Chapt. I - OBJECTIVE
Art. 1. Asociación del Personal Superior de la Organización TECHINT  (TECHINT Group Association of Senior Staff - APSOT) is a Health Maintenance Organization created to provide medical assistance coverage and any other service authorized by the Health Maintenance Organization Act and the current legislation, to the Senior Staff employed by the member Corporations of the so-called TECHINT Organization and to the family members and other dependents, who meet the conditions detailed in this Regulation.
The economic and financial resources needed to provide the mentioned assistance shall come from the funds and contributions set forth in the Health Maintenance Organization Act and the current regulation, and from any other income authorized by the Bylaws.
Art. 2. Enrollment. Affiliation to APSOT is automatic for those who are in the pertinent conditions provided in the Bylaws and entitles them to make use of its services, under the conditions set forth in Chapter IV of the Medical Assistance Plan and those that may be set forth in the future.
Art. 3. Management Body. The Association's administration and management shall be handled by the Board of Directors, which shall have the powers set forth in the Act and the Bylaws, not withstanding the power to delegate certain specific functions to someone specifically designated for.
Chapt. II – BENEFICIARIES
Art. 4. .Primary Holders. The whole staff covered by the terms of Art. 1 of the Bylaws. A Senior Staff member is someone who is excluded from the collective labor agreements, in the respective situation as referred to in the Bylaws, and is not subject to any objection neither by the state authority of the Health Maintenance Organization or by APSOT’s Board of Directors, due to his/her level of income or employment category.
Art. 5. Non-Primary Holders. Family Members and Cohabitants. The following Non-Primary Holder beneficiaries are entitled to be beneficiaries of the Association, under the same conditions as primary holders.
5.1. The Primary Holder’s spouse, under the conditions stated in the Health Maintenance Organization Act.
5.2. Unmarried children to age twenty one, non-emancipated for being under legal age or performing any professional, business or employment activity.
5.3. Unmarried children aged over twenty one and up to and including twenty five, who are students of regular courses recognized by the pertinent authority and related to an official curriculum, according to the respective educational legislation, and who have no social security coverage and depend on the Primary Holder Affiliate for their living.
5.4.
Disabled children who depend on the Primary Holder, without age limit. For this purpose, disabled children are the ones who meet the conditions set in the respective disability legislation for total disability.
5.5. The spouse’s children, under the conditions stated in items 5.2 and 5.3.

For “Non-Primary Holder Subscribed” Affiliates, in case of death of the Primary Holder under which they are enrolled, affiliation may be maintained for the same time period, directly making them responsible for the payment of the pertinent contribution.
Art. 8. “Dependents” Concept. Enrollment acceptance for the “dependents" referred to in Art. 5.8 shall be subject to verification of all the requirements listed below, with no exceptions and jointly, substantiating the request through an affidavit signed by the primary holder, which states:
a) that they live with the Primary Holder Affiliate and his/her family, at the same address, and do not receive any income as an employee or self-employee.
b) that they do not enjoy any retirement or pension benefits and are not in legal conditions to retire or obtain any pension benefit.
c) that they do not have any income or real estate property, which forces them to be financially supported by the Primary Holder Affiliate exclusively, and that they do not have any brothers/sisters or any other closer relative with an equal or higher income than their own one.
d) that they are not entitled to use services by the INNSJyP (PAMI) (Institute of Social Security for Pensions and Retirements (Comprehensive Plan for Eldest Adults))or any other social security coverage or prepaid health care coverage.
If only some or absolutely none of the previous requirements are met, enrollment shall not be applicable and the respective request shall be rejected.
The Primary Holder Affiliate shall properly inform, in writing and promptly, any changes that may occur in the mentioned circumstances and that may result in an alteration or definite influence in the affiliation access and/or maintenance for “Non-Primary Holder” or “Dependent” beneficiaries. Failure to comply with such obligation or any false or improper statement with the intent to enroll beneficiaries as “dependents”, or to maintain them as such, insofar as subject to constitute a civil and criminal illicit act, shall hold the beneficiary liable for the resulting legal responsibilities, not withstanding the measures that may be adopted in this regard by the Health Maintenance Organization. The same tone shall be adopted where pertinent, whenever the reports for updating the “dependents" status established periodically by the Board of Directors are not submitted to the Health Maintenance Organization within the time period set by the Board.
Art. 9. Verification. All and each of the conditions mentioned in the previous articles shall be stated in writing and in the form of an Affidavit by the interested party. The Board of Directors reserves the right to verify -by itself- the truthfulness of what has been stated and/or to require the pertinent accreditations.
In the case of “dependents”, non-affiliation to the INNSJyP (PAMI) (Institute of Social Security for Pensions and Retirements (Comprehensive Plan for Eldest Adults)) or to any other Health Maintenance Organization shall be accredited by means of a certification issued by the competent official authority, confirming that the corresponding person is not a beneficiary of any body or agent of the social security or health systems. Additionally, he/she shall submit an affidavit stating non-compliance with any restriction or impediment circumstances stated in Art. 8.
Chapt. III – AFFILIATION, ACCESS TO SERVICES and SANCTIONS.
Art. 10. Affiliation. In the case of primary holder beneficiaries’ enrollment, the application for their affiliation to APSOT, including that for their primary family group, shall be filed by the employee when he/she enters the Company, by signing the affiliation form specifically provided for by the Staff Management area.
Regarding the foregoing “dependent” beneficiaries referred to in this Regulation, they can be directly affiliated at the Health Maintenance Organization by the Primary Holder beneficiary; in the case of retirees or pension-owners, they can apply for affiliation directly with the Health Maintenance Organization.
Art. 11. Identification Cards. The applicant will be notified of his/her application acceptance or rejection within 30 (thirty) days of submitting the affiliation form and, if applicable, he/she will receive the corresponding identification card.
This identification card must be submitted to the physicians, medical assistance institutions, entities and/or general providers that have entered into an agreement with APSOT, whenever their services are used.
Art. 12. Benefits Effective Date. Services provided or recognized by APSOT shall become effective as of employment start date or APSOT affiliation, depending on the case. The members of the primary family group who meet the requirements imposed by the current rules shall be entitled to use services as of the same date, provided that the bond with the primary holder beneficiary has been properly accredited.
Services not included in the Program of mandatory covered services by Health Maintenance Organizations shall be available after 90 (ninety) days of enrollment approval.
Art. 13. Interruptions. The cases in which the Primary Holder Affiliate stops receiving incomes from the employer due to a temporary interruption in his/her services shall be regulated, in addition to what is stated in the respective legislation, according to the following rules depending on the cases to which they refer.
13.1. Absence without Pay due to Accident or No-fault Illness
In the case that work has to be interrupted due to an accident or no-fault illness, the worker shall maintain his/her condition as beneficiary, during the whole period of paid leave as well as during the period of employment continuation; in the latter case, there shall be no obligation to make contributions if no income is received.
13.2. Leave without Pay due to Other Reasons.
In case of leave without pay for time periods not exceeding 60 (sixty) days, the beneficiary may choose to maintain his/her condition as such, by paying the same amount that it would have been legally required to pay for the contribution, plus the employer’s corresponding contribution.
In case of leave without pay for time periods exceeding 60 (sixty) days, the beneficiary shall obtain APSOT's previous consent. In such a case, he/she shall conform to the statements in the last part of the previous sub item related to applicable funds and contributions.
13.3. Regarding the foregoing amounts to be paid on a monthly basis by the beneficiary mentioned in items 13.1 and 13.2, they shall be paid in advance, unless they are satisfactorily granted at the discretion of the Health Maintenance Organization.
Art. 14. Employment Termination. If an Employment Contract is ended, primary holder beneficiaries who have worked steadily as employees for more than 3 (three) months shall maintain their condition us such, for a 90 (ninety)-day-period from Employment Contract termination, with no obligation to make any contributions.
Upon employment termination, they will have to bring back their identification card to APSOT and they will receive another one valid for 3 (three) months, stating that practices shall only be performed upon APSOT’s previous consent, regardless of their nature.
Art. 15. Infractions and Sanctions. Any of the following shall be considered a serious infraction subject to service suspension and Affiliate exclusion, not withstanding the legal responsibilities that may be applicable:
a) misrepresenting information, submitting documentation that does not match the services effectively received or performing any kind of maneuver intended to obtain an improper benefit, or any other different from the corresponding one, in accordance with APSOT regulations.
b) in case of direct payment by the beneficiary, failure to comply timely with contribution payments shall be subject to the same sanctions as in subsection a) when the Affiliate, who has been authentically presented with an ultimatum to pay off, does not do it within 72 hours of subpoena.
In all cases, the sanctioned Affiliate shall return to APSOT, within 24 hours of notification, his/her identification card, and those of the family group and other dependent beneficiaries, as well as any qualifying documentation in his/her possession at that moment.
Art. 16. It is stated that enrollment as an APSOT Affiliate shall imply full understanding and duly agreement with the present rules and those that may be set forth consequently.
Chapt. IV - MEDICAL ASSISTANCE PLAN
Art. 17. Services provided by APSOT are comprehensive and cover all the specialties enumerated in Art. 19, under the conditions defined in this regulation and in other rules that may be set by APSOT. Direct services
APSOT Affiliates shall enjoy a system that enables them to make use of all services at no charge - other than the applicable co-pays stated in the current regulation - provided that services are rendered by professionals and institutions previously contracted by the Health Maintenance Organization and indicated in the list that it will publish periodically.
In the case of contracted professionals and providers, the checking account system shall be used, being APSOT direct responsible for the payment of the service or provision rendered; this prevents the affiliate from making any kind of disbursement - except the co-pays above indicated - except when expressly indicated by APSOT. APSOT shall pay 100% of the incurred expenses, whenever they are related to doctor visits, outpatient practices, hospital stays and any clinical or surgical service provided in those occasions, including treatment and prosthesis supply.
The same procedure shall be adopted for the use of prescription drugs during hospital stay. Services at experimental stage or that have not been properly accepted by the competent state authority shall not be covered.
Art. 18. Freedom of Choice. In the case that Affiliates do not want or cannot use APSOT direct services, they shall be able to use services by their personal physicians or by any other they may choose in the true spirit of liberty, except when otherwise expressed by APSOT through general indication (e.g.: psychiatric treatments - see Art. 27-, etc.). In such cases, the Affiliate shall be able to request a reimbursement for the incurred expenses, using a reimbursement system whose mechanism is defined in Art. 38 (Chapt. IV b).
It is clearly stated that reimbursements shall be made in accordance with the fees stated by APSOT, which shall agree with those received by the contracted professionals and institutions offering the same service subject to the request according to what is stated in these rules, through payment of the applicable co-pays according to the service received and in compliance with the current rules.
Art. 19. Services. The following are some of the covered services, according to the current rules and within the framework and scope of the statements in the regulation of mandatory covered services by Health Maintenance Organizations:

