Steps and Requirements to affiliate beneficiaries to EPS Sanitas

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The Government of Colombia through the Ministry of Social Protection created a “Mandatory Health Plan (POS), which allows comprehensive protection of families, maternity and diseases in general; To meet this objective, the EPS (Health Promoting Entities) were created.

This is how Sanitas, SA, begins to function as such and offer its medical assistance services. In this article we will show you the Requirements to affiliate beneficiaries to EPS Sanitas.

Steps and Requirements to affiliate beneficiaries to EPS Sanitas

There are different affiliation options for the first time with EPS Sanitas; It may vary depending on the city where you are or your employment condition, that is, if you are an employee of a company, independent worker or pensioner.

The steps you must follow are very simple, you can consult the web portal of Sanitas Colombia, make your affiliation and then register as a user and obtain more detailed information about the benefits you can enjoy.

Here we leave you the documentation you will need:

Documents to affiliate beneficiaries

To obtain EPS Sanitas services, you must:

  • Fill out the membership form, listing each of the members of your family group. This can be made up of:
  1. The husband.
  2. In the absence of a spouse, the partner or permanent partner including same-sex couples.
  3. Children under twenty-five (25) years of age who are financially dependent on the contributor.
  4. Children of any age if they have permanent disability and are financially dependent on the contributor.
  5. The children of the member’s spouse or partner, including those of same-sex couples, who are in the situations defined in paragraphs 3 and 4 of this article.
  6. The children of the beneficiaries described in numerals 3 and 4 of this article until said beneficiaries retain such condition.
  7. Children under twenty-five (25) years old and children of any age with permanent disability who, as a consequence of the death of the parents, the loss of parental authority or the absence of these, are up to the third degree of consanguinity with the contributor and economically dependent on it.
  8. In the absence of a spouse or permanent companion and children, the contributor’s parents who are not pensioned and are financially dependent on it.
  9. Minors under eighteen (18) years of age given into legal custody by the competent authority.
  10. The members of the family nucleus who are not contributing to the system and the contributing pensioners will only receive the provision of the health services provided for in the benefit plan.

It should be noted that the affiliation of family members is automatic, however the form requires that all the requirements be completed for the family to be affiliated.

  • Attach the identification documents according to the following cases:

To prove the relationship with your beneficiaries:

  • The quality of spouse will be accredited with the Civil Registry of Marriage.
  • The quality of companion or permanent companion will be accredited in accordance with the provisions of Decree 780 of 2.016.

Colombian Citizens:

  • Under 3 months old / Live birth registration
  • Children under 3 months and over 7 years / Civil birth registration
  • Over 7 years old and under 18 years old / Identity Card
  • Over 18 years old / Citizenship Certificate
  • Children under 7 / Passport

Foreign Citizens:

  • Over 7 years old / Immigration Identification Card
  • People over 18 years of age / Alien Identification Card, Special Permit of Permanence, Diplomatic Card, Except Conduct of Permanence.
  • Refugees and / or isolated / United Nations passport
  • File the form and documents in EPS Sanitas, which will depend on the city where you are.

If you wish change your employment status or report any news, you must present these same requirements.

If you want move from EPS You must meet the requirements established in current regulations, and here we detail them:

  • Be enrolled in the same EPS for a minimum period of (360) continuous or discontinuous days from the moment of enrollment. In the contributory regime, the term provided will be counted from the date of registration of the contributing member.

If it is a beneficiary who acquires the conditions to be a contributor, this term will be counted from the date of registration as a beneficiary.

  • Not being the contributing member or any of its beneficiaries, interned in an institution that provides health services.
  • Enroll in the transfer request the entire family group that is registered with the EPS from which you are going to move.
  • The independent worker must be up to date with the payment of their contributions to the General System of Social Security in Health.

When there is a continuous transfer of EPS, there will be no restrictions on the provision of the services included in the Benefit Plan.

For Independent:

As a freelancer, they may ask you to:

  • Independent membership form.
  • Health declaration form.
  • Copy of identification document.
  • Employment contract for the provision of services.

In Sanitas, you can make your affiliation by calling or visiting the application filing offices, at the following times:

TOWNSCHEDULETELEPHONE
BogotaMonday through Friday from 8:00 a.m. to 4:00 p.m.(1) 646 6082
CaliMonday through Friday from 2:00 pm to 4:00 pm(2) 553 6422
Rest of the countryCome to their application filing offices.

For Pensioners:

If you are a Pensioner, you must present:

Membership form for independent workers or pensioners (in case of not being linked to work).

  • Health declaration form.
  • Photocopy of the identification document.
  • Copy of pension resolution (ISS pensioners) and / or copy of the last receipt of pension payment.

