Health Care Plan
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Ecopetrol´s Health Care Plan is considered the most complete and comprehensive

Health Care Services

Health Care Plan

Última actualización 27 nov. 2014

Ecopetrol´s Health Care Plan is considered the most complete and comprehensive in the country, as it includes services that other entities do not offer their users and falls under strict quality parameters to improve the quality of life and wellbeing of the user population. 

The beneficiaries of the Ecopetrol´s health care services belong to the rules of exception of the country´s General Social Security System for Health.

Ecopetrol´s health care plan is the set of services, benefits and supplies provided in a comprehensive manner to which workers, retirees and their respective registered family members are entitled.

  • Its main focus is the Promotion of Health and the Prevention of Illness.
  • There are no restrictions on pre-existing conditions (restriction on the treatment of any disease, malformation, condition existing on the date of enrollment).
  • There are no waiting periods for care (waiting periods in months).
  • There is no limit to the cost of coverage.
  • We provide care for catastrophic diseases (cancer, AIDS, among others) as of the date of enrollment in the service.
  • Beneficiaries are also entitled to medical and dental referrals within the country and referrals abroad (in accordance with the provisions established in the Health Care Service Regulations), if required due to their health condition and services available at the regional or national level.

This plan includes Promoting health and preventing illness:

  • General Medicine
  • Complementary Therapies.
  • Specialized Medicine
  • Home Care
  • General Dentistry
  • Specialized Dentistry
  • Diagnostic support services: clinical laboratory, pathology and genetics, diagnostic imaging, electrodiagnosis, endoscopic studies and audiology, among others
  • Therapeutic support services: physical therapy, occupational therapy, respiratory therapy, speech therapy, audiology, nutrition and dietology, optometry and orthoptics, psychology and nursing, among others
  • Hospital care, surgery and maternity service
  • Care for catastrophic diseases:
  • Medical and dental urgencies
  • Ambulance
  • Prescription and dispensing of medicines
  • Optometric supplies.
  • Provision of internal and external prosthetics.
  • Provision of orthopedic shoes, insoles, orthotics, appliances and braces
  • Provision of elastic support for the treatment of venous insufficiency
  • Rehabilitation
  • Medical and dental referrals within the country
  • Referrals abroad, in accordance with the provisions of the Health Care Service Regulations (5.1.12.6).
  • Comprehensive care of occupational illnesses and work-related accidents
  • Other services and supplies that may be required depending on the needs of the patient and medical opinion
  • Plastic surgery for functional and/or reconstructive purposes. Aesthetic surgery will not be provided or paid by Ecopetrol.

As a result of updating the Health Care Service Regulations, which took force on August 1, 2008, the following services were included in the Health Care Plan:

  • Treatment for infertility
  • Provision of adult diapers
  • Provision of special eyeglasses
  • Oral implants (edentulous and single tooth replacement) based on defined protocol
  • Provision of blood glucose meters and supplies for self-monitoring of diabetic patients

In addition, the criteria to authorize the following services were increased or updated:

  • Refractive surgery for treatment of eye diseases
  • Dental surgery
  • Corrective orthodontics
  • The immunization plan was extended, including the application of vaccines for chicken pox, hepatitis A, rotavirus and human papilloma virus.

These new services and supplies are subject to compliance by the patient with the criteria defined for these purposes.
Remember, your general practitioner (Mega) is the one who integrates your health care plan. For further information: contact center: 2345000 in Bogotá and 018000918418 anywhere else in the country (options: 4/0/2 or 5/2).

Exclusions and limits on the Health Care Plan:

  • Health care abroad (see limitations in the Health Care Service Regulations (5.1.12.6).
  • Medical or surgical treatment for aesthetic or cosmetic purposes.
  • Treatments (procedures, medicines or supplies) that do not provide a real beneficial impact on the beneficiary´s health condition.
  • Treatments (procedures, medicines or supplies) in the research stage or that are not approved by the competent authorities at the national or global level for implementation.
  • Provision of pharmaceutical products or items classified by the National Food and Drug Safety Institute (INVIMA) as cosmetics (INVIMA-C)
  • Products that are part of the family basket: toothpaste, dental floss, soap, shampoo, softeners, cosmetics.
  • Nutritional supplements (except in cases expressly defined by attending professionals).
  • Formulas.
  • Sclerotherapy on peripheral venous insufficiency.
  • Nursing home.
  • Day nursery.
  • Aesthetic procedures, during a surgical procedure at the expense of Ecopetrol S.A.
  • Diagnostic tests requested by beneficiaries for purposes other than health care or as a requirement for special procedures related to work, education, insurance, requirements resulting from legal proceedings in which the beneficiary is involved but are not related to the provision of the health care services of Ecopetrol S.A., travels abroad or sports, with the exception of those defined by Industrial Health.
  • The treatment of alcoholism and drug addiction will have a maximum duration of thirty-six (36) months, continuous or not.  Following this term, the Company´s responsibility to care for this need ceases to exist.
  • Dental implants, blood glucose meters, artificial fertilization treatments and disposable diapers, will be treated in accordance with the protocols established by the USS.

Referrals:

  • In the event that a beneficiary of the health care services should require specialized equipment that is not available in the town where he/she is enrolled in the health care services, the patient shall be referred, based on the opinion of the attending physician and the established levels of care, within the country, to the city where said resources are available. In addition, the allowance for medical outpatient treatment will be authorized, in accordance with the Conventional System, Agreement 01 and the Health Care Regulations in force.

Travels abroad on the part of the beneficiary:

  • Health care for workers, retirees or family members traveling abroad at their own expense is not included in the benefits of health plan. The Company will not pay or reimburse any amounts incurred due to health problems during said travels. However, ECOPETROL recommends that in these cases, the interested parties should purchase insurance to cover any contingency during their travels abroad.

Reimbursement

The Comprehensive Health Unit (USD)-, will only authorize reimbursement when:
 

  • The urgency takes place in locations where the USS does not have an assigned service network.
  • Ambulances are used in cases of extreme urgency, such as heart attack, accidents or blows that can pose serious risk to the patient if moved.
  • The requirements to apply for reimbursement are those set forth in the Health Care Regulations in force

Traffic accidents

In accordance with current regulations, the cost of health care services caused as a result of a traffic accident is to be covered by the Mandatory Auto Accident Insurance policy (SOAT)- or the fund created for this purpose. Any amounts exceeding the limits established by law shall be covered by ECOPETROL.  In order to do so, the beneficiaries of the health care services will be required to complete the respective forms and make sure that the cause of admission to the clinic or hospital is registered as a traffic accident.