• Primary Health Care, First level of Care and Prevention Programs.
• Secondary Care:
• Specialties:
• Pathology
• Biological Analysis
• Anesthesiology
• Dental Care
• Cardiology
• Cardiovascular Surgery
• Head and Neck Surgery
• General Surgery
• Child Surgery
• Plastic and Reconstructive Surgery
• Thoracic Surgery
• Clinical Medicine
• Cobalt Therapy
• Courses on Psychoprofilaxis (delivery without fear)
• Dermatology
• Diagnostic Imaging: Radiology, CT scans, MRI and Ultrasound scan
• Endocrinology
• Specialized Studies
• Infectology
• Coronary Care Unit Stays
• Injections and Nebulization Therapy
• Physical Medicine and Rehabilitation
• Gastroenterology
• Geriatric Medicine
• Gynecology
• Hematology
• Hemotherapy
• Physiotherapy
• General and Family Medicine
• Nuclear Medicine: Diagnosis and Treatment
• Nephrology
• Neonatology
• Pneumonology
• Neurology
• Nutrition
• Obstetrics
• Ophthalmology
• Oncology
• Orthopedics and Traumatology
• Otorhinolaryngology
• Oxygen Therapy
• Pediatrics
• Plasma Therapy
• Clinical Practices (ECG, EEG, Endoscopy, Washouts, Tests, etc.)
• Surgical Practices (sutures, casts, biopsies, infiltrations, etc.)
• Orthopedic Prostheses Supply
• Cardiac and Vascular Prostheses Supply
• Osseous Prostheses Supply
• Lens Supply
• Removable Dentures Supply
• Hearing Aids Supply
• Psychiatry
• Radiotherapy
• Rheumatology
• Emergency Clinical and/or Surgical Services
• Pharmacy Services (drugs dispensing)
• Intensive Care Unit
• Urology

In case of changes in the state regulation (acts, regulatory decrees, resolutions, etc.) of mandatory services by Health Maintenance Organizations, in relation to both, the type of services and their scope, terms and conditions, they shall conform to what may be potentially stated there, not withstanding the greater benefits that may be set by APSOT.
In rare cases and on proper grounds, the Board of Directors shall be able to establish full or partial coverage and corresponding payment method (direct, reimbursement , etc.) for services not specifically included in the above-mentioned list.
Services excluded by APSOT are indicated in art. 38 (Cap. IV c). Art. 20. Usage.
20.1 In order to use the services, Affiliates shall proceed as follows:

• Upon submitting the identification card, professionals shall also request their national identity document, to verify their identity.
• At the time of service, providers shall fill out a form summarizing care-related information and shall require the affiliates’ signature to give consent for the service provided.
• When a provider recommends a practice to be performed by another provider, he/she shall prescribe it using his/her own prescription (preferably including letterhead) and indicating the affiliate’s information according to the identification card.
• Complex practices require authorization and, for this purpose, orders shall be submitted to APSOT Medical Audit together with a summary of the Medical History.
• Prescription drugs shall be ordered by the physician using his/her own prescription, including letterhead if possible, and properly indicating the product according to the current rules. There, he/she shall identify the beneficiary, indicating APSOT name, affiliate’s number, plan and first and last name, according to the information in the identification card.
• When the physician orders a prescription drug for long term administration, he/she shall do it under the same conditions as indicated in the previous subsection, using a separate prescription, including dosage and expected treatment length and attaching the medical history.
• For prescription drugs dispensing at the pharmacy, the affiliate shall submit the identification card, the prescription meeting the conditions previously described and the corresponding national identity document. Dispensing-related information shall be indicated at the back of the prescription, which shall be signed by the affiliate for consent.
• For Kinesiology, Speech and Hearing Therapy and Psychiatry/Psychology, the affiliate shall submit to the professional a prescription by the attending physician indicating the number of authorized sessions and provide a signature per session.

i) If it is not possible for the provider to take his/her information from the magnetic stripe in the identification card, he shall stamp on the documents, if possible, the embossed information from the identification card using carbon paper, for a better control.
j) Hospital Stay. In order to authorize hospital stays at the contracted medical assistance institutions, APSOT shall provide the affiliate with an inpatient order.
k) Dental Treatment Form. For all services, the professional shall fill out this form, indicating the practice(s) performed and including the corresponding Affiliate’s signature for consent, and attach it to the invoice.
20.2. The Board of Directors shall state, within the framework of the current regulation, the value of the co-pay per Office Visit and Practice, which shall be paid by the Primary Holder Affiliates through paycheck deduction, when the Health Maintenance Organization receives the invoice by the provider. For this purpose, the primary holder Affiliate shall sign the pertinent deduction authorization form provided to his/her employer.
In case of employees on leave without pay who decide to stay in APSOT or any other beneficiaries who are not working as employees (retirees, subscribers, etc.), the value of the co-pay per Office Visit and Practice shall be paid directly by themselves at APSOT offices at the time of paying their monthly contribution rates, once the Health Maintenance Organization receives the invoice by the provider.
Chapt. IV a) DIRECT SERVICES
Guidelines to follow in case of services provided by physicians or institutions contracted by APSOT.
Art. 21. Doctor Visits.
21.1. Doctor Office. In all cases, the beneficiary shall schedule an appointment well in advance, identifying himself/herself as an APSOT Affiliate.
When going to the doctor office, the corresponding identification card and national identity document shall be submitted; the physician shall fill out a sheet or form and the Affiliate shall sign it to give consent.
21.2. Home Care. The beneficiary shall resort to the services in the directory of providers, identifying himself/herself as an APSOT Affiliate.
When the professional arrives, the corresponding identification card shall be submitted to him; the physician shall fill out a voucher and the Affiliate shall sign it to give consent.
21.3. Advisors. APSOT professionals shall be able to refer their patients to an advisor physician from the Health Maintenance Organization, whose fees shall be paid by APSOT. For his purpose, such referral shall be required to be put in writing.
Art. 22. Hospital Stays.
22.1. The physician who orders a hospital stay shall certify it using his/her own prescription, stating diagnosis and required treatment. Upon its submission, APSOT shall issue an Inpatient Order.
In case of emergencies, the Affiliate shall be admitted for hospital stay upon mere submission of his/her identification card and physician prescription. The medical institution shall give the beneficiary 48 hours to submit the corresponding Inpatient Order.
Clinical syndromes implying imminence of death or serious consequences and stays in coronary care or intensive care units shall be communicated PROMPTLY to APSOT.
In case of inpatient children under the age of 12, APSOT shall pay expenses for one guest stay during inpatient care, except when the child stays in intensive or intermediate care or coronary care units.
In all hospital stays, the medical assistance institution shall be able to require the Affiliate to make a previous deposit or to offer sufficient guarantee, to afford potential expenses that may not be covered (guests, extra services, phone calls, etc.). Such deposit or guarantee shall be returned or rendered void, respectively, at the time of discharge, after deducting those expenses that may have been incurred in.
If a guest stays after regular visit hours, the clinic shall be able to charge a guest fee, whether the bed is used or not. For such purpose, Affiliates are recommended to find out the amount to pay, before making use of the service.

