Home > Health insurance for my business > Frequently Asked Questions – Health

Frequently Asked Questions – Health

What self-service options are available online for MAPFRE Health?

Request Coverage Certifications including Maternity, Student, and Accreditable Coverage Certification and you will automatically receive the document via email or fax, according to the method you select. Request the card duplicate for you and any of your dependents.  Consult preventive services and validate eligibility, confirming if an insured is active. Request maintenance prescriptions online to get them by mail.  Generate your Vaccines Coverage Certification and get the digital image of your health plan card. Register on our Insured Portal and everything will be easier for you where you can generate the documents. Under View my Policies you can check the contracts active period, request to add or eliminate dependents, request to change your information, and obtain request forms.  Your dependents may register and have access to their information and card.

Get the request forms you need to fill. They include instructions on how to complete and file your claim in order to guarantee their seamless transmittal.  

These transactions are subject to the underwriting guidelines on the policy.

Order prescriptions by mail                               –       Complete the request form and send to:
                                                                                         MedVantx, Inc.
                                                                                         PO BOX 5736
                                                                                         Sioux Falls, SD 57117
    
Prescriptions Reimbursment                                –    Complete the request form and send to:
                                                                                         MAPFRE LIFE INSURANCE COMPANY OF PUERTO RICO
                                                                                         PO BOX 70297
                                                                                         SAN JUAN, PR 00936 -8297

Medical and Dental Services Reimbursement      –    Complete the request form and send to:
                                                                                          MAPFRE LIFE INSURANCE COMPANY OF PUERTO RICO
                                                                                          PO BOX 70297
                                                                                          SAN JUAN, PR 00936 -8297

  Pre-Authorization of Services                              –    Complete the request form and send via any of these options:
                                                                                          oam@mapfrepr.com
                                                                                          via fax 787-772-8476, 787-772-8503

Authorization to Disclose Protected Health Information    –        Complete the request form and send to:
                                                                                                                 hipaa@mapfrepr.com

These transactions are subject to the underwriting guidelines and coverage on the policy. They should be submitted through your plan administrator.

Continuance of Handicapped Child Coverage     –    The completed form can be send via any of these options:
                                                                                           faxsuscripciones@mapfrepr.com
                                                                                           via fax 787-772-8448
                                                                                           MAPFRE LIFE INSURANCE COMPANY OF PUERTO RICO
                                                                                           PO BOX 70297
                                                                                           SAN JUAN, PR 00936 -8297

Employee Transaction                                        –    The completed form can be send via any of these options:
                                                                                      faxsuscripciones@mapfrepr.com
                                                                                      via fax 787-772-8448
                                                                                      MAPFRE LIFE INSURANCE COMPANY OF PUERTO RICO
                                                                                      PO BOX 70297
                                                                                      SAN JUAN, PR 00936 -8297

For MAPFRE Health Self-Service Options click here.

What are the service hours of MAPFRE Health?

MAPFRE Contact Center is available 24 hours a day, 7 days a week. You can reach us at 787-622-7780 (metro area) and 1-888-981-3271 (toll free). Our office hours are Monday through Friday 8:15 am to 4:45 pm.

How do I find a participating health care provider?

The information is available online through our mobile app MIS SEGUROS and our webpage www.mapfre.pr under Medical Providers Network. Search by name, specialty and/or city. The result includes names, physical addresses, and telephones.  Click on “Maps”” and you will get the exact location of the selected facility or provider. You can also call MAPFRE Contact Center at 787-622-7780 (metro area) and 1-888-6164947 (toll free).

For a health care provider or facility on our network click here.

How much does it cost me to use a MAPFRE participating provider?

Visiting a participating provider will keep you expenses at a minimum, you will incur in deductibles, co-payments, co-insurance and/or services not covered by your plan. You are responsible for the full cost of any care you receive out of network at the time of service. You may file a reimbursement claim according to the terms of your plan.

Can I add or remove dependents?

The underwriting rules establish dependents can only be added during renewal period with evidence establishing your relationship to them. You have thirty (30) days after a qualified life event (childbirth, marriage, among others) to apply for enrollment changes.  Please refer to you benefits certificate for your dependents’ eligibility. You may be required to submit your request through your group plan administrator. Dependents can be removed at any time.

How do I request a reimbursement from my health plan?

