Introduzca aquí el título · 2019-09-23 · IMPORTANT: Being this a resumee, it can not include all the topics and limitations of every coverage, so every case will be considered

Gabriela I. Correa Domínguez

AVP

Mexico City

Executive’s benefits

VMware

2 MERCER MARSH BENEFITS

Agenda

1 Objective

2 General Information

3 Life Coverage

4 Mayor Medical Expenses


Explaining to Vmware’s employees the benefits that the insurance is offering

in order to make a better use of the resources and take care of you and your

relateds

Objective

IMPORTANT: Being this a resumee, it can not include all the topics and

limitations of every coverage, so every case will be considered with the

particular conditions of the contract.

** Also, the conditions, amounts, etc, may be modificated based con the

renewal decision.


General Information


Insurance Agent for VMware

Effective since June 1, 2019, MMB has been appointed as the agent of the

insurance that forms part of the benefits program for VMware employees

in its operations in Mexico, therefore, responsible for the administration,

attention and service of the users of insurance Major Medical Expenses

and beneficiaries of Group Life insurance, mainly.


First contact: Carla M. León

Office: (55) 9628 6382

Mobile: 04455 3444 1984

Atention and Service


Current term (New plan) : June 1st, 2019 to June 1st, 2020

Coverage: Mayor Medical Expenses and Life Coverage.

What you should know:


Life Coverage


Who is participating?

Evaluate & Define

Exemption from premiums for total and permanent disability

Waiting period of 3 months. (36 monthly salary*)

Anticipated payment for total and permanent disability

Waiting period of 3 months. (36 monthly salary*)

Payment of Sum Insured in case of death

(36 monthly salary*)

Only active employees

Coverages:

Double indemnization for accidental death

and organic losses (72 monthly salary*)

* For commercial employees, is considered base salary + comissions


Special endorsements:

Private flights

Private flights for officials and employees, as a passenger for up to 100 annual flight hours per person,

understood by private aviation any flight made online non-commercial and the pilot has a valid license

that accredits it, and no more than 4 insured travel on the same flight

EXCLUSIONS: Military aircraft are excluded

Suicide Elimination of the 2 years waiting period by suicide as indicated in article 197 of the Law on the

insurance contract

Motorcycle

Death or injuries that occur by accident due to the use of motorcycles, scooters or other similar motor

vehicles will be covered, as long as it is used within working hours and in the performance of their work

activities.

EXCLUSIONS:

· Practice as a sport, resistance tests, competition and / or speed, whether professional or amateur.

· When the Accident occurs on highway or highway

Dangerous Sports

The injuries suffered by the insured by the amateur practice of dangerous sports such as skydiving,

diving, mountaineering, charrería, skiing or bullfighting, will be indemnity under the coverage of

accident and disability, provided that they do not derive from the participation of the insured in any type

of competition or endurance or demonstration test.

Advance payment, by

terminal illness

In case of suffering the following terminal diseases: Hepatic insufficiency, Chronic Respiratory Failure,

Cancer in terminal stage, Chronic renal failure, heart failure and advance brain vascular disease;

MetLife will make an upfront payment of 30% of the basic Insured Sum with a cap of $575,000 MXN.

Beneficiaries designation

in other insurers format

The insurer accepts the Individual Certificates issued by the insurance that previously covered the risk

described in the Cover of the Policy.

Funeral Assistance Covered. Funeral Expense Additional sum insured of $20,000


Beneficiaries assignment

• Designate beneficiaries with legible letters in the MetLife consent form

• Specify the percentage for each beneficiary and make sure to sign the consent

• It is important to write correctly the names and data in the format, if there was an error, it would

be difficult to receive the insurance amount.

The collection of the sum insured by death of the worker will be exempt from

Income Tax (ISR) as long as the beneficiary who receives this amount is a

spouse or concubine, ascendant (parents) or descendant (child) in a straight

line.

If the beneficiary is different from the mentioned, the insurer will retain 20% of

the corresponding compensation


Tips and recomendations

VMware cares for you and your family, including a life coverage:

• Fill in the Beneficiaries designation. The original remains in the company.