All the receipts issued by the providers at APSOT expense shall be signed by the Affiliate or by the closest responsible family member.
Signature implies previous verification that the billed services are real.
22.2. Institutions that Work with their Own Professionals (CLOSED). These are all contracted institutions that have their own professional staff and provide care according to the chosen specialty service; that is to say, that such service determines the staff member who shall provide the required care.
The Affiliate shall not require a preferred staff member. In such a case, this means receiving customized care, which enables the professional to charge a preferential fee that shall be paid by the affiliate.
The institutions mentioned here are contracted to offer only those services stated in the current regulation of mandatory services by Health Maintenance Organizations. Therefore, any uncommon practice and/or surgery shall be managed exclusively through the providers specifically contracted for.
In case that the Affiliate still decides to use such services, APSOT shall recognize them through reimbursement, which shall be limited to the values agreed upon with its providers, upon submission of the supporting documentation.
Art. 23. Emergency Services and Home Care. This service shall be available 24 hours a day, everyday of the year and shall be provided by a group of physicians (clinicians and pediatricians, and/or physicians of other specialties that may be set forth) contracted by APSOT; it may be required directly by the Affiliate, family member or acquaintance at the phone number stated by the Health Maintenance Organization. Provider companies shall commit themselves to respond emergencies and urgent cases as soon as possible according to the request category and with doctor visits, within a time period not exceeding 2 hours.
Art. 24. Prescription Drugs. Drug prescriptions shall conform to the statements in Art. 20 “e” of this Regulation. Upon submission of a properly issued prescription, contracted pharmacies shall directly apply a 50% discount on those products covered by APSOT, being the Affiliate responsible for paying the other 50%. In case of inpatient stays, clinics shall supply any needed drugs to the patient at no charge, being APSOT responsible for their payment in full.
In case of requiring prescription drugs from the pharmacy during inpatient stay, such situation shall be substantiated at the time of reimbursement request.
24.1. Long Term Treatments. In case of conditions requiring long term treatments, the Affiliate shall submit to APSOT administration a prescription where the physician has stated, in his/her own, true and proper handwriting, its purpose of a long term treatment, together with a brief medical history where the professional has stated diagnosis and expected treatment length. The issue date of the prescription, upon its submission, shall not be over 30 (thirty) days old.
Upon submission of such prescription, APSOT shall control it and provide coverage directly through the providers specifically contracted for, enabling the beneficiary to acquire prescription drugs periodically, until the prescribed treatment is completed or up to a maximum of 180 days.
24.2. Maternal and Child Health Care Plan. This plan shall provide services related to pregnancy, delivery and puerperium, which shall be absolutely free for mothers during the whole pregnancy and up to 30 (thirty) days of delivery and, for children, up to one year of birth.
This benefit shall not cover over-the-counter drugs and baby food, other than maternalized or medicinal milk when prescribed according to the rules of mandatory coverage by Health Maintenance Organizations. Upon submission of medical certificate stating pregnancy and expected delivery date, APSOT shall provide the mother with special Prescription Orders including her name and expiration date, which shall enable her to acquire prescription drugs with 100% coverage during pregnancy and up to 30 (thirty) days of delivery.
After child birth, she shall submit to APSOT a copy of the birth certificate, upon which she shall be provided with new Orders, to purchase those drugs that my be required by the child up to age 1 (one).
24.3. Chemotherapy. Except in urgent cases, supply of oncologic drugs shall be made directly by the Health Maintenance Organization, upon submission of the medical history and corresponding prescription. Expenses for oncologic treatment drugs are 100% recognized. When they are used during inpatient stay, coverage is automatic.
24.4. Exclusions. It is expressly stated that, except those products that may be defined to have mandatory coverage in the applicable regulation by Health Maintenance Organizations or by APSOT, no amount shall be reimbursed for the acquisition of any the following elements, even when the physicians have prescribed them:
Anovulatories and contraceptive drugs (other than those indicated in the previous paragraph)- - Aspirin (acetylsalicylic acid) - Bio-Organotherapy products for hair - Cosmetic shampoos - Sweeteners - Intestinal evacuation products - Laxatives - Milk - Dietetic Preparations - Flavorings - Seasonings - Mineral Water - Cotton - Electric Pads - Typical pain relievers - (Geniol, Bayaspirina, etc.). - Dressing material - Rubber or plastic devices (bags, cannulas, breast pumps, etc.) - Toiletries (combs, hair brushes, etc.) - Sprays - Tooth brushes (with or without prescription) - Adhesive tapes and the like - Face or hair cream - Pacifiers - Tooth pastes of any type and other items that may replace them - Deodorants (Anhidrot, Neobitol, Sodorane, etc.) - Supports - Denture adhesives (Co-re-ga, etc.) - Analysis containers - Gauzes - Soaps of any type (Jabonacid, etc.) Disposable or common syringes - Inhalers - Surgical Instruments - Irrigators - Face or Hair Lotions - Baby bottles - Suture material - Dental supplies (Acitra, Nenedent, Deone, Encident, Gingivalina, etc.) - Disposable diapers - Perfumes - Pessaries- Plac-out and the like - Tubes - Thermometers - Thermos - Bandages - Ace bandages - Herbal remedies and any type of drugs sold over the counter or with no medicinal value.
Art. 25. Medical Practices. The physicians shall indicate in his/her prescription the required studies, using a different one for each type of specialty (radiology, biological analysis, nuclear medicine, outpatient practices, hematology, etc.).
These practices shall be provided at no charge - other than the co-pay recognized by the current regulation - provided that they are rendered through services or by professionals contracted by APSOT.
Art. 26. Psychiatry. Considering the particular features of the psychiatric specialty and according to what is stated in Art. 18, the following rules are set forth:
 26.1. Psychiatric care shall be provided exclusively by the staff of specialists contracted by APSOT, which shall include a psychiatric coordinator, advisors, psychiatrists specialized in adult, adolescent and child psychiatry, psychologists and educational psychologists.
Previous authorization by Medical Direction shall be required. Otherwise, potentially used services shall be charged to the Affiliate.
Once the authorization is obtained, in all cases, the psychiatric coordinator shall be consulted, following the same procedure as indicated for visits to physicians contracted by APSOT.
Authorization or Recognition for psychotherapy treatments shall be limited to a maximum of 30 (thirty) sessions per year, a maximum of 2 (two) sessions per week and no more than 4 (four) sessions per month.
In case of acute pathologies, inpatient stay shall be covered for a 30 (thirty)-day period in the year, requiring previous consultation with the coordinator, medical report within 15 (fifteen) days and definite diagnosis within 30 (thirty) days of hospitalization.
26.2. Educational Psychology. This service shall be provided to children with unsatisfactory academic performance (dysgraphia, dyscalculia, dyslexia) and to children requiring psychomotor re-education due to a specific pathology.
Art. 27. Sessions. In case that the treatment indicated by the physician in his/her prescription consists of several sessions, the Affiliate shall obtain the corresponding authorization by APSOT for the indicated session number and shall sign it whenever a session is completed to give his/her consent. This shall remain in possession of the attending professional, so that he/she can then submit it together with the invoice.
27.1. Physiotherapy and speech and hearing therapy services shall be indicated by the physician in his/her prescription and shall be provided in cases of motor, psychomotor, orthopedic and sensory rehabilitation:
a) Due to fractures.
b) Due to surgical operations.
c) Due to sequelae of neurological or vascular diseases.
d) Due to any sequelae of other pathologies properly indicated in the Practice Order by the attending physician and among those defined to have mandatory coverage in the current legislation by Health Maintenance Organizations.
In such cases, APSOT coverage shall be limited to a maximum of 25 (twenty five) sessions per year. A session is defined as the set of one or more kinesiology practices at the doctor office, at home or in the assistance institution.
For coverage of cases indicated in items a), b) and c), APSOT may consider an extension of the treatment, should there be well-grounded medical reasons recommending so. For such purpose, the Affiliate shall submit all reports and documentation that allow to make a better analysis of the case.
Art. 28. Dentistry. For services defined to have mandatory coverage according to the current regulation, the professional shall fill out the Dental Treatment Form, indicating the practice(s) performed and including the corresponding Affiliate’s signature for consent, and shall attach it to the invoice.
APSOT reserves the right to summon the Affiliate initially to verify the need of treatment and/or finally to verify the quality and type of the services used.
28.1. Dentures. All the Affiliates shall be covered under the conditions detailed below:
1) Acrylic and Chrome-Cobalt removable dentures. Fixed dentures shall be excluded and beneficiaries shall not be entitled to any recognition for them.
2) Affiliates shall submit a sheet properly signed by the dentist, which shall be provided by APSOT within 5 (five) days of submitting a written request, stating the name of the professional who required placement of the denture indicated in item 1).
3) The Affiliate who has obtained APSOT coverage for a denture shall be able to replace it by another one, no earlier than 3 (three) years of initial provision, after verifying that the first one is no longer usable.

4) In all cases, recognition shall be based on the fees especially set for by the Health Maintenance Organization, regardless of the value that the Affiliate may have effectively paid for the denture.
5) Denture treatments provided by professionals listed by APSOT shall be directly billed by them, attaching the sheet indicated in item 2), which shall include the Affiliate’s consent. Such sheet shall state the Affiliate’s full understanding and agreement with what the professional has indicated and his/her responsibility in case of incorrect provision.
6) In case of using services by dentists not listed by APSOT, reimbursement shall be obtained by submitting the sheet indicated in item 2) with the Affiliate’s consent, together with an official receipt by the attending professional issued under the conditions required by the Resolution 3419 of the D.G.I (Internal Revenue Service).
7) APSOT reserves the right to summon the Affiliate, at any time, for controlling purposes or to demand any explanation it may consider convenient. Failure to respond or to comply with the requirements imposed may be considered a serious infraction and shall be subject to the pertinent liabilities.
28.2. Orthodontics and Orthopedics. Coverage for treatments of orthodontics (fixed appliances) and orthopedics (removable appliances) shall be exclusively applicable to children aged up to 18, only once, and shall require previous authorization by APSOT administration.
The cost of the service shall be recognized based on APSOT current fees, at the time of payment.
Amounts for the cost of the services shall be paid directly by APSOT to the professionals.
Art. 29. Optical Supplies - Orthopedics - Dentures.
29.1. Optical Supplies. When prescribed by ophthalmologists, APSOT shall recognize the following devices, provided that they have been previously authorized:
·  Glasses:

• Dioptric, white and colored lenses, including RAY BAN II, Kryptok, Ultex and Bio Vis bifocals, trifocals.

Photochromic lenses, executive, organic or made of tempered glass bifocals and multifocals shall not be recognized.
Glasses that have been recognized may not be replaced earlier than 24 (twenty four) months of initial supply, unless a new prescription is issued during this period, due to a change in the grade of the lenses.
Regardless of their cost, frames shall have a fixed recognition based on the values previously set by APSOT, which shall be periodically adjusted by the Board of Directors.

