Direct payment - not Scheduled:

Available
In the event of a Medical Emergency and/or Accident, with 24 Hours a day
365 días a year
care in a Network Hospital and Physician.
1. Identify yourself to the Hospital administration as an 800 872 0585
insured with your Medical Expenses credential. atencionalclientemmb@marsh.com
2. Each Hospital has an internal policy of requesting a
deposit or signing a promissory note, while the Insurance
Company authorizes the admission.
PCE Technology de Juarez
3. If the insured does not require hospitalization for more

MAYORES
than 24 hours, you will have to settle the account and
process it for reimbursement. Benefit programs
Nuestro
Refund Procedure

• We suggest you observe the following

Insurances
recommendations:
• Fill out the initial major medical expense
reimbursement request form with banking information,
including a copy of the IFE.
Policy number
Contact 2) Alejandro Salcedo
• Fill out the illness or accident notice as clearly and Alejandro.salcedo@Marsh.com
completely as possible.
FK00632A
Móvil. 5579 323460
• Present the doctor's report completed by the treating Contact 3) Gilberto Sanguino
Gilberto.Sanguino@mercermarshbeneficios.com
doctor, who should be asked to be as explicit as Movil. 656 3600349
possible when filling out the form.
• Verify that the doctor's fee receipts specify the concept
(surgeon, assistant, anesthetist), mention how many
consultations and that they are issued in accordance
with fiscal requirements.
INSURANCE COMPANY APP:
• Accompany the pharmacy invoices with the medical
prescription and break down each of the medications.
MY AXA MEXICO
• Invoices for x-rays, laboratories, ultrasounds, etc.,
must be accompanied by the results (interpretation)
obtained (definitive diagnosis).
• Gather this documentation and deliver it to Human
Resources and your payment will be received in 8
business days.

HOSPITAL AGREEMENTS:
An important characteristic is that the insurer has direct
payment agreements with the main hospitals throughout
the Mexican Republic.

For the agreement to take effect, it is required:

a) Hospitalization longer than 24 hours.
b) That the illness or accident is covered.
c) Check that you are an active worker
d) Deliver forms to the hospital properly
required. This brochure is descriptive and does not include all the conditions and
restrictions of the policy. Consult your Human Resources area.
On the website, you will find the forms, Network of
Hospitals and Doctors in agreement and other information
of interest to you.

OBJETIVO:
Reimburse the insured for major medical expenses incurred
as a result of illnesses or accidents that occur to him or her or
a member of his or her family (spouse and children included
in the policy). In this way, the company prevents the family
budget from becoming significantly unbalanced.
Likewise, he is given the opportunity to go to the doctors,
specialists, laboratories and hospitals that he himself selects.
The Major Medical Expense Plan operates under certain
characteristic rules and limitations which are described below.
One of the most important features of the Plan
is that it is not necessary to undergo a
prior medical examination.
COVERAGE:
Broker: Mercer Marsh Beneficios
Period: December 31, 2023 al 2024
Sum Assured : 1,797 UMAM ($5,667,199 MXN)
Deductible: 1.8 UMAM ($5,676 MXN)
Coinsurance: 10%
• By using an agreement hospital and doctor, the
deductible and coinsurance are eliminated, whether in
direct payment or reimbursement (Coinsurance limit:
$30,000.00 MXN)
• Accident Deductible and Coinsurance: Not applicable
Maternity: Childbirth $35,000 MXN and Cesarean section
$60,000 MXN, benefit for the owner and spouse, no
deductible or coinsurance applies.
UMAM value during 2023: $3,153.70
Children born within the term of the policy and the spouses of
people who marry will be considered dependents; However, it
is essential to report your discharge to the Human Resources
Department within 30 days of the event.
WHAT DOES MY PLAN COVER? Main coverages
• Congenital conditions: as long as the mother has been
an Insured in the policy for 10 continuous months and the
Company has been notified no later than 30 days after the
birth.
• Circumcision: As long as it is not for prophylactic
purposes.
• Pre-existence: No waiting period
• Border Strip: only for reimbursement and applies double
deductible and double coinsurance, within 40 km of the
border line
•Nose and paranasal sinus surgery: 100% coverage for
accidents and illnesses. Sum insured, deductible and
coinsurance of the policy.
•Involuntary abortion: Deductible Sum Insured and
coinsurance of the policy.
Hospitalization:
•Private room (standard)
• Operating room, healing and recovery
• Intensive therapy
• Medical and surgical material
•Medical and surgeon team fees
•Assistant (20% of Surgeon's Fees)
•Anesthetist (30% of Surgeon Fees)
•Consultations, therapies, rehabilitations and nursing
•Orthopedic devices and prostheses up to the insured sum
of the policy.
Expenses Not Covered:
•Sterility treatments, birth control
•Cosmetic treatments or plastic surgery
•Treatments against baldness, obesity or weight loss
•Treatments resulting from alcoholism and drug addiction
•Professional practice of extreme sports
•Check-ups
•Replacement of appliances and prostheses
•Moles or nevus
What do I need to use the policy?
• That the treating doctor dictates the definitive diagnosis,
whether due to illness or accident.
• That the condition is covered by the major medical
expenses policy
• AXA Seguros determines whether or not the diagnosis
proceeds according to what was contracted in the policy.
EXCLUDED EXPENSES:
1. Psychiatric and psychological treatments for states of
mental or nervous depression, hysteria, neurosis or
psychosis.
2. Treatments to correct behavioral and learning disorders
3. Conditions resulting from alcoholism or drug addiction.
4. Dental, orthodontic and maxillofacial treatments.
5. Plastic or aesthetic surgery. Except reconstructive
ones as a result of an accident covered by the
plan.
6. Treatment of baldness, obesity, weight reduction,
sterility and birth control.
7. Check-up type exams or rest or rest cures.
6. Treatment of baldness, obesity, weight reduction,
sterility and birth control.
7. Check-up type exams or rest or rest cures.
8. Expenses for attempted suicide or voluntary
mutilation.
9. Any complication derived from or that may arise
during or after the treatment of illnesses, injuries,
conditions or interventions expressly excluded in
the conditions of the Plan.
10. Expenses for accidents and illnesses that arise
from participating in:
11. a) Military service, acts of war or rebellion
12. b) Criminal acts
13. c) Quarrels whenever he was the provocateur
14. Injuries suffered by the insured when traveling as
an occupant of any racing vehicle, tests or speed
contests.
15. Experimental medical or surgical treatment that has
not been properly proven effective.
16. Medical or surgical treatments for sterility, infertility,
birth control, sexual impotence and its
complications, regardless of their causes and/or
origins.
17. Medical treatment as a result of menopause.
18. Replacement of orthopedic devices or prostheses
existing on the date of contracting the policy.
HOW TO USE MY PLAN:
Direct payment your best option
The direct payment system allows the participant to
receive care at any hospital and doctors with
whom Grupo Nacional Provincial has established
an agreement. WITHOUT DISbursing the total
cost of the confinement, thus protecting it from an
economic imbalance. (Except when hospitals are
used in the Border Strip or Abroad.)
Scheduled direct payment:
Hospital and Doctor in agreement.
It is when the participant carries out the procedures in
advance of his/her hospitalization to obtain his/her
authorization letter for direct payment according to
the following:
1) Present medical report and clinical history.
2) Request accident or illness notification yourself at
all points.
3) Attach interpretation of studies carried out.
4) Choose your Agreement Hospital.
Deliver the documentation to Human Resources for
the issuance of the pass letter.