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Health and Maternity Insurance - Coggle Diagram
Health and Maternity Insurance
Concept
A legal benefit that provides medical and economic support to insured workers and their families in case of illness or maternity.
Origin
Originates from Mexico’s social security system, administered by the IMSS (Instituto Mexicano del Seguro Social) to ensure workers’ well-being.
Foundation (Legal Basis)
Based on Articles 84 to 90 of the Ley del Seguro Social (Social Security Law), which outline the rights, benefits, and requirements of health and maternity coverage.
Assumptions
The worker must be officially insured under IMSS.
Must have contributed the required number of weeks.
The condition must be included within the benefits defined by the law.
Types of Insurance
Sickness insurance
(non-occupational disease).
Maternity insurance
(pregnancy, childbirth, postpartum care). Occupational risks are covered under a separate insurance branch.
Difference between Accidents and Occupational Diseases
Accident at work:
Sudden, unexpected event related to labor activity.
Occupational disease:
Condition developed over time due to exposure to harmful factors in the workplace.
Network of Public and Private Hospitals
IMSS has its own hospitals and clinics nationwide.
Collaborates with private providers through agreements to expand access.
Services coordinated through primary care doctors (family doctors.
Types of Prevention
Primary Prevention:
Avoid the occurrence of disease (vaccination, health campaigns).
Secondary Prevention:
Detect conditions early (screenings, checkups).
Tertiary Prevention:
Treat and manage chronic diseases (rehabilitation).
Types of Coverage
Medical consultations (general and specialist).
Medications and lab tests.
Prenatal, childbirth, and postpartum care.
Hospitalization services.
Temporary disability leave and financial assistance.
Variables in Case of Applying for Sickness and Maternity Benefits
Must be insured and up to date with contributions.
Maternity leave:
At least 30 weeks of contributions within the last 12 months.
Must go through proper IMSS channels for documentation and validation.