• Contact Lenses:

Soft or flexible, common, non-colored and toric lenses shall require previous authorization by APSOT.
They may not be replaced earlier than 12 (twelve) months of initial supply, unless a new prescription is issued during this period, due to a change in the lenses power.
In case that the Affiliate cannot get used to contact lenses within a 60 (sixty)-day period, he/she may choose coverage for common glasses. In such a case, he/she shall proceed to return the no-longer-used lenses to the optical store or to APSOT.
c) In case of broken, lost or stolen lenses, frames or contacts provided by APSOT, the Affiliates shall be responsible for their replacement.
29.2. Orthopedics (Shoe orthotics, corsets, supports, busks, Zimmer collars, etc.):
The Affiliate who is prescribed an orthopedic appliance shall submit to APSOT, apart from the prescription by the physician stating such requirement, three budget quotations for the prescribed appliance, which shall be technically evaluated by the Health Maintenance Organization before approving, if applicable, its purchase or rental; such appliance shall be delivered on loan to the Affiliate by APSOT, who shall provide full coverage. If the appliance may be reused, APSOT shall decide upon its destination and may consider its donation to any public welfare organization.
Supply of shoes (except the cost for turning common shoes into corrective ones), ace bandages, knees, wrists ankles and thighs supports and any other elastic device is excluded.
29.3. Medical Prostheses (Pacemakers, hips prosthesis, etc.)
100% coverage shall be granted to prosthetic appliances and implants of permanent internal implantation; excluding myogenic or bioelectrical prostheses. Medical requirements shall be stated using generic names. APSOT shall supply the respective prostheses according to the statements in the regulation of mandatory covered services by Health Maintenance Organizations. In rare cases and on proper grounds, and upon previous evaluation, APSOT shall be able to approve supply of prosthetic appliances of foreign origin.
29.4. Values and Reimbursements: If the Affiliates require any of the appliances enumerated in item 29.1 through any of the providers contracted by APSOT, the latter shall cover its total value, within its own limits, paying the invoice cost directly to the provider. If, on the contrary, the Affiliate purchases the appliance directly, that is to say, without consulting any provider listed by APSOT, reimbursement shall be limited to the values set by APSOT for their providers, as the maximum allowable amounts.<
29.5. Hearing Aids. The Affiliate who has been prescribed hearing aids shall submit to APSOT, apart from the pertinent prescription by the physician, the studies for the hearing aid selection performed by a competent professional, together with three budget quotations for the prescribed appliance. When applicable, APSOT shall approve its supply providing full coverage, within the limits recognized by the Health Maintenance Organization.
Art. 30. Outpatient Practices. They are the ones mentioned in the regulation of mandatory medical assistance services by Health Maintenance Organizations and shall be indicated by the physician in his/her own prescription, even if he/she is the provider.
Art. 31. Specialized Studies. Specialized studies, such as those related to nuclear medicine, gamma camera, genetics, mammography, ultrasound scan, radio-immune tests, CT scans, holter monitoring, bone densitometry, MRI, brain mapping, polysomnography, normalized practices, etc., shall be indicated by the physician in his/her own prescription stating presumptive diagnosis.
Complex and specialized studies (.) shall be previously authorized by APSOT by submitting medical history and medical requirement, in a prescription by the attending physician, preferably including letterhead.
Art. 32. Injections and Nebulization Therapy. Regardless of their cost, they shall have a fixed recognition, which shall be periodically adjusted by the Board of Directors.

Art. 33. Comprehensive Treatments. In case of requiring financial support for comprehensive and long term treatments, the Board of Directors shall define in each case both, the source and, if applicable, the amount of the potential support, in view of the information that it may require to the Affiliate and attending providers.
Art. 34. Care Provided by Non-Medical Professionals. It shall be recognized only when there is medical prescription by an authorized professional, stating the pertinent diagnosis.
Art. 35. Verification. APSOT reserves the right to verify - by itself or by means of contracted professionals, depending on the case- anything in relation to the services: from Affiliates’ physical conditions to prescribed treatments, destination or value of the products, services used, etc.
Art. 36. Directory of Providers. APSOT shall inform periodically the roster of health care entities, institutes, laboratories, physicians and other professionals that have entered into agreements with it, to provide services.
Chapt. IV b) FREE CHOICE OF PROVIDER
Art. 37. Reimbursements. Reimbursement requests for services shall be submitted no later than 90 (ninety) days from payment date. Afterwards, no recognition shall be made, other than cases of force majeure duly substantiated.
For this purpose, the Affiliate shall fill out a form of Reimbursement Request for Medical Expenses for each of the beneficiaries subject to reimbursement request.
37.1. <}89{>Doctor Visits. The Affiliate shall submit a receipt by the attending professional, issued according to the statements in Resolution 3419 of the D.G.I (Internal Revenue Service).
37.2. Hospital stays and other services by medical institutions that have not entered into any agreement with APSOT.
The Affiliate shall pay the cost of the service and, afterwards, shall submit to APSOT the detailed, nominal invoice (hospital stay, fees, charges, practices and other services provided, etc.), together with the corresponding receipt of payment properly issued.
APSOT shall reimburse the amount of fees and expenses according to the corresponding number of doctors and clinics in each case. When applicable, such practices shall be subject to current co-pays according to APSOT rules.
37.3. Requirements common to all medical practices:
Under the conditions set in Art. 25, 30 and 31, medical practices may be required by APSOT non-participating professionals and shall be prescribed by the physician using his/her own prescription, including letterhead if possible. They shall also by provided by contracted providers.
If the Affiliate does not select this option, he/she shall submit:
a) the prescription by the physician indicating name of the direct beneficiary of the service and detailing each of the studies ordered. In case of prescription drugs, they shall be identified according to the statements in the current regulation.
b) the respective receipts issued in accordance with Resolution 3419 of the D.G.I (Internal Revenue Service).
37.4. Dental Care. In case of reimbursement requests for dental care, they shall be substantiated according to the current fees previously set forth by APSOT. In such cases, the following guidelines shall be adhered to:
1) Submission of the Dental Treatment Form properly filled out; otherwise, certificate issued by the attending professional indicating all the information required in such Form.
2) For the purpose of a proper reimbursement settlement, the professional shall indicate the location of the treated tooth, using the graphic in the dental form. He/She shall inform whether the restored dental condition is single, compound or complex, together with the material used (amalgam, silicate, acrylic, composite, etc.) and, if possible, the corresponding code of the dental fee scheduler.
3) For reimbursement requests for endodontics (root canal treatment), pre-operative and post-operative X-rays shall be attached without exceptions.
4) In cases of surgery due to bony or submucous impacted teeth, pre-operative and post-operative X-rays shall be attached.
5) Scaling (dental cleaning) shall be limited to one per year.
6) Serial X-rays shall be accepted in cases of periodontics and septic foci.
In case that the Affiliate wants to know the amount to be reimbursed by APSOT, at the beginning of the treatment he/she shall ask the attending professional to fill out the sheet of the practices to be performed, which shall indicate his/her corresponding reimbursement.
In order to have the cost of the treatment reimbursed, this should have been fully paid; reimbursement shall be made upon submission of the corresponding documentation and receipts, issued in accordance with Resolution 3419 of the D.G.I (Internal Revenue Service).
37.5. Prescription Drugs. Prescription drugs shall have 100% recognition during hospital stays and 50% recognition during outpatient practices, according to the following rules:
Prescriptions by professionals not contracted by APSOT shall also be accepted by contracted pharmacies.
If the Affiliate does not select this option, he/she shall submit:
a) the prescription by the physician, preferably including letterhead, indicating name of the direct beneficiary of the service, detailing each of the prescription drugs ordered.
b) the invoice by the pharmacy issued in accordance with Resolution 3419 of the D.G.I (Internal Revenue Service).
c) cut-out bar codes from the packages of the prescription drugs acquired.
No photocopy or any other type of reproduction shall be accepted, except for Long Term Treatments, in which case, they shall be issued and submitted directly by APSOT to the Affiliate.
If it is not possible to submit the prescription because it must be compulsorily retained by the pharmacy, notification about this in the corresponding invoice together with bar code cut-outs submission shall be sufficient.
No notifications or other inscriptions shall be added to the receipts attached for reimbursement requests. Required information shall be stated by the attending professional or facility. Otherwise, reimbursement shall be cancelled and documentation returned to the interested party.

37.6. Expense Reimbursements for Services Provided Abroad. In case that the affiliates have found it necessary to incur in expenses for general medical assistance, hospitalizations, surgical operations, dentistry, etc. while temporarily abroad (tourism, etc.), recognition for them shall be limited to the current reimbursement values in Argentina. Regarding prescription drugs, reimbursement shall be limited to 50% of their value in Argentina. In all cases, previous submission of the respective expense receipts shall be inevitably required.
Chapt. IV c) NON-COVERED SERVICES AND TRASPLANTS
Art. 38. Non-Covered Services. APSOT shall not pay nor recognize any reimbursement for services resulting from:

• Participation in criminal offenses.
• Non-therapeutic abortion.
• Hospital stays during chronic processes of any etiology and pathogenesis, with no reverse or enhancement possibility by means of medical or surgical treatments, other than acute episodes, complications or end stages arisen during such processes.
• Geriatric hospitalization.
• Professional or work-related illnesses. Work-related accidents. High-risk sports, such us: Injuries or conditions resulting from the Affiliate’s participation as driver or accompanist in car, motorcycle or motor boat competitions, aviation, parachuting, hang gliding, diving, submarine hunting, etc.
• Services or drugs resulting from practices related to acupuncture, homeopathy and chiropractics, even when provided by authorized physician.
• Treatments or operations at experimental stage, that is to say, that they are not recognized by any Official or Scientific Institution.
• “In Vitro” fertilization or other “Assisted Reproductive” technologies, related studies, analysis and /or procedures not included in the National Fee Scheduler or Mandatory Medical Program (PMO), such us artificial insemination, etc.

