What benefits are excluded and what is not covered?

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Plan Auge

She eye or also known as Plan General Access to Express Warranties This is about coverage of 87 guaranteed diseases through Fonasa or Isapre. However, There are some features that are not included in it.

What is not covered by AUGE? Benefits not included in the plan

As confirmed by Health Management, among benefits not found included in the Additional Coverage for Catastrophic Illnesses (CAEC) is:

  • Those benefits covered by the AUGE plan; las exclusions from the contract (pre-existing conditions, non-tariff benefits); hospitalization and treatment in psychiatric pathologies, drug addiction or alcoholism; out-of-network or out-of-country surgeries and hospitalizations; las pathologies obtained from complications and consequences of cosmetic treatments or for beautification purposes; los infertility or sterility treatments; los dental treatments; THE home care and hospitalization in all its forms except for qualified exceptions; approved benefits (understanding by homologation to replace the benefits of others that are not coded in the health contract tariff); Surgical treatments for morbid obesity its complications and consequences, except for qualified exceptions, such as any treatment after obesity treatment, surgical and non-surgical with a cosmetic nature, such as abdominoplasty or other corrections obtained from weight loss.
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On the other hand, the Protection Network defines the following not covered by AUGE:

  1. No health problems not included in AUGE, established by the Ministry of Health.
  2. Of people with AUGE health problems who don’t meet the criteria specified access codes, for example: age
  3. To those insured in the social security institutions of the Armed Forces and Carabineros such as: Dipreca or Capredena.

What do I do if I have a claim?

If you go to the health center:

  • It does not provide guaranteed health care.
  • Deadlines are not met.
  • You will be charged a higher amount than the equivalent amount.
  • The health team is not registered in the Registry of Individual Providers of the Superintendency of Health.
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If you Fonasa you can call 600 360 3000 and/or visit any of its branches or enter Fonasa.cl
On the other hand, if you Isapre you should go to available service channels where do you belong.

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