EsSalud Form 6011: Format, Filling and MORE

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Having health insurance is very important, since it can be of great help when you or any of your family members suffer an illness or suffer an accident that requires immediate medical attention. The Form 6011 It allows the insurance holder to register their family members in the EsSalud health care program.

Keep reading with us about this form, we will tell you what it is, what it is for, how to proceed to fill it out and what are the main advantages of being part of a health policy in the Republic of Peru.

This information will interest you, Here we explain everything about the EsSalud Form 6011!

EsSalud Form 6011 Format

If you want to download the format of the EsSalud Form 6011 in PDF, you can do it through this link. Where you will find both copies of the form, one for you as a user and the other for the EsSalud agency. The filling of this form must be done on a computer, presenting the original and the duplicate of the form to the EsSalud agencies, with your handwritten or digital signature.

Note: When delivering the Form 6011 it is very important that it is in optimal condition, without smudges, cross-out or transcription errors.

Filling out the EsSalud Form 6011

Complete the EsSalud Form 6011 It is very simple. For this, the holder requesting the benefit, must first place the identification of the company or entity for which he works (if it is a dependent worker). You can put the name or the Company Name of the organization.

Next, in the second section you must enter your personal data such as names and surnames, type and number of national identity document, date of birth and the type of affiliation you are requesting. For this last item, select from one of these options:

  1. Regular affiliate
  2. Agrarian
  3. Craftsman, Fisherman, etc.
  4. Optional
  5. Other (if you select this option, you need to indicate the specific type of affiliation).

Also, enter your contact details, phone number, and email address. The third section corresponds to the data of the couple, whether this spouse or common-law partner. Where you should add your first and last names.

Finally, the last section refers to the identification of the beneficiaries that the holder wishes to add to the Health Insurance, which may be children, parents, spouse, etc. It is important that in this table, the relationship that the beneficiaries have with the owner and the percentage of participation that is given to each of them is indicated.

To complete the registration, enter the date of issue of the Form 6011 and the signature of the insured holder. This form has two (2) exactly the same forms in order for the user to deliver one of these to the EsSalud assurance office, and keep the duplicate, previously signed and sealed by the agency, thus guaranteeing its receipt.

Who should submit Form 6011 to the EsSalud agency?

The Form 6011 It can be delivered to the Social Health Insurance agency (EsSalud) both by the owner (if he is an independent worker), and by the company or work for which he provides his services. Being in this case presented under the consent and approval of the employee.

Usefulness of EsSalud Form 6011

The Form 6011 It is used for the registration of beneficiaries in the Peruvian health insurance EsSalud. By means of this, interested persons can request the affiliation of one or more family members to the insured medical care provision service. This benefit extends from the affiliated person to their spouse (whether they are legally married or not), their children under eighteen (18) years of age and the father or mother of the holder.

Important
If any child of the holder who is of legal age, has a physical or mental disability that makes him unable to fend for himself, he also falls within the insured medical care program.

This form is specially visualized for independent workers such as: merchants, artisans, farmers, driver of public transport vehicles, etc.

Or also students and professionals dedicated to the undertaking of a commercial project. In order to guarantee the welfare and social security of the affiliated holder and his dependents.

What is EsSalud?


It is a public entity dedicated to protecting the well-being and health of its members. Its purpose is to provide health benefits and medical care at all levels. People insured under this body have multiple health care benefits, since this organization covers the medical needs of its insured on a large scale.

If you wish to contact this body, to consult your doubts, you can communicate through the following email address: atencionalasegurado@essalud.gob.pe. And in case of emergencies, you can contact emergency7x24@essalud.gob.pe. Which is a permanent service of immediate attention that is active twenty-four (24) hours a day, seven (7) days a week.

Additionally, as a result of the general confinement situation caused by the Covid-19 pandemic, a modality of remote medical appointments has been activated. If you are interested in accessing any of them, you can enter this link.

Another service modality is by telephone where the insured can contact 411-8000 and follow the steps indicated by the operator. Receiving advice and solving doubts about self-medication or side effects of taking any medicine. Finally, home care especially dedicated to people who do not have the ability to go personally to the assistance centers.

Advantages of EsSalud

People affiliated with the EsSalud entity have access to various comprehensive and outpatient care programs. In the first place, the insurance holder and his enrolled family members have the benefit of an annual check-up for prevention and hospitalization if required. Likewise, the insured can take part in the treatment programs for chronic diseases, surgeries and emergency care.

Investing in health insurance is one of the best decisions that an employee can make, since in this way it is possible to protect themselves against any unforeseen situation related to illnesses or accidents. In fact, many times the medical care carried out in a private way can generate expenses much greater than the insurance premium.

Health insurance offers you the peace of mind of having a backup in the middle of an unfortunate event. Thanks to them it is possible to receive timely medical treatment without having to sacrifice all of your income, go into debt and therefore throw your economy out of balance.

What are the benefits offered by EsSalud?

Depending on the policy plan you choose, EsSalud offers you the payment of your medical expenses and the reimbursement of your money when these consultations and assistance are carried out on your own.

Did you know?
It is even possible to pay through this means, the purchase of medicines and pharmaceutical supplies. As long as these are approved and justified before the insurance company.

In the same way, insurance coverage can include rehabilitation services in case of accidents or motor disabilities and orthopedic equipment (prostheses, crutches, wheelchairs, immobilized, etc.).

As well as the payment of laboratory tests and plates, when these are supported by an order issued by a health professional. It is even possible to access financing for vaccinations for minors affiliated with the service and to receive vitamins and minerals necessary for their nutritional growth.

Finally, EsSalud provides its patients with specialized services, such as dialysis for people with end-stage kidney failure or organ transplants. All this under a complete prior evaluation where it is authorized by a professional specialist to proceed with such care.

What is EsSalud Form 6011?

The EsSalud Form 6011 is the Registry of the Holder and Beneficiaries at «+ Life Accident Insurance» program of the EsSalud agency. It is then a form for the registration of a worker in the Social Security of Health of the Republic of Peru. Through this format, the citizen is inserted in a process of requesting a family health grant. Which serves both for the applicant and for his partner, parents and children.

This form goes hand in hand with Form 6010 called the registration coupon, which is used to expose information about the company or work for which the employee provides his services (if he is a dependent worker). And also the data of the holder of the deguro.

In this same form, the discount of money corresponding to the payment of the insurance premium is managed and authorized from the monthly income of the affiliated holder. This monthly payment, withdrawn from the salary, corresponds to the contribution that the employee makes to maintain the validity of the insurance.

As we have explained to you on this occasion, the EsSalud Form 6011 It’s very important. Well, it will allow you to enroll your relatives and dependents to the comprehensive health insurance of the national EsSalud program. And have an endorsement against possible medical needs that arise in your life.

What are you waiting for to complete your EsSalud Form 6011?

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