Services for maternity, resulting from any of the mentioned technologies or treatments, and for the new-born baby care shall be recognized, according to what is stated in the current regulation of mandatory coverage by Health Maintenance Organizations.

• Contraception, except the services stated in the current regulation of mandatory covered services by Health Maintenance Organizations.
• Extra expenses during hospital stay or not (guest, skilled nursing, etc.).
• Podiatry and cosmetology, iconography, hydrotherapy, cellular therapy.
• Rest cures and rejuvenation treatments.
• Hospital stays for complementary exams and/or clinical or surgical treatments that, according to APSOT Medical Audit, may be provided as outpatient services or may have no medical value either.

Blood donation, temporary removable prosthodontics, aesthetic plastic surgery, colored lenses without diopter and their corresponding frames and orthotics supply shall also be excluded from coverage.
No expenses for differences due to hospital stay in department, suite of special room, guests and/or extra services shall be recognized, except when otherwise stated in this Regulation.
The Board of Directors shall consider recognition of services not covered by APSOT, should there be well-grounded medical reasons recommending such exception and provided that services are a supplement to a recognized service.
For his purpose, the Affiliate shall submit all medical certificates and documentation that may be required to him to substantiate such circumstance.
Art. 39. Transplants.
39.1. Any such surgery shall be previously approved by the Board of Directors and the Affiliate shall require its recognition by submitting medical history, complete familial history and three budget quotations by different public and/or private providers authorized by the INCUCAI (Unique Central National Institute for Ablation and Implant).
Chapt. V. SUBROGATION
Art. 40. Subrogation - Duty of Communication - Jurisdiction.
APSOT is subrogated for all Affiliates’ rights and actions resulting from incurred expenses that may have been paid or afforded by employers, insurers or third parties, in case of work-related accidents or professional or work-related illnesses, as well as from expenses due to culpable or unintentional action and/or omission by third parties or its consequences.
The Affiliate or his/her acquaintances shall inform promptly to APSOT and offer full assistance in relation to the statements in the previous paragraph. Concealment, fraud or failure to comply timely with what has been stated may be considered a serious infraction, which enables APSOT to bill the affiliate for the amounts it may have paid.
In case of any controversy, the Affiliate gives his/her consent to the jurisdiction of the Courts in the Federal Capital, ordinary jurisdiction.
Art. 41. Cases not specifically provided for: The Board of Directors reserves the right to solve the cases that may not be specifically provided in this regulation.
The Board of Directors shall be able to authorize, meeting the requirements it may set forth, inclusion of other beneficiaries, as well as establishment of special plans for them. Exceptionally, it may also be able to extend coverage deadlines, conditions and contents and to change those cases and conditions, under which it may state enforcement or extension of the right to enjoy services, new and plural coverage plans for the affiliates and/or changes in the existing ones.


MEDICAL ASSISTANCE PROGRAM
Period 2005
 Services provided by APSOT are comprehensive and cover the requirements by the Mandatory Medical Program. All specialties.
 SERVICES BY PROVIDERS CONTRACTED BY APSOT
APSOT beneficiaries enjoy a system that enables them to make use of all services at no charge, provided that services are rendered by professionals and institutions previously contracted by the Health Maintenance Organization and indicated in the list that it permanently publishes. In case of contracted professionals and providers, the checking account system shall be used, being APSOT direct responsible for the payment of the service or provision rendered; this prevents the beneficiary from making any kind of disbursement, except when otherwise expressed by APSOT through general indication. APSOT shall pay 100% of the expenses incurred in, whenever they are related to doctor visits, outpatient practices, hospital stays and any clinical or surgical service provided in those occasions, including treatment and prosthesis supply.
In case of prescription drugs used during hospital stays, APSOT shall also cover 100% of their value.
FREEDOM OF CHOICE
In case that beneficiaries do not want or cannot use APSOT direct services, they shall be able to use services by their personal physicians or by any other they may choose in the true spirit of liberty, except when otherwise expressed by APSOT through general indication, as well as by another professional or institution, whose services are referred to in this regulation, being psychiatric treatments the only exclusion from this possibility. In such cases, the affiliate shall be able to request a refund for the incurred expenses, through reimbursement system.
It is clearly stated that reimbursements shall be made in accordance with the fees stated by APSOT, which shall agree with those received by the contracted professionals and institutions offering the same service subject to the request, according to what is stated in the regulation.
GENERAL RULES FOR CARE
Regarding outpatient visits, APSOT affiliates shall enjoy this benefit by submitting the identification card and national identity document accrediting their condition as such.
For rehabilitation practices beneficiaries shall submit to the contracted specialized centers the identification card and national identity document, together with the medical order, or shall use the reimbursement system.
For non-complex practices, beneficiaries shall submit to the contracted specialized centers the identification card and national identity document, together with the medical order, or shall use the reimbursement system.
For complex practices, the beneficiary shall submit his/her identification card and national identity document, together with the practice order previously authorized by APSOT, indicating date of prescription, signature and seal by the attending professional.
This Health Maintenance Organization shall comply with all complex practices enumerated in Resolutions N° 001/98 and 500/04.
BENEFICIARIES' ACCREDITATION
Beneficiaries and their family group shall accredit their condition as such, by means of the personal identity card and the national identity document.

MEDICAL ASSISTANCE PLAN
GENERAL REGULATION
APSOT shall recognize, exclusively, all practices included in Resolution 201/2002 and their modifications and complex practices, upon fulfillment of the authorization modalities stated by APSOT. No other practices that the affiliate may require without previous authorization by Medical Audit shall be recognized.
Only those requests by professionals from contracted centers and State Bodies (Hospitals or National, Provincial or Local Health Units) shall be recognized. In case of using the reimbursement system, the corresponding paperwork shall be processed at the Health Maintenance Organization offices.
APSOT shall comply with all the practices included in the Mandatory Medical Program for Emergencies (PMOE) and shall oblige its providers to comply with the National Program of Medical Care Quality Assurance and the Program of Health Supervision.
Faithful compliance shall be granted to the obligation to submit, to the Health Services Regulatory Body, the rosters of patients included in the program.
All those practices referred to in Resolutions N° 001/98 and 500/04 shall be covered through the Solidary Redistribution Fund.
PRIMARY HEALTH CARE PROGRAM


Considering that Health Insurance Agents are not mere financial supporters of the system, but, primarily, agents responsible for the health care coverage for the beneficiaries’ community, APSOT shall adopt those prevention programs mentioned in the Mandatory Medical Program and others that grant a highest quality of life to the beneficiary, for considering human beings, subject to the health care system and health, an inalienable right.
These strategies and actions are meant to reduce health care and epidemiology risk for the entire community, fostering those activities that emphasize health care promotion and prevention, especially those associated with maternal and child health care, and help to reduce mortality due to nutritional and contagious and infectious diseases and other preventable ones.
In order to give priority to policies for disease prevention over curative actions, APSOT shall adopt a servicing model based on the strategy of primary health care, granting accessible continuous and comprehensive care and reasonable use of health care, diagnosis or therapy technology, according to the principles of evidence-based medicine.
Primary Health Care (APS) is based not only on the coverage for first level of care but also on the strategy for reinforcement of prevention programs.
Such program shall be implemented by those physicians playing the role of Family Physicians, who are functionally called Reference Physicians for their being a reference to any health care topic.
Due to its servicing modality, APSOT includes the EBAMP (Basic Team for Primary Health Care) among the physicians that form part of its directory of providers for all the required specialties, which enables its beneficiaries to be additionally assisted through the open system, thus offering a wider range of services. This way, it includes the entire community in the program, since affiliation. In compliance with the information required by Resolution /97, National Health Insurance Administration, and its modifications, APSOT shall communicate quarterly, to the Health Services Regulatory Body, the roaster of people included in prevention plans.
PREVENTION PROGRAM
1.        MATERNAL AND CHILD HEALTH CARE PLAN
In accordance with Resolutions 939/00 and 201/2002 of the Ministry of Health (PMO: Mandatory Medical Program) and their modifications in relation to this plan, APSOT shall provide medical coverage to all its beneficiaries including comprehensive care as of pregnancy diagnosis and periodical checkups of the pregnant woman, which shall include studies according to the corresponding gestation period (1°, 2° and 3° quarter). It shall also include prescription drugs supply at no charge for the mother during pregnancy, delivery and puerperium month, or until complications are solved, and 100% coverage for the new-born baby up to age one.
Regarding normal pregnancies, checkups shall be performed on a monthly basis up to week 35, on a 15-day basis from weeks 35 to 38 and on a weekly basis from week 38 to delivery.
Regarding high-risk pregnancies, checkups shall have no restrictions and shall include any of the Complementary Studies that each of the pathologies may require.
Hospitals stays shall consist of, at least, 48 hours for vaginal delivery and 72 hours for cesarean section.
Immunoglobulin anti-Rh shall be supplied to Rh (-) mothers not sensitized with Rh (+) children and Coombs negative, within 72 hours of delivery and during the hospital stay. Immunoglobulin anti-Rh shall also be supplied to Rh (-) mothers whose pregnancies result in abortion.
APSOT also offers courses on delivery Psychoprofilaxis and prevention of contagious and infectious diseases, as well as educational publications.
Studies for the detection of phenylketonuria, hypothyroidism and cystic fibrosis in the new-born baby shall be covered.
Faithful compliance shall be granted to Resolution 940/2000, which states mandatory first Hepatitis B vaccination for the new-born baby, prior to discharge; second dose, within two (2) months of birth; and third dose, within 6 (six) months of birth.
Semiotic research of any sign of hip dysplasia.
Hips ultrasound scan is required for internal podalic version deliveries with positive or misleading semiotics and for baby girls with familial history.
Determination of blood group and Rh factor, intramuscular administration of vitamin K. BCG vaccination prior to discharge.
Follow up visits and post discharge checkups shall be performed, as well as immunizations according to the corresponding period.
Studies for the detection of sensory deficiencies shall also be performed.
For the purpose of promoting maternal lactation, maternalized milk shall not be covered. Medicinal milk coverage shall be limited to 4kg/month, during the first three months of birth. Medical requirement shall be submitted together with its supporting clinical summary.
For children who do not receive maternal milk, cow milk fortified with iron, zinc and ascorbic acid shall be recommended from the 2nd semester onwards for the prevention of anemia due to iron deficiency, in accordance with the Public Maternal and Child Health Care Plan.
After the first 4 months, children who do not receive iron-fortified milk shall have coverage for oral iron-containing supplements, up to 18 months from birth.
Clinical studies for the detection of Sensory Deficiencies shall be performed:

• Hearing
• Sensitivity to touch stimuli
• Reflexes
• Checkups to be performed as of one week from birth: Sounds hearing, photomotor reflexes, Moro reflex, plantar and palmar prehension, righting and walking.
• In case of sensory pathologies, early stimulation and speech and hearing therapy shall be performed.

2.      ONCOLOGIC DISEASES
APSOT shall provide prevention programs for women’s cancer:
breast and uterine neck.
For the first one, breast self-examination, periodical office visits and mammograms, when applicable, shall be encouraged by means of educational publications of free and massive distribution.
Mammograms shall be considered a preventive practice if performed annually and periodically for the systematic screening of breast cancer. For such purpose, women beneficiaries shall be, at least, 49 years old or, if younger, shall present cancer familial or personal history or other risk factors.
Concerning uterine neck cancer, checkups shall consist of Pap smear and colposcopy
2.1. For any woman who has initiated sexual relationships or is aged over 18.
2.2 Coverage is limited to one pap smear per year for a three-year period and, in case of normal results, to one pap smear every two years, within the framework of a massive screening program and, following the previous case, by spreading and illustrating to women beneficiaries, by means of educational brochures, the importance of visiting the professional periodically and following his/her instructions.
Regarding lung cancer, efforts shall aim at primary care through tobacco cessation programs.
Regarding colorectal cancer, prevention shall be based on fecal occult blood testing, on an annual basis for people aged over 50.
100% oncologic coverage shall be granted to both, outpatient and inpatient care, including all the prescription drugs needed for treating the different conditions related to this specialty. It is stated that non-oncologic drugs shall enjoy the same discount as the rest of the outpatient prescription drugs (50%), except in case of ondansetron, for the treatment of acute vomiting induced by highly emetogenic drugs.


3.      HEALTH CARE PROGRAM FOR HEALTHY PEOPLE
This program shall be based on periodical health examination for beneficiaries. It shall aim, basically, at the prevention and detection of health problems, including annual clinical exams and diagnostic prevention practices and/or detection of different pathologies. Access to physicians from the directory of providers shall be direct and unrestricted for any specialty and for complementary studies, except complex studies that shall require previous authorization by the Health Maintenance Organization.

Checkups specifications

• General clinical exam
• Weight and height control
• Lab testing:

Uric acid
Creatinine
Erythrocyte Sedimentation Rate
Fibrinogen
Glucose
HDL
Complete blood count (Hemogram)
Complete hepatogram
Complete urinalysis
Triglycerides
Uremia
Thoracic X-ray
ECG
Tobacco and lung cancer
Colorectal cancer screening
Detection of prostate, breast and uterine neck pathologies.
Detection of addictions
4.      APSOT National Program of Sexual Health and Responsible Procreation (Act 25673) Resolutions 201/02 and R310/04
APSOT National Program of Sexual Health and Responsible Procreation is created in compliance with Act 25673, Art. 7.
Goals:
The goals of the Program shall be:

• To reach the highest level of sexual health and responsible procreation for the community, so that it can make decisions free from discrimination, coercion and violence;
• To reduce maternal and child morbimortality;
• To prevent unwanted pregnancy;
• To promote sexual health among adolescents;
• To contribute to prevention and early detection of genital tract and sexually-transmitted diseases;
• To grant access to information, guidance, methods and services regarding sexual health and responsible procreation, for the entire community;
• To encourage women participation in decision-making.

Scope:
This Plan is intended for APSOT community.
Human Resources:

• Administrative staff
• Technical staff - Health care professionals and social workers

Dissemination Program:

• Call Center -
• APSOT news
• E-news

1.      Information on Prevention and Early Detection

• Talks with Health Care professionals.

2.      Contraceptive and Prevention Methods and Elements according to Resolution of the Ministry of Health. 310/04

• Copper intrauterine devices
• Oral contraceptives
• Condoms with or without spermicide
• Diaphragms and spermicides

 Copper intrauterine devices:
Implantation and supply exclusively via closed system by professionals designated by APSOT, upon affiliate’s request and submission of medical prescription.
The frequency of replacement shall be, at least, 3 years.
Oral Contraceptives:
Drugs for oral contraceptive use included in the Annexes III and IV of Resolution 310/04 - of the Ministry of Public Health - shall have 100% coverage via closed system, for fertile-aged women who have no specific contraindication.
Condoms:
They shall be supplied via closed system to male community from age 15 to 65, upon affiliate’s request.
Diaphragm: (National origin)
Upon fertile-aged women affiliates’ request, with medical prescription and via closed system, recognition shall be limited to one every 2 years, including the corresponding spermicidal cream that shall be supplied on a monthly basis.

Practices such as tubal ligation and ductus deferens ligation or vasectomy, formally required as contraception or family planning method as set forth in Act N. 26130, are also accepted.


SECONDARY CARE
a) OUTPATIENT CARE
GENERAL DOCTOR VISITS.
Doctor visits for every medical specialty recognized by the health care authority shall have coverage. This includes emergencies and previously scheduled office visits and home care.
Every beneficiary in conditions to use services shall have direct access to them, with no previous authorization at all. He/she shall also have access to professionals, medical centers, complementary studies and inpatient institutions not included in the directory of providers, through the reimbursement system.
HOME CARE VISITS.
This service shall be available 24 hours a day, every day of the year. It shall be intended to provide medical health care to those patients whose illness prevents them from going out. The affiliate shall require this benefit to the Service specifically set for by this Health Maintenance Organization, for which there shall be a special phone line.
OUTPATIENT, DIAGNOSTIC AND THERAPEUTIC PRACTICES AND COMPLEMENTARY STUDIES.
All diagnostic practices detailed in Annex II of Resolution N° 939/00, Ministry of Health, and its modification, Resolution 201/2002, Ministry of Health , shall be covered, as well as any disposable, radioactive or contrast material, drug or element needed to perform them. Beneficiaries shall have access to these services through the centers specifically contracted for, upon submission of the practice order, indicating date of prescription and signature and seal by the attending professional. Complex studies and/or practices shall be previously authorized by APSOT. Such practices and studies may also be obtained through the reimbursement system.
STUDIES REQUIRING HOSPITAL STAY.
Beneficiaries shall have access to such practices by meeting the following requirements: practice order indicating date of prescription and signature and seal by the attending professional, being the Health Maintenance Organization 100% responsible for the hospital stay expenses.

• HOSPITAL STAYS

100% coverage shall be granted for clinical, surgical, specialized, complex or home inpatient care, with no co-pay or time limits, except those indicated under Mental Health of the Mandatory Medical Program.
They shall include 100% coverage for expenses, fees, charges, contrast or radioactive material, drugs, elements and instruments, whether disposable or not.
One-day hospital stay and outpatient surgery modalities shall have the same coverage as a hospital stay.

For scheduled surgeries, waiting periods shall not exceed thirty (30) days of prescription and affiliates shall be able to use, either the directory of providers or the reimbursement system.
If beneficiaries cannot go to these centers due to an emergency, APSOT shall recognize 100% of expenses when inpatient services are provided by State Bodies (Hospitals or National, Provincial or Local Health Units), and if they are notified by means of the inpatient order supplied by them within 24 hours of service to issue the corresponding authorization.
MENTAL HEALTH
APSOT shall perform activities for reinforcement and development of healthy behaviors and life styles. These are specific activities intended to prevent behaviors that may result in disorders, such as depression, suicide, addictions, violence, family violence, child abuse, etc.
Promotional practices by the Health Maintenance Organization shall be carried out by developing group activities and workshops.
Coverage for patients with psychiatric pathologies shall be limited to 30 sessions of comprehensive outpatient care per affiliate, per year, without any co-pay for consultation or office visit. It shall include the following modalities: Psychiatric Consultation, Psychological Consultation, Educational Psychology Consultation and Treatment, Individual Psychotherapy, Group Psychotherapy, Family and Couple Psychotherapy, Psycho-diagnosis.
Regarding hospital stays for acute and sub-acute cases and for flare-ups in chronic psychiatric patients, 100% coverage shall be granted for a maximum of 30 days, per affiliate, per year.
For the treatment of chronic pathologies, this Health Maintenance Organization shall refer its patients to Private or Public Institutions (National, Provincial or Local).