If you received care from a medical provider that is not part of the network of preferred or PPO MAPFRE Health providers for services under your plan you must thoroughly complete a claim form for Medical and Dental Services Reimbursement available through our webpage and mobile app MIS SEGUROS. Print, complete the form, and mail it to PO Box 70297 San Juan, PR 00936-8297or turn it in personally at our main offices or branches within 12 months after receipt of services. You must attach original receipts for services rendered.

Click here to download the reimbursement form.

How long does after filing a reimbursement claim should I get a response from MAPFRE?
If your claim is complete, form thoroughly filled and receipt (s) attached, it will be processed as soon as possible and no later than 30 calendar days after submission. MAPFRE will issue an Explanation of Benefits detailing the determination and will mail it to the address specified to MAPFRE by the policyholder during enrollment and/or subsequent official changes. If you do not receive your Explanation of Benefits within the above mentioned period of time, you can call MAPFRE Contact Center at 787-622-7780 (metro area) or 1-888-981-3271 (toll free) and a Service Representative will assist you.

What if I have questions about a service or benefit?

Refer to your Summary or Certificate of Benefits, if you still do not find the answer call MAPFRE Contact Center at 787-622-7780 (metro area) and 1-888-981-3271 (toll free) and a Service Representative will assist you.

What should I do if there are services on my explanation of benefits that I didn’t receive?
Call MAPFRE Contact Center immediately at 787-622-7780 (metro area) or 1-888-981-3271 (toll free) and a Service Representative will verify your Explanation of Benefits to identify whether it was an error or we will explain how to request an investigation.

How can I get a copy of my Summary or Certificate of Benefits?
You should contact your Employer or Plan Administrator to request a copy of the Summary or Certificate of Benefits.
What services require a prior authorization under my health plan?

Your Summary or Certificate of Benefits identifies specific services that are subject to pre-authorization under your plan. If required for a service, you or the service provider must request the authorization from MAPFRE 7 days prior to the date set for the service by completing the form and submitting it to oam@mapfrepr.com. Not pre-authorizing services may result in a reduction of your benefits.  

Click here to download the form from our webpage. You can also do it through our mobile app MIS SEGUROS selecting Self Service Options, Request Forms.

For more information, please call MAPFRE Contact Center at 787-622-7780(metro area) or 1-888-981-3271 (toll free).

How do I get a duplicate of my Health Card or a Certificate/Letter of Coverage?

There are several options:

  • Have immediate access and even be able to share the digital image of your Insurance card by using our mobile app MIS SEGUROS
  • To download Android version click here
  • To download iOS version click here
  • Request a Card Duplicate on line on our webpage on this link here
  • Obtain your Letter of Coverage on our webpage selecting the following link Coverage Certificate 
  • Call MAPFRE Contact Center at 787-622-7780 (metro area) and 1-888-981-3271 (toll free) and use the interactive options for duplicate of card or coverage certificate. 
  • Talk to a Service Representative at MAPFRE Contact Center.

Please be aware that you will need to have your contract number or social security number and date of birth readily available.

Once you make your request you should receive your card in approximately 10 days. Ask your Plan Administrator to find out the way card duplicate delivery was previously coordinated for the group, through them or directly to your mail address.

The Certification of Coverage will be sent at the moment via email or fax, according to the method you select. Your Plan Administrator will get also get a copy.

What is Health Insurance?

A health insurance aims to protect the health and well-being of the person contracting the insurance, and their family or employees, as it guarantees the payment of the health expenses that they may need in exchange for a monthly or annual payment. The expenses covered can be medical, clinical, pharmaceutical, or hospital related.

What are the advantages of contracting a Health Insurance with MAPFRE?

Contracting your health insurance policy with MAPFRE has the following advantages:

  • Access to a 24/7 phone service in Puerto Rico that is specialized in assisting your needs and claims.
  • MAPFRE’s offices across Puerto Rico to process all the paperwork in person. 
  • Online consultation. Now you can be examined by a doctor directly from your home.
  • Medications are delivered to your home.
  • Mis Seguros mobile app you can have all the services you need at your fingertips.

Health Services for my Business

Check the services related to Health insurance for business offered by MAPFRE PUERTO RICO.

Offices Network

Find our offices network, general agencies or authorized representatives.

Pay

~|elegant-themes~|elegant-themes-icon~|5

Claim

~|elegant-themes~|elegant-themes-icon~|5

Medical Provider Network

~|elegant-themes~|elegant-themes-icon~|5

Health Web Portal

~|elegant-themes~|elegant-themes-icon~|5
Frequently Asked Questions

Consult the FAQ's - Health

See questions