1.2 What is life insurance?

Life insurance is a promise: if something happens to you, the people who depend on you will be financially protected.

Your life insurance offers:

• Peace of mind that your family will be protected
• Financial support for your loved ones
• In some cases, living benefits (such as savings or retirement)

1.3 Realistic expectations: What your insurance IS and what it IS NOT

Your insurance IS:

• Financial protection against unexpected medical expenses
• Access to a network of doctors and hospitals
• Peace of mind for you and your family

Your insurance IS NOT:

• A plan that covers absolutely everything — There are limits, exclusions, and conditions
• A savings account — It's not designed to "get back what you paid"
• A credit card — It's not meant to be used indiscriminately

2.1 The important parts of your policy

Your policy is the contract between you and the insurer. Let's explain each part in simple words:

2.2 Pre-existing conditions: Why honesty is your best ally

A pre-existing condition is any health condition you already had before getting your insurance: diabetes, hypertension, asthma, a previous surgery, frequent migraines, etc.

Why does it matter?

• Some pre-existing conditions may have exclusions (the insurance won't cover them)
• Others may have a waiting period (they're covered after a certain time)
• Some are covered normally with a surcharge

2.3 Waiting periods: Patience has its reward

For some coverages, there is a waiting period before you can use them. This is normal and protects the system.

3.1 The provider network: Your best friend

In-network = More benefits, fewer complications

When you use doctors and hospitals within your insurer's network:

• You generally don't pay upfront (direct billing)
• Rates are pre-agreed (no surprises)
• The paperwork is simpler
• You get a better coverage percentage

Out-of-network = More expensive, more paperwork

When you use out-of-network providers:

• You generally pay first and then request reimbursement
• Coverage may be lower (example: 60% instead of 80%)
• There's more paperwork and waiting time
• There may be differences between what the doctor charges and what the insurance pays

3.2 Preventive care: Use it (it's almost free!)

Many plans include preventive benefits that generally don't affect your usage history:

• Annual check-ups
• Vaccines
• Routine exams (blood, urine, etc.)
• Wellness visits
• Mammograms and other screenings by age

3.3 Prior authorizations: A step that prevents headaches

For certain procedures, your insurer needs to approve BEFORE they are performed. This is called pre-authorization or pre-certification.

You generally need authorization for:

• Scheduled surgeries
• Expensive studies (MRIs, CT scans, etc.)
• Planned hospitalizations
• Specialized treatments
• High-cost medications

3.4 Emergencies: What to do when something happens

In a real medical emergency:

1. First: Seek immediate care (your health comes first, ALWAYS)
2. When you can: Notify the insurer (generally within the first 24-72 hours)
3. Save everything: Bills, prescriptions, medical reports
4. Call us: Your broker will guide you on the next steps

3.5 Telemedicine: The doctor on your phone

Many plans now include virtual consultations. They're ideal for:

• Mild symptoms (flu, headache, general discomfort)
• Prescription renewals
• Follow-up visits
• Quick medical questions
• Guidance before going to the ER

Advantages: Fast, convenient, from anywhere, generally free or with minimal copay.

4.1 Maternity: Planning for baby's arrival

If you're thinking about having a baby or are already expecting, there's a lot to plan:

Before pregnancy:

• Verify that your plan includes maternity coverage
• Know the waiting period (usually 10-12 months)
• Understand what it covers: prenatal care, normal delivery, C-section, complications, newborn care

During pregnancy:

• Choose your OB/GYN within the network
• Choose the hospital where you want to deliver (within the network)
• Request a predetermination of benefits — this tells you exactly what the insurance will cover and what you'll pay

4.2 Serious or high-cost illnesses

If you or a family member face a serious diagnosis or a high-cost condition:

First, breathe. You're not alone.

Your rights:

• Right to a second medical opinion (many plans cover it, even internationally)
• Right to choose a specialist within the network
• Right to fully understand your coverage before starting treatment

Important steps:

1. Notify your broker immediately — We're your ally in difficult times
2. Request a predetermination for high-cost treatments
3. Document everything — Keep an organized file of reports, prescriptions, bills
4. Ask about limits — Make sure you understand how far your coverage goes
5. Explore all options — Your broker can help you find alternatives

4.3 International coverage

If you travel frequently or need medical care outside the country:

Before traveling:

• Check if your plan has international coverage
• Know the limits of that coverage
• Get your travel assistance card
• Save the international emergency numbers

If you need care abroad:

• Call BEFORE going to the hospital (if it's not a life emergency) — The insurer will tell you where to go
• In a real emergency, seek care first and notify later
• Save ALL documents (bills, reports, prescriptions)
• Documents may be in another language — that's fine, your broker can help with that

4.4 Other specific coverages

Dental and Vision

• Generally have separate annual limits
• Take advantage of preventive cleanings and exams
• Major treatments (orthodontics, eye surgery) usually have sub-limits

Medications

• Many plans have outpatient medication coverage
• Use in-network pharmacies for better coverage
• High-cost medications may require authorization

Mental Health

• More and more plans include mental health coverage
• There may be limits on sessions or annual amounts
• Telemedicine is an option for many consultations

5.1 Two payment methods

Direct billing (in-network)

The hospital or doctor bills the insurer directly. You only pay your share (copay, coinsurance, or deductible if applicable).

Advantage: Less paperwork for you.