REHABILITATION
Beneficiaries shall have access to such practices through the centers specifically contracted for, upon submission of the identification card, National Identity Document and practice order, indicating date of prescription and signature and seal by the attending professional. All practices of kinesiology and speech and hearing therapy detailed in Annex II of Resolutions 939/00, Health Services Regulatory Body, and 201/2002, Ministry of Health, shall be recognized. Coverage in case of needing motor, psychomotor, orthopedic and sensory rehabilitation shall be limited to 25 physiotherapy sessions per affiliate, per year, including $ 1 co-pay per session.
In cases of rehabilitation for brain vascular accidents (CVA), APSOT shall offer coverage for a maximum of three months and shall be able to extend such benefit according to the patient’s evolution assessed by Medical Audit.
For adults’ accidents, APSOT shall cover the first six months of the treatment and shall be able to extend the service if objective progress is certified by Medical Audit.
In cases of traumatology post-operative rehabilitation, recognition shall be initially limited to thirty days. APSOT shall continue coverage for the service, according to the patient's evolution assessed by Medical Audit.


DENTISTRY.
The beneficiary shall have access to this service through the contracted dental centers, upon submission of the affiliate’s identification card and National Identity Document, enjoying coverage for all the services included in Resolution 201/2002, Ministry of Health. This service may also be covered through the reimbursement system.
This Health Maintenance Organization shall provide its affiliates with prevention, fluoridation, oral hygiene and health education campaigns.
The dental care system shall be structured into three levels, according to complexity and to the following scheme:
LEVEL 1. Basic Dentistry

• Office Visits

01.01  Visit. Diagnosis. Filing and treatment plan.
01.04 Emergency visit
An emergency visit is defined as any visit without previous appointment in which a spontaneous requirement is solved. For example: periocoronitis, stomatitis, crowns and bridges cementation, incision and drainage of abscesses, phlegmons, hemorrhages, dry sockets, etc.

• Dental surgery

02.01 Amalgam filling - single cavity
02.02 Amalgam filling - compound or complex cavity
02.08 Filling with aesthetic self-curing material.
02.09 Reconstruction of front teeth angle
02.15 Filling with photo-curing single composite
02.16 Filling with photo-curing compound composite.

• Preventive dentistry

05.01 Scaling and mechanical brushing
This practice does not include teeth whitening.
Limited to patients aged over 18, once per year.
05.02 Preventive office visits. Fluoride therapies.
They include scaling and mechanical brushing, detection and control of bacterial plaque, hygienic techniques education. Limited to patients up to age 18, twice per year. They include topical fluoride application, varnish, mouthwashes.
05.04 Preventive office visits. Detection and control of bacterial plaque and hygienic techniques education.
They include education of brushing techniques and use of hygienic devices. Interdental devices, nutritional advice and plaque disclosure. They include annual monitoring.
05.05 Sulci, fossae and fissure sealants.
This practice shall be limited to patients up to age 15, for permanent premolars and molars.05.06 Application of cariostatic cement in permanent teeth.

• Radiology

09.01.01 Periapical X-Ray. Long or short cone technique.
09.01.02 Bite-Wing X-ray
09.01.03 Occlusal X-Ray
09.01.04 Dental X-Rays, partial series: 5 to 7 films
09.01.05 Dental X-Rays, complete series: 8 to 14 films

• Surgery

10.01 Dental extraction
10.05 Dental reimplantation after trauma, without fixation.
10.06 Incision and drainage of abscesses.
10.12 Apicoectomy
LEVEL 2. Specialized Dentistry

• Endodontics

03.01 Endodontic treatment in single-rooted teeth
03.02 Endodontic treatment in multi-rooted teeth
03.05 Partial biopulpectomy
03.06 Partial necropulpectomy or mummification.
In teeth where common endodontic treatments cannot be performed, due to technical reasons.

• Pediatric Dentistry

07.01 Visits for motivation
Limited to patients up to age 13, including diagnostic visit, examination and treatment plan. Limited to three office visits.
07.03 Reduction and dislocation with dental fixation
07.04 Formocresol treatment in temporary teeth
When the treated tooth is far from exfoliation.
07.05 It shall also be covered for permanent teeth with considerable crown destruction.
07.06 Dental reimplantation and fixation due to complete dislocation.
07.07 Direct pulp protection.

• Periodontics

08.01 Examination visit. Exploration. Filing. Diagnosis and prognosis.

• Surgery

10.03/10.07 Punch, aspiration or excision biopsy.
10.04 Stabilizer alveolectomy
10.08 Surgical lengthening of the clinical crown.
10.11 Eruption of impacted teeth
10.13 Osteomyelitis treatment
10.14 Removal of foreign bodies

• Corrective alveolectomy.
• Stomatology

12.01 Specialized visit for the treatment of injuries specifically related to oral mucosa.
LEVEL 3. Complex Dentistry

• Office Visit

01.02 Home care visit
Home care visit is defined as care provided to patients who are not able to go to the provider's office.

• Dental Surgery

02.04 Filling with screw implantation in root canal
It covers treatment of teeth hard tissues to solve damages caused by tooth decay, when crown destruction is greater than two thirds of intercuspid distance. Definite filling must include sealant for every non-treated surface for patients under age 18. Limited to only one treated tooth.

• Prostheses

04.02 Removable partial dentures. Acrylic dentures shall be limited to one every 3 years; Chrome-Cobalt ones, one every 3 years.
04.03 Complete dentures. Limited to one every 3 years.
04.04 Repairs, except what is stated in code 04.04.09 (Acrylic veneer)

• Orthopedics and orthodontics

Limited to patients aged over 5 and up to and including 18. Limited to one single treatment per patient.
Lost or broken appliances shall be paid by the beneficiary and replacement values shall be previously agreed upon by the beneficiary and the Health Maintenance Organization jointly.
06.01 Specialized visit for orthodontics
It includes orthodontic filing, which shall indicate, apart from the patient's affiliation information, the features of the case including diagnosis, prognosis, length and treatment plan.06.02 Treatment of primary or mixed dentition
06.03 Treatment of permanent dentition
06.04 Correction of single abnormal positions with space.

• Pediatric Dentistry

07.02 Space maintainer
It includes fixed or removable space maintainers. Limited to one tooth, once; for patients aged up to and including 8. Crown or band and wire loop or expansion screw are excluded.
07.05 Temporary steel crown due to crown destruction.
It shall be covered for temporary teeth under formocresol treatment or with considerable crown destruction, not within their exfoliation period. Limited to permanent first molars, for patients under age 15.

• Periodontics

08.03/08.04 Gingivitis treatment
It includes scaling, supragingival curettage and planning, detection and control of bacterial plaque, topical fluoride treatment and oral hygienic techniques education. Limited to one, every two years.
08.05 Selective wear or occlusal harmonization.

• Radiology

09.02.04 Pantomography or panoramic X-ray.
09.02.05 Cephalometric analysis

• Surgery

10.02 Plastic, mouth and sinus communication
10.09 Extraction of impacted teeth
10.10 Germectomy
10.16 Frenectomy
DRUGS
Coverage according to Resolutions 310/2004 and 758/04
En función del la modificación del apartado 7 del Anexo I de la Resolución n°201/02-MS, se cubrirán con el descuento del 50% a cargo de APSOT, los medicamentos de uso ambulatorio y habitual que figuran en el anexo III de la Resol. 310/04 y con el 70% de descuento sobre los medicamentos destinados a patologías crónicas prevalentes, que requieren de modo permanente o recurrente del empleo de fármacos para su tratamiento, conforme al precio de referencia (monto fijo), que se publica en el Anexo IV de la Resol. 310/04 y para las formas farmacéuticas, concentraciones y presentaciones de cada medicamento, que allí se individualizanIn compliance with the modification in section 7 of Annex I under Resolution n°201/02, Ministry of Health, APSOT shall provide 50% discount on outpatient and common drugs indicated in annex III of Resolution 310/04 and 70% discount on drugs for prevalent chronic pathologies whose treatment require permanent or recurrent use of medication, according to the reference price (fixed amount) published in Annex IV of Resolution 310/04 and for the pharmaceutical forms, concentrations and presentations identified for each drug. It shall also provide, through its contracted providers, 60% discount on drugs, for prevalent chronic pathologies, whose treatment require permanent or recurrent use of medication, that are not included in Resolution 310/04.