• Keep a copy along with your important papers.

• You can update it as many times as necessary. In the end, the most recent date is valid.

• It also includes the VMware Human Resources phone.

• Notify your beneficiaries that you designated them, or they will not know of the existence of

this benefit. They must approach to carry out the procedure.

• Personal documents always updated. If you lost them or they were stolen, replace them.

• Take photocopies or digitalize them.


Mayor Medical Expenses


Who is participating?

Evaluate & Define

Child under 25 years old and economic dependants

Of the employee (single and without incomes)

Spouse or concubine

Active employees


What do I need to use my MME coverage?

—

The coverage

begins from the

registration of the

insured and your

dependents

—

—

Present the complete

documentation to

know if your

condition and

procedure are

covered

—

—

That the illness is

covered by the plan

according to the

conditions of the

policy, some of

which will be

mentioned later

—

—

The doctor

determines the

definitive diagnosis

of your illness or

accident and this is

corroborated by

means of studies

—


• The birth must be notified to HR to be

registered in the first 30 days.

• Review the information of your insured in the

credentials:

- Full name

- Birthdate

- Relationship

- Seniority

• If someone is missing, report it to HR

immediately, attaching the necessary

documentation:

- Birth certificate

- Marriage certificate

- Cohabitation certificate

- Divorce Act

Update your information

Marriage or

concubinage

Divorce

Newborn

Death


Management for open and new cases

• The conditions with which the

case was opened will be

respected.

• At the time of claiming a

supplement in the new

coverage, the letter of Sum

Insured Remaining will be

presented

• It will open with the new

conditions

• The information must be

presented with the new MetLife

formats and the rest of the case

documents

Open cases – continuity (before June 1st, 2019)

New cases


Evaluate & Define

5,000 UMAM

($12,842,500 MXN)

1.5 UMAM

($3,853 MXN)

$0 in case of

accident.

10%

Cap of $25, 300

$0 in case of

accident.

UCR MetLife + 100%

Sum Insured $50,000

USD and Deductible of

$50 USD, without

coinsurance

Coinsurance Deductible Sum Insured

How much does my plan cover?

* UMAM: Unit of Measurement and Update for 2019 = $2, 568.50

Medical fees

for reimbursement Abroad’s

emergency

Exe

cuti

ve


Example:

Accident

•Expenses covered: $103,852.75

Deductible* (1.5 UMAM) $ 3,852.75

•Subtotal $100,000

Coinsurance* (10%) $ 10,000

•Total to be reimbursed $ 90,000

Expenses: $18, 852.75

Insurance’s coverage: $ 90,000

*Deductible is covered once per event.

*Coinsurance will be payed until it reaches $25, 300

per event.

• Expenses covered: $103,852.75

Deductible (N/A)

• Subtotal procedente $103,852.75

Coinsurance* (N/A)

• Total to be reimbursed $103, 852.75

Expenses: $ 0

Insurance’s coverage: $103, 852.75

**It is necessary to report the event within 90

calendar days following the date of occurrence,

otherwise, it will be considered a disease

Being treated in the emergency room does not

imply an accident, it can be a disease

Disease

* UMAM: Unit of Measurement and Update for 2019 = $2, 568.50


Pincipal coverages

1/2

Covered without waiting period

Aplies a minimum of 5 diopters at list in one eye.

SI of $ 20, 000 MXN without deductible and

coinsurance, without waiting period.

For illness: Deductible and coinsurance will aply.

For accident:: Without deductible and coinsurance.

Second medical opinion is omitted

Vision

correction

Nose

surgery

Preexistance

Dental

Employees: Initial Plan, Sum insured of

$10,000, without deductible and with coinsurance

of 30%

Executives : Expansion plan, Sum insured of

$120,000, without deductible and with

coinsurance of 20%


SI of 25 UMAM ($2, 568.5) = $ 64,

212.5, without coinsurance and

deductible and waiting period

Covered without waiting period for

newborn during the current term. Having

the first manifestation after 5 years old.