Reimbursement (generally out-of-network)

You pay the full expense first, then request that the insurance reimburse you for the corresponding amount based on your coverage.

Requires: More paperwork and patience.

5.2 How to prepare a reimbursement claim (stress-free)

If you paid a medical expense and need the insurance to reimburse you:

Documents you need:

• Original invoices with NCF (fiscal receipt number)
• Medical prescriptions (if applicable)
• Doctor's reports
• Lab or study results (if applicable)
• Insurer's claim form

The invoice must have:

• Patient's full name
• Date of service
• Clear description of the service (diagnosis, procedure)
• Cost breakdown
• Provider details (name, address, RNC)
• Valid NCF

Common mistakes to avoid:

• Incomplete invoices or missing required data
• Missing diagnosis or medical indication
• Illegible or damaged documents
• Missing the submission deadline (generally 30-90 days)
• Not including all required supporting documents

5.3 Important deadlines

5.4 If a claim is denied

A "no" is not always final. You have options.

Steps to follow:

1. Ask for the reason in writing — You have the right to know exactly why
2. Talk to your broker — We'll analyze whether the denial is correct or if there's an error
3. Review the documentation — Sometimes something simple is missing that can be corrected
4. File an appeal — If warranted, we'll prepare the formal arguments
5. Escalation — If necessary, there are higher resolution authorities

6.1 Annual renewal

Your policy generally renews every year. It's an important moment.

What to expect:

• Premium adjustment: It's normal for the price to change each year
• Changes in terms: The insurer may modify conditions
• Opportunity to review: Are your needs still the same?

Why the price may increase:

6.2 Changes in your life = Changes in your insurance

Let us know when any of these happen:

• 💍 You get married or divorced
• 👶 A baby is born (you only have 30 days to add them!)
• 🎂 Your children reach adulthood
• 💼 You change jobs
• 🏠 You move
• 📈 Your financial situation changes significantly
• 🏥 There are important changes in your health status
• ✈️ You plan to travel extensively or live temporarily in another country

These changes can affect your coverage, your premiums, or your protection needs.

6.3 If you're considering switching insurers

Before switching, talk to your broker. There are important things to consider:

What you could lose:

• Accumulated seniority with your current insurer
• Pre-existing condition coverage you already earned
• Continuity of ongoing treatments

What starting over means:

• New waiting periods for certain coverages
• New medical evaluation
• Current conditions could be considered "pre-existing" in the new plan

7.1 What does your broker do for you?

Before purchasing:

• Explains the options available in the market
• Helps you choose the plan that best fits your situation
• Handles the entire application process
• Makes sure you declare everything correctly

During your policy term:

• Answers your questions (any question, anytime)
• Guides you when you need to use the insurance
• Helps with paperwork, authorizations, and claims
• Fights for you if there are problems or denials
• Keeps you informed of important changes

At renewal:

• Reviews the new conditions with you
• Negotiates on your behalf when possible
• Presents alternatives if available
• Advises you on the best decision

7.2 When to call your broker

Call us when:

• You have any questions about your coverage
• You're going to use the insurance for the first time
• You face an important medical situation
• You need authorization for a procedure
• You're going to submit a claim
• Something is denied and you don't understand why
• Something changes in your life (marriage, baby, job, etc.)
• Your renewal is approaching
• You're considering changing plans
• You simply don't understand something

In summary: When you have any insurance-related question, call us. That's what we're here for.

7.3 What your broker CANNOT do (being honest)

• We don't make medical decisions for you — That's between you and your doctor
• We can't guarantee claim approval — That depends on the insurer and your policy terms
• We don't control market prices — But we can look for the best options
• We can't unilaterally change your policy terms — But we can negotiate and find alternatives

What we CAN do: Inform you, guide you, accompany you, defend your interests, and fight for you within the system.

8.1 Your rights as an insured

You have the right to:

• Clear and complete information about your policy
• Fair and respectful treatment from the insurer
• Submit claims and receive responses in a reasonable time
• Appeal decisions you consider unfair
• Access your data and documents
• Receive the benefits you paid for according to your contract terms
• A second medical opinion
• Privacy of your medical information

8.2 Your responsibilities as an insured

In return, your responsibility is to:

• Provide truthful and complete information when signing up
• Declare all pre-existing conditions honestly
• Pay your premiums on time
• Follow established procedures (authorizations, network, etc.)
• Notify important changes in your situation
• Use the insurance responsibly and ethically
• Report incidents within deadlines

The principle of good faith

Insurance works on the basis of mutual trust. The insurer trusts that you're telling the truth, and you trust that they'll keep their promise to protect you.

Your honesty = Full insurance protection

9.1 Best practices for making the most of your insurance

1. Know your policy — You don't need to memorize it, but know where to look
2. Use the network — Whenever possible, use in-network providers
3. Take advantage of preventive care — Check-ups, vaccines, screenings... generally at no cost
4. Authorize first — For major procedures, always request authorization
5. Document everything — Keep bills, reports, prescriptions organized
6. Don't wait — Submit claims on time, renew on time
7. Ask before assuming — If you don't know if something is covered, ask
8. Stay in touch — Report life changes, don't disappear
9. Use your broker — That's what we're here for, no extra charge for consulting

This series of 13 short videos explains everything you need to know about your health and life insurance. Each video is less than 3 minutes and gets straight to the point.

"Behind every policy, there's a person who knows you."

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