• Coverage for therapeutic alternative drugs indicated in Annex V of Resolution 310/04 shall be defined by APSOT Medical Audit, according to the use recommendations stated in such Annex. This shall include 50% recognition for commonly- used drugs and 70% recognition for drugs for prevalent chronic pathologies whose treatment require permanent or recurrent use of medication, according to the reference price published in the mentioned Annex and for the pharmaceutical forms, concentrations and presentations identified for each drug.
• Drugs used during hospital stay shall have 100% coverage.
• Additionally, the following drugs and those that may added by enforcement authority in the future shall have 100% coverage:
• Erythropoietin, for the treatment of Chronic Renal Failure.
• Dapsone, for the treatment of leprosy in any of its clinical forms.
• Oncologic drugs, according to the protocols approved by enforcement authority.
• Anti-hepatitis B immunoglobulin, according to use recommendations in Annex III of Resolution 310/04.
• Drugs for the treatment of Tuberculosis.
• Drugs included in Annexes III and IV and explicitly included in the following enforcement rules:
• Resol.301/99, Ministry of Health and Social Action, Insulin coverage.
• Resol.791/99, Ministry of Health and Social Action, pyridostigmine coverage (tablets, 60mg.), for the treatment of Myasthenia Gravis and according to the daily dosage needed in each case.
• Drugs for oral contraceptive use included in Annexes III and IV of Resolution 310/04 and explicitly included in the enforcement rules from Act 25.673 on Sexual Health and Responsible Procreation shall have 100% coverage.
• 100% Coverage:
• Intrauterine contraceptives, copper devices.
• Condoms with or without spermicide, diaphragms and spermicides.
• 100% coverage for drugs for chemotherapy clinical support, for the prevention of vomiting induced by antineoplastic agents, according to the oncologic protocols approved by enforcement authority.
• 100% coverage for analgesic drugs, for the treatment of pain in oncologic patients, approved by enforcement authority.
• 100% coverage for drugs included in Resolutions Nº 475/02, 500/04, 5600/03 and 2048/03, Special Programs Administration, and their modifications.
• Drugs shall be prescribed by professionals who provide services to APSOT, according to their generic name or common international name and shall be subject to principles and mechanisms set forth in Act N° 25.649 and its regulatory Decree. In order to promote reasonable use of drugs and the use recommendations set forth in Annexes III and IV of Resolution 310/04, no restrictions shall be applied to pharmacological treatments in force at the time of their definition, provided that expected therapeutic benefits for each case and convenience of treatment continuation are accredited by APSOT Audit department.

OTHER COVERAGES
1.      PALLIATIVE CARE
Palliative care consists in the provision of active and total assistance by a multi-professional team to the patient and his/her family, when the disease does not respond to the curative treatment.
It includes patients with oncologic, active or degenerative neurological, chronic renal, metabolic or genetic diseases, potentially fatal in the short or mid term, that do not respond to the curative treatments available at the present time. The Health Maintenance Organization aims at turning the right to a decent death into a reality, seeking emotional support for the beneficiary and his/her family through a level of care that serves this purpose.
Treatments for the pain and other distressing symptoms shall have 100 %.coverage.
This care shall aim at controlling the symptoms and understanding and alleviating the pain that patients and their family members inevitably go through.
2.      HEMODIALYSIS
The Health Maintenance Organization shall provide full coverage to hemodialyzed patients who enroll in the INCUCAI within 30 days of starting the dialysis treatment, which is mandatory for coverage continuation. Upon requirement, the beneficiary shall have 100% coverage for erythropoietin and for transportation to and from the place of dialysis treatment, if Medical Audit considers that he/she cannot do it by himself/herself.
3.      OUTPATIENT CONTINUE PERITONEAL DIALYSIS
The Health Maintenance Organization shall provide full coverage upon patients’ previous medical assessment and under the conditions previously stated in Resolution N° 528/96, Ministry of Health and Social Action, Art.2° annex I.
4.      TRANSPLANTS
Beneficiaries shall have access to such practices through the centers specifically contracted for, upon submission of medical prescription, Medical History and certificate of enrollment in the INCUCAI.
Unrestricted coverage shall be recognized, including pre and post transplant studies.
5.      HEARING AIDS COVERAGE
100% coverage for sensory-neural or perceptive pathologies as well as conductive pathologies shall be granted. The affiliate shall submit to APSOT Medical Audit, the medical prescription with their respective studies (audiometry and logoaudiometry) together with three budget quotations from current recognized stores, so that it can assess and approve the less expensive device with best pathological results.
6.      OPTICAL SUPPLIES
The affiliate shall enjoy 100% coverage for 1 pair of common lenses, regardless of their grading, every 24 months. Regarding soft contacts, 100% coverage shall be limited to 1 pair per year, unless a change in the power is required. Loss or break shall not be covered.
To have access to this benefit, the affiliate shall submit medical prescription, including date, signature and seal by the attending professional, plus the original receipt from the optical store in case of reimbursement.
100% coverage for replacement eye prostheses and intraocular lenses.
7. ORTHOPEDICS, PROSTHESIS AND ORTHOTICS
The affiliate shall enjoy the following benefits:
Orthotics and external prostheses: APSOT shall pay 100% of the total value.
The Health Maintenance Organization shall quote the current less expensive prosthesis and that shall be the maximum allowable coverage. Coverage shall also be granted to patients who need orthopedic bed and wheelchair. Shoe orthotics, limited to 2 pairs per year, up to age 14; thereafter, one pair per year.
In case of prostheses of surgical implantation, this Health Maintenance Organization shall pay 100% of their value.
To have access to this benefit, the affiliate shall submit medical prescription, including date, signature and seal by the attending professional, and authorization by the Health Maintenance Organization.
Specialists are informed that prosthesis requirements shall be stated using generic name, not accepting prescriptions or trademarks or any suggestion by the provider. The Health Maintenance Organization shall quote the current less expensive prosthesis and that shall be the maximum allowable coverage.
This Health Maintenance Organization shall not recognize any myogenic or bioelectrical prostheses.
8.      AMBULANCE SERVICES
It shall be accessible for those affiliates who cannot travel by themselves, from, to or across health facilities, during hospital stay or not, when needed for the diagnosis or treatment of their pathology. Selection of specific means of transports and features of the vehicle shall be subject to the patient’s clinical condition certified by medical prescription.
In case of outpatients, APSOT shall recognize transportation for those who are not in conditions to walk and have the corresponding medical order substantiating the service.
9.      HIV/AIDS, DRUG ABUSE AND ALCOHOLISM
APSOT shall provide 100%coverage for drugs against HIV, AIDS, drug dependency and alcoholism.
It shall also provide 100% coverage of medical and psychological treatments for people suffering such pathologies.
Beneficiaries shall be provided with outpatient and inpatient care for detoxification as well as inpatient care at communities, through the following services: visit and guidance, one-day hospital stay, one-night hospital stay, psychiatric hospital stay for detoxification including specific therapy and drugs, stay at authorized “therapeutic communities”.
APSOT shall carry out permanent dissemination work for the prevention of these conditions, through educational talks and illustrative brochures about these pathologies.
 10. DIABETES MELLITUS
According to the statements in Act N° 23753 and regulatory Decree N° 1271/98, this Health Maintenance Organization shall provide its beneficiaries with basic drugs and supplies and minimum initial coverage for the control and treatment of diabetes mellitus and with 100% coverage for insulin, syringes and needles, oral hypoglycemiants and 400 test strips per year. Unstable diabetic insulin-dependent patients who participate in specific programs of secondary prevention shall receive double supply of stripes for glucose measurement (self-monitoring) and of punch elements and test stripes for ketonuria and glucosuria.
Equipment and supplies for reading test stripes for glucose measurement through reflectometry shall also be provided. Rosters of patients included in prevention programs shall be prepared.

11. COMPLIANCE WITH THE NATIONAL PROGRAM OF SEXUAL HEALTH AND RESPONSIBLE PROCREATION
This Health Maintenance Organization shall promote forums for reflection and action intended to:

• Acquire basic knowledge about this program.
• Properly detect risk behaviors and provide emotional support to risk groups.
• Educate, advise and cover all prevention levels for sexually transmitted diseases, VIH/AIDS, genital and breast cancer.

For such purposes the Health Maintenance Organization shall state:

• A proper health monitoring system for early detection of sexually transmitted diseases, VIH/AIDS, genital and breast cancer, carrying out diagnosis, treatment and rehabilitation.
• Prescription and supply of contraceptive methods and elements that shall be reversible, non-abortive and transitional, approved by the ANMAT (National Administration of Drugs, Food and Technology).
• Periodical checkups after using the selected method.

12. COVERAGE FOR DISABLED PEOPLE
This Health Maintenance shall include, among its services, coverage for disabled affiliates, according to regulations in Act N° 24901 and Resolution N° 400/99, Health Services Regulatory Body, and their modifications.
Such coverage shall include medical, psychotherapy and rehabilitation assistance. Generally, they are neurological and psychiatric visits, treatments related to psychomotor performance, educational psychology, speech and hearing therapy, psychology, physical therapy, kinesiology, music therapy, early stimulation, occupational therapy, vocational training, etc., which are provided in the (contracted) doctor offices, Hospitals or Centers and Institutions for rehabilitation of disabled people. The last ones shall provide comprehensive care to the handicapped and shall operate according to the following modalities: outpatient facilities (individual sessions), simple session from Monday to Friday or three times a week, hospital stay from Monday to Friday or permanently. Authorized amounts shall vary according to specifications in each case.
CO-PAYS
All services mentioned in Resolutions 939/2000 and 201/2002 of the Ministry of Health shall be 100% covered.
Co-pays shall be paid at the Health Maintenance Organization office through paycheck deduction.
In case of 100%-covered services, beneficiaries shall not pay any kind of co-pay, except the ones detailed below.
The following people shall be excluded from co-pay payment in all specialties:
The pregnant woman from diagnosis up to 30 (thirty) days of delivery, for all services related to pregnancy, delivery and puerperium.
The new-born baby up to age 1.
Patients who suffer oncologic diseases, for all services related to diagnosis, follow up and treatment of the disease after diagnosis.
Disabled people according the statements in Act 24901 and its regulatory decree.
People infected by any of the human retroviruses and those who suffer the human immunodeficiency syndrome, for monitoring of underlying condition and diagnosis and treatment of intercurrent diseases.
Dental services shall not pay any kind of co-pay.
Except the cases previously stated, outpatient visits shall be charged with $4 co-pay and complex and non-complex studies, with $5 copay.
VARIOUS NON-COVERED SERVICES
a)   Non-function reconstructive surgery or treatment: aesthetic plastic or cosmetic (post-scars, face, breast, abdomen and testicle surgery, liposuction, etc.)
b) Hospital stays that do not require staying at a hospital setting, due to the clinical s