Cover of $4,000 MXN for pediatry, without

coinsurance and deductible

SI of 25 UMAM ($2, 568.5) = $ 64,

212.5, without coinsurance and

deductible and waiting period

Congenital

diseases

New born

Birth

C- section

Vision Incremental: SI of $1,100, deductible of

$87 MXN, without coinsurance

Pincipal coverages

2/2


Principal exclusions

• Nervous diseases

• Infertility, sterility, sexual impotence and birth control

treatments.

• Baldness´treatment

• Aesthetic and dermatological treatments

• Check-ups

• Injuries caused by:

- Military activities

- Criminal acts

- Participation in competitions

- Professional practice of some sport.

- Travel as a mechanic or member of a crew on any

aircraft


Principal exclusions

• Medical and surgical treatments of experimental

nature.

• Injuries caused by any attempt of suicide and / or

voluntary mutilation, even when committed in a state

of mental alienation.

• Prophylactic treatments

• Dietary, obesity, weight reduction treatments and

vitamin supplements

• Others (Consult General Conditions)


Especial coverages

Conversion to Individual:

Grant the insured who stop belonging to the insured group, the right to contract an individual insurance policy

before 65 years of age and without a medical selection process an the waiting period of 180 days after the

endorsement of the policy has been adhered.

The plan, sum insured, tabulator of medical fees, level of hospitals, deductible, co-insurance and optional

coverage will be the most similar that the insurer has for the current products of Individual Medical Expenses.

The payment of add-ons covered up to 1,500,000 UMAM ($ 3,852,750) is covered for open claims during the

VMware group coverage. It does not apply in massive dismissals.

Start

accident 1

Register of

Vmware’s insured

Start

accident 2

Contract an individual

insurance policy before

30 days after the

separation

Complements: Accident 1: It is not covered.

Complements: Accident 2: It is covered. (With the

insurances’ conditions).


What to do in case of accident?

Surgery programation

Documents to present:

- Letter Remittance and privacy notice "Mercer Marsh Benefits" signed on both sides by the insured or beneficiary

- Notice of accident and / or illness signed by the affected insured (In case of being a minor, by the policy holder)

- Medical Report signed by the attending doctor

- Copy of an official photo ID.

- Copy of the interpretations of studies.

The insurer will be responsible for the hospitalization expenses for the illness or accident covered according to the established limits of the policy. A surgery must be scheduled at least 10 business days in advance

Direct payment

The insurer in a medical emergency and with a minimum stay of 24 hrs, will be responsible for the expenses for the illness or accident covered according to the established limits of the policy.


- Present credential and official identification

- Report the hospital admission to the insurer

- As a policy of the hospital, an open voucher or a deposit will be requested

- MetLife has 24 hours to dictate the case from the moment you have the complete information so that the direct payment authorization is granted

Refund


- Letter Remittance and privacy notice "Mercer Marsh Benefits" signed on both sides by the insured or beneficiary

- Accident and / or illness notification form filled out and signed by the owner.

- Medical Report Format completed and signed by the attending doctor

- GMM Reimbursement Request signed by the affected or owner

- Copy of an official photo ID

- Receipts and / or invoices with current tax requirements in the name of the owner

- Copy of the interpretations of studies

- Copy of the heading of the bank account statement of the holder with an age not older than 3 months

The employee faces the expenses and subsequently requests the reimbursement of the same. If the claim is appropriate, the insurer will reimburse the expenses according to the established limits of the policy.


Remittance Letter

• Company: VMware

• Insurance: MetLife

• Policy:

• Certificate: Indicated on MetLife’s ID

• Relation:

- Owner

- Spouse

- Child

• Type:

- Initial

- Complement

• Claim’s number :

• In case of sending a bill, indicate number and

amount

• Sign bout pages


Remittance Letter

Indicate the documents

sent to MMB

Indicate the detail of the

bills sent

Sign of the person who was affected. If it is child, the

employee signs


Consulting information

Medical net

a) Metlife’s call center

b) Enter to website: http://mlmservicios.mx/5_doctores/

c) Download the app “MetLife Contigo” from AppleStore or PlayStore.

http://mlmservicios.mx/5_doctores/


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