Form 1010: Single Form for insurance and financial benefits

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Need to make a registration of insured? So keep reading and find out how to fill out the Form 1010: Single Form for insurance and financial benefits.

Form 1010

Also called Unique Insurance and Economic Benefits Form, It is a system designed for the registration of insured owners and right holders of the different insurances that EsSalud manages.

EsSalud has created a variety of forms in order for the procedures and processes to be carried out quickly, comfortably and efficiently, providing the applicant with a quality and efficient service.

The following link is to download the Form 1010 in PDF format.

Guide to complete the form

We already know a little about Form 1010, now we will show you how simple and easy the process is.

It is important to take into account the following aspects before starting to fill out the form:

  • It is essential to record the data of the people according to their Identity Document, as well as the signature of the legal representative.
  • The fields of the «USE OF ESSALUD» box and the two blue boxes that are in the upper right part of the form should not be filled out.

  • The form must be filled out in print and legible.
  • Forms that have erasures or amendments will not be accepted.
  • In the case of economic benefits, you must confirm the payment with BBVA at the telephone number: 5950000.

Based on these important aspects, we will present the steps you must follow to complete it successfully:

  1. To begin, we must fill in Table I called «INFORMATION OF THE INSURED HOLDER». We must first mark the type of Identification Document that the insured has, then enter the number of the same
  2. In the same box we must also provide the employer’s data, so we mark its type of document and then write its number.
  3. We move on to the second table (Table II) called “REGISTRATION APPLICATION”, We must indicate the type of registration (registration, cancellation, update), then indicate the type of document of the person to be registered. (If it is the same insured owner, do not fill in this information), then we will write the number of said document.
  4. We must mark the relationship condition in relation to the insured owner.
  5. Then we will place the names and surnames of the person to register, we will indicate the gender, whether female or male, we will mark the marital status of the person, we will place the date of birth, a contact telephone number and a valid email that is in use .
  6. Then the form asks us to indicate the address of residence, in case it is different from the one entered in the DNI.
  7. We will place the type of area, urbanization, neighborhood unit, housing complex, cooperative, residential, community among others. We will also indicate a reference to locate the given address.
  8. We will fill in Table III called “APPLICATION FOR A SPECIAL UNEMPLOYMENT COVERAGE RIGHT (LATENCY)“, in this part we must provide the Company Name, the RUC to request said coverage and we will record the completion date, in the event of the end of the employment relationship or the license start date.
  9. We will proceed to fill Table IV called «APPLICATION FOR FINANCIAL BENEFITS», for this we will mark the form of economic benefits of payment.
  10. When the payment of the amount of the financial benefit is made directly by isHealththen we will mark the option «Direct payment».
  11. we will mark «Refund» when isHealth reimburse the employer for the amount of the subsidy for temporary disability or maternity, which has been granted to the worker in a timely manner in their earnings.
  12. We will indicate the type of procedure, in case it is disability and maternity, record the start date and the end date, the subsidized days and the amount to be paid for the subsidy.
  13. In the same table we must indicate the data of the beneficiary. In case of request lactationwe must place the name of the mother and if the case is burialthen we will place the data of the person who was in charge of the funeral expenses.
  14. Next, the form shows us another box that bears the name «Sworn declaration», where we must provide the projected net income amount if you enroll in the Independent Agrarian Health Insurance.
  15. We will mark the option YEAH either NOTto authorize or deny isHealth sending notifications of administrative acts through the mail consigned in the form.
  16. In the following table that appears, we must enter the type of link or relationship of the person requesting the procedure with the insured owner, whether spouse or common-law wife, the owner himself, father, mother, among others.
  17. We must place the signature and seal of the employer(The signature of the employing entity is only necessary in the case of applications for disability or maternity allowance).
  18. In addition to this, we will place the type of document of the person and its number.
  19. Then we will proceed to consign the signature of the registrant or applicant of the financial benefit.
  20. Finally, a box called “OF USE OF ESSALUD”, which should not be filled out, since these fields are only for EsSalud personnel.

If you followed the steps to the letter you will have successfully completed the form.

What is Form 1010 used for?

Form 1010 or better known as the Single Insurance and Economic Benefits Form, is used to register the insured owners and beneficiaries (Update, data modification, registration) of the different insurances administered by EsSalud.

It can also be used to request the special right to unemployment coverage. Likewise, this form will be used to request direct payment of financial benefits for breastfeeding, maternity, burial or some type of work disability, obtaining the corresponding reimbursements.

How to carry out your processing process?

