The Fondo Est, a health insurance fund for Commerce Tourism Services and Related Sectors, has announced changes for its members for the year 2025 in terms of additional health care. As of 1 January 2025, for individuals who are disabled, in order to access the health coverage caps, the health coverage must be active on the date of the service’s performance. Reimbursements will be issued based on the date of service provision (invoice date), even for diseases or injuries that occurred before 2014.
Among the available services, medical transportation and dental services have been added, as long as these are related to the disease causing the disability. For such individuals, service provision will be allowed within a year from the date of termination of health coverage.
Changes have also been made to the maternity package. The limitation on the number of reimbursable visits has been removed, with the provision of reimbursement for all specialist visits aimed at monitoring the health of the pregnant woman and the fetus, regardless of the type of visit made.
To the list of diagnostic services, joint ultrasound has been added, through direct provision and reimbursement of the SSN Ticket. Meanwhile, for physiotherapy, the inclusion of the diseases Amyotrophic Lateral Sclerosis, Multiple Sclerosis, Muscular Dystrophy (Duchenne and Becker) and limb or limb segment amputations among the diseases eligible for reimbursement has been decided.
Finally, in the list of orthopedic medical devices and aids, the inclusion of anti-thrombosis and lymphedema pressure garments for upper limbs has been defined. These changes are aimed at improving healthcare accessibility and the overall health outcomes of the fund’s members.