Through Sanitas, you can make your affiliation as we indicate:

TOWNSCHEDULETELEPHONE
BogotaMonday through Friday from 8:00 a.m. to 4:00 p.m.(1) 646 6082
CaliMonday through Friday from 2:00 pm to 4:00 pm(2) 553 6422
Rest of the countryCome to their application filing offices.

For dependents of companies with NIT or employer cards with NIT:

In this case the requirements will be:

  • Photocopy of the identity card of citizenship, immigration, diplomatic card of the employer and photocopy of the identity document of the employee.
  • Photocopy of the affiliation of the company to ARL.
  • Photocopy of the RUT.

And if it is a new company, you must present:

  • Copy of the contributor’s identity document
  • Photocopy of the ID of the Legal Representative
  • Photocopy of the company’s affiliation to ARL
  • Photocopy of the Chamber of Commerce certificate (no more than 60 days of issue), with the respective renewal of the commercial registration.

It will be valid to present a letter of affiliation to the ARL as long as it is issued by the company in letterhead format and with its respective signature and seal.

How long does EPS Sanitas cover?

The expiration date of the Insurance Contract will be that established in its Particular Conditions and, upon its expiration, in accordance with article 22 of the Insurance Contract Law, it will be tacitly extended for periods of one annuity.

However, either party may oppose the extension by written notification to the other party, made not less than two months in advance of the end date of the current period if Sanitas carries out said extension. notification, and one month if it is the Policyholder or insured who carries it out.

Other scenarios may also arise such as:

  • If the Insurance policy is terminated by the unilateral will of Sanitas, it will not be able to suspend the provision of the guarantee when the Insured is in treatment, in a hospital regime, until discharge from hospital, unless the Insured waives to continue the treatment.
  • If it is resolved by the Insured, the coverage will cease in any case on the expiration date established in the Particular Conditions of the policy, without the provisions of the previous paragraph being applicable.
  • Regarding each Insured, the Insurance is terminated:

a) Due to death.

b) Due to transfer of residence abroad or for not residing a minimum of six (6) months a year in national territory.

If you need more information regarding the coverage of your Sanitas policy, here is the link with the information.

What benefits does Sanitas offer?

EPS Sanitas, SA is a health promoting entity of the Contributory Regime, authorized to function as such by the National Superintendence of Health since 1994 and offers the medical-assistance services contemplated in the Mandatory Health Plan (POS) in accordance with what is stated in the current legal regulations on the matter.

In this sense, it offers you the following benefits:

  • Consultation: general and specialized medicine.
  • Dentistry: with the exception of orthodontics, periodontics and prosthetics.
  • Actions to promote health and prevent disease.
  • Initial emergency care.
  • Diagnosis: clinical laboratory, radiology, ultrasound, nuclear medicine, electromagnetic resonance and scenography.
  • Hospitalization.
  • Surgical treatments, in low, medium and high complexity services.
  • Therapeutic support: physical, respiratory, occupational and speech therapy.
  • Supply of medicines.
  • Processing of disabilities and licenses.

At the time of enrollment, the person has the right to emergencies during the first four weeks, that is, the first month. As of the second month, you already have the right to request medical appointments.

If you are already affiliated:

Once affiliated, if you wish to enjoy EPS Sanitas services at any health service center, you must present the following documentation to be treated:

  • Identification document and proof of payment of the moderator fee (when applicable).
  • Additionally, and if required, they may request the respective authorization.

What is an EPS?

Its acronym stands for «Health Promoting Entity».

It is a company in charge of promoting affiliation to health programs in the commercial and administrative part, under two schemes: contributory regime and subsidized regime.

Belonging to an EPS is achieved through the human management department of the company in which you work or for the independent if it is the case, through a direct visit to the different entities that provide this service in the city or the place where live.

These companies offer health care services and benefits to their members within the Mandatory Health Plan (POS – Law 100 of 1993).

What is the POS?

The POS is a mandatory health plan, which according to the Ministry of Social Protection of the Republic of Colombia.

It allows the integral protection of families, maternity and diseases in general, in the phases of promotion and promotion of health and prevention, diagnosis, treatment and rehabilitation for all pathologies, according to the intensity of use and the levels of care and complexity to be defined.

There are also the IPS: (Institutions that provide health services), hospitals, clinics, laboratories and all those that may have agreement with EPS, to serve members in accordance with the “mandatory health plan” (POS).

We hope that you can easily join the EPS together with your family members, once you know the Requirements to affiliate beneficiaries to EPS Sanitas. Enjoy its benefits!

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