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What is the Health Insurance Policy?
A Health Insurance Policy is a contract with an insurance company intended to provide a high-quality complement to the health services offered by Health Promoting Entities (EPS).

While there are multiple advantages, one of the most significant is the reduction of waiting times for appointments and hospital emergencies.

It also provides access to top specialists without having to wait months for authorization from a general practitioner.

What is the difference between health insurance and a prepaid medical plan?
Both options give you faster access to medical services, specialist opinions, and technology.

Prepaid medical plans are offered by companies regulated by the Health Superintendence, while health insurance policies are offered by insurance companies regulated mainly by the Financial Superintendence.

Health insurance policies have a coverage limit for each medical case as specified in the policy. Pre-existing conditions and age limits must also be evaluated in both cases.

Experience in insurance provides trust, as well as the possibility to extend the policy abroad and reimburse expenses incurred outside the company’s medical network.

What other benefits can I get with health insurance?

• Personalized attention from highly experienced doctors.

• Flexible appointment schedules.

• Services available in multiple cities nationally and internationally.

• Timely medical care.

What is a pre-existing condition in health insurance?
A “pre-existing condition” is any illness that develops before entering the policy, even if it manifests afterward.

What is the waiting period in health insurance?
In MAPFRE health insurance, the “waiting period” is the uninterrupted time in the policy required to use certain coverages or services, such as specialized diagnostic tests, MRI, etc.

Where can I find the Sura Medical Directory?
Here is the Sura Medical Directory, where you can consult the wide range of health professionals accessible throughout Colombia.

When a family has 2 children over 2 years old and they are being insured individually, are medical exams required?
No exams are required as long as there are no medical antecedents.

Up to what age can optional medical visit and emergency annexes be included?
Up to 60 years old.

Can a policy be requested without an EPS?
No, you must have a valid EPS. The Sisben is not considered an EPS.

Requirements for enrolling a person 46 years or older:

• Medical exam

• Urine test

• Blood glucose

• Total cholesterol, HDL cholesterol, triglycerides

• EKG

Additional:

• Women: latest Pap smear result and mammogram result (less than 1 year old)

• Men: Prostate-specific antigen test result (less than 1 year old)

Requirements for pregnant women joining the policy:

• Medical and urine exams

• Prenatal control history

• Only outpatient annex will be granted, with a temporary 20% additional premium for the first year.

The extra premium allows coverage for outpatient emergency care related to pregnancy complications if selected.

Respecting policy seniority:

• The study must be done before canceling the current policy.

• Include a properly completed insurability declaration.

• Include seniority certificate, usage, and pre-existing conditions from the previous insurer.

• Applicants must be under 60 years old.

Transferring from a prepaid medical plan to a family health policy:

• Must be under 60 years old (only for GLOBAL FAMILY HEALTH PLAN)

• Policy must cover the entire family group insured under the current plan.

• Existing exclusions are maintained.

• Premium cannot be lower than the current prepaid plan.

• If the insured has a condition or service not covered by the prepaid plan but covered by the policy, an exclusion or limitation annex will be added.

What is EMI and MEC?

• EMI (Integral Medical Emergency): Optional annex for Global and Suramericana Health Policies. User calls the provider directly. No copay.

• MEC (Doctors at Home): Urgent home medical attention. Requires optional illness emergency annex. Available in Medellín, Cali, Bogotá.

Do health policies cover vaccines?
No.

When can coverage be added to the policy?

• Optional annexes like outpatient consultation or illness emergencies can only be added at policy renewal.

• Medical emergency annex can be requested anytime.

Collective health policy eligibility:

• People under a legal entity with an employment contract.

• Minimum of 10 insured workers or heads of household.

Policy freeze:

• Can be done twice.

• Each freeze costs 20% of the insured’s premium.

• Maximum duration: 2 years.

Maternity coverage requirements:

• Must be insured for a minimum continuous period.

• Solo or family coverage rules apply.

SURA authorization channels:

• Authorization line for urgent care

• CAS Salud for scheduled procedures

Documentation for authorization:

• Claim form

• Medical order

• Clinical history (if required)

Documentation for reimbursement:

• Original invoices

• Medical order

• Test results

• Clinical history (if required)

Coverage differences:

• Line authorizations: emergencies

• CAS: scheduled events and complex procedures

Reimbursements:

• Only for emergencies where there is no network, at SURA agreement rates.

Personalized Health Plan (Plan Salud Personalizado):

• Integrates hospital and outpatient coverage.

• Includes a “care group” of an internal medicine specialist (adults) or pediatrician (children) and a general physician.

• Specialist referrals require approval from the care group (except gynecology and ophthalmology).

• Closed network directory, reimbursements only in emergencies outside the network.

Copay amounts (examples):

• Diagnostic tests: 20%, max $40,000, min $18,000

• Lab tests: $18,000

• Therapies: $8,000

• Emergency care: $34,000

• Outpatient consultation: $18,000

Coverage abroad:

• Valid only in Colombia

Portfolio:

• Wide selection of health insurance policies for domestic or international coverage.

• Access to prestigious hospitals and healthcare professionals with high standards of quality, timeliness, warmth, and technological infrastructure.