benefits Plan.
17. Work accidents or professional illnesses for Insureds who, due to their work, are considered within the Complementary Risk Work Insurance (SCTR). Additionally, the following are excluded from coverage:
18. Orthopedic and orthotic devices and equipment, external prostheses, mechanical or electronic equipment, stockings for varicose veins, hearing aids, titanium dental implants. Durable medical equipment such as pulse oximeters, secretion aspirators, portable nebulizers, and clinical beds are not covered. Likewise, care by special and private nurses and/or nursing technicians or assistants is not covered.
19. Plastic or aesthetic surgery and treatment of keloid scars. Treatment of consequences resulting from the accident.
20. Any medication and/or treatment that is in the experimental phase and/or trial period or whose indication is not specifically approved by the FDA (Food and Drug Administration – USA) or EMEA (European Medicines Agency) for the diagnosis under evaluation.
21. Blood and derivatives (plasma, albumin, red blood cells, platelets, coagulation factors), except compatibility tests. Donor testing is not covered. Auto transfusion equipment is excluded.
22. Expenses that, according to current laws, must be covered by mandatory insurance; in which case, the coverage of this Policy will apply for expenses or excess expenses not covered by the mandatory insurance in force, provided that such expenses are not expressly excluded or not covered under the terms and conditions of this Policy.
23. The use of the following supplies or procedures: patellar tendon autograft, bone grafts (autograft or demineralized bone), spinal instrumentation (except in cases approved by the Company), interbody cages, nazca mesh; sayfre mesh, brain mapping, nucleoplasty, bipolar radiofrequency, rapid lock, Transfix, Rigidfix.
24. Treatment expenses for accidents or illnesses that are incurred through the reimbursement system or abroad, except when they are the first emergency care. Likewise, dental and ophthalmological expenses due to accidents that do not have prior authorization from the Company or are made through the reimbursement system.
25. Acquired Immune Deficiency Syndrome (AIDS), as well as all diseases caused or related to the HIV positive virus.
26. Any type of accident that occurs due to non-compliance with the Safety Rules and Regulations established by the competent authorities and/or that goes against what is stated in article 10.