Registration of Beneficiaries

The requirements for the registration of Beneficiaries are the ones that will be shown below:

Spouse

  1. The Form 1010 and annexes Essalud (Access the link given at the beginning of the article to download it).
  2. Civil marriage certificate, at least 2 months old
  3. Copy of DNI or other Identification Document of both, which are updated.

Concubinage

  1. Submit the Essalud Form 1010, duly completed.
  2. Possess the Affidavit of Domicile and Cohabitation.

Minor Children

  • Photocopy of ID of the minor and the owner.
  • Form 1010 completed.

Surrogate Mother of Extramarital Child

  • Notarial certificate of paternity.
  • Submit the Payment Form of the Insured Holder.
  • Photocopy and original of the DNI of both.
  • Pregnancy Control Card, if you cannot also present the last Ultrasound.

Subsidy Application

It is the amount of money to which the Insured Holders are entitled, with the purpose of compensating the lost earnings as a consequence of the situation presented, whether maternity or lactation.

Maternity

Requirements:

  • Calculation of Maternity Allowance (Exhibit)
  • Form 1010 signed and duly filled out with the requested information.
  • Show the Affidavit of Maternity.(Format)
  • ID of the person signing the refund request.

Lactation

Requirements:

  1. Form 1010 duly signed by the insured.
  2. Show Identity Document in original and copy.
  3. If the application is submitted by another person who is not the insured owner, they must have a copy of the DNI and show the original.

The person responsible for processing and collecting the subsidy in this case is the mother and in the event that she dies, the father or person in charge of the child will be responsible for this.

Validity

Regarding the maternity allowance

This Subsidy granted has a duration of 98 days, which begins 49 days before the date of delivery, the mother may defer the start of the break with the help of the attending physician. If the birth is multiple or the mother has a disabled child, the subsidy is extended for 30 more days.

The first payment is made when the first 49 days are finished, then the second installment is canceled at the end of the 98 days or 128 subsidized days (multiple births or children with disabilities) and the final total payment is made at the expiration of the payment period. maternity.

The submission period is 98 days, which are after the day of birth of the child, plus 6 months. In the case of multiple births, it is 128 days after the child’s date of birth plus another 6 months.

Regarding the Breastfeeding Allowance

To request the lactation subsidy, you have a period of 98 days plus six months from the date of birth of the child. In the case of multiple births, 30 days are added.

With your sealed Form 1010 and a copy of your ID, you can go to the authorized banks and collect your subsidy.

Where and when to deliver?

The application for the required Subsidy must be submitted to one of the following Offices of Insurance and Economic Benefits (OSPE):

If you are in Lima you can access the following offices:

  • Corporate: Av. Arenales No. 1302, Arenales Complex. Of. 113-125-111.
  • Jesús María: Arenales Av., Arenales Complex, Of.128.
  • San Isidro: Av. Arequipa 2890, San Isidro.
  • Salamanca: Calla Paracas No. 181, Salamanca de Monterrico.
  • San Miguel: Av. La Marina No. 2299, San Miguel.
  • San Martín de Porres: Av. Peru No. 3869, San Martín de Porres.
  • Comas: Av. Universitaria No. 7355, Urb. Retablo, Comas.
  • San Juan de Lurigancho: Av. Cajaamarquilla No. 788, Urb, Zárate, San Juan de Lurigancho.
  • Huacho: Francisco Vidal Avenue No. 707, Gustavo Lanatta Luja Hospital, Huacho.
  • Cañete-. Jr. San Agustín No. 130, San Vicente de Cañete, Cañete.

Telephone: (001) 2656000. Office hours are Monday through Friday from 8am to 4pm and Saturdays from 8am to 12pm.

Normative

Maternity

Terms:

  • The insured must have at least three consecutive months of contribution or four non-consecutively that is within the six calendar months, which are prior to the month in which the subsidy begins.
  • Three consecutive months or with four non-consecutive months in the last twelve months that are prior to the month in which the benefit begins.
  • Employment relationship at the time of acquisition of the benefit and in the month of conception.
  • Have paid the required contribution for the month of conception before submitting said application.

Lactation:

Terms:

  1. Have three consecutive months of subscription or four non-consecutively within the six months prior to the month of delivery.
  2. The insured must have registered the infant as the beneficiary of the insured.
  3. The mother must be registered with EsSalud if she is not the insured holder.
  4. The agricultural insured must have at least three consecutive months of payment or four non-consecutively in the last twelve months, before the month of delivery.
  5. If the infant is deceased, posthumous registration must be made.

We hope the information has served you! Greetings.

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