Secretaría de Obra Social

Obra social: osepjana_mdq@hotmail.com  Tel 472-2001 int 211
Fondo Solidario: fosolyf@hotmail.com Tel 472-2001 int 224

En nuestro Fondo Solidario, la Afiliación es voluntaria y se mantiene con un 4% de aporte (que se calcula de una parte del salario y/o Jubilación o Pensión) que hacen sus afiliados, en forma directa, o por descuento en su recibo de haberes.

Nuestro Fondo Solidario devuelve en prestación médico asistencial casi el 80 % de sus ingresos. Teniendo en cuenta la ampliación de cobertura en cada año con recursos que, en comparación con los exuberantes aumentos que sufrieron los servicios que cubre, siguen iguales como consecuencia de la política de salarios estuvieron congelados, y que siempre están por debajo de las necesidades de los trabajadores.

Actúa en muchos casos como Obra Social Primaria siendo que su porcentaje de ingreso no supera el 50% del aporte que recibe cualquier obra social.-

Cubre el ciento por ciento (100 %) de los valores permitidos por el Programa Médico Obligatorio de Emergencia en COSEGUROS que, contra entrega de los recibos correspondientes, se devuelven al momento.-

Reintegra, o cubre en forma directa, el 25% en medicamentos cuando actúa como complemento de cualquier Obra social y el 40% cuando actúa como Obra Social primaria.

Otorga préstamos por estrictas razones de atención de la Salud.

Destina el 50% de un monto determinado por la Comisión Directiva para el otorgamiento de Becas a hijos de Afiliados que deben cursar estudios terciarios. Dado que la educación la consideramos uno de los pilares de la salud para nuestros hijos.

Contempla con un aporte mínimo y una cobertura especial, a los Compañeros/as que las Empresas dejan sin trabajo sin una causa justa y/o por razones de su militancia gremial.

Reconoce a los compañeros que deben viajar a otras Localidades para la atención o tratamientos médicos, con la debida justificación, el gasto del valor del pasaje, y hasta catorce pesos ($ 14) en concepto de refrigerio, como así también un monto determinado para hotelería, o su cobertura directa en hoteles de Mar del Plata. Ante cualquier duda debe consultarse la normativa de pasajes y alojamientos.

Realiza prevención para el mejor cuidado de la Salud de los afiliados al desarrollar GIMNASIA DE MANTENIMIENTO en tu Sindicato, con Profesores especializados en gimnasia para la tercera edad, sólo con la adquisición de un Bono contribución mensual

Entrega un ajuar a los recién nacidos, que contiene: un bolso estampado, una batita de algodón, una batita fina, un medio osito, dos pares de zoquetes, una mamadera, un chupete, un paquete de pañales y un babero.

Garantiza Servicio de Traslado en Ambulancia sin cargo, de Larga, Media, y excepcionalmente Corta distancia, con todos los servicios que sean necesarios para realizar dicho traslado.

Ofrece sin cargo de ninguna clase, Elementos Ortopédicos: Silla de ruedas, Camas Ortopédicas, Bastones, Muletas, etc.

focoseguro

La cobertura que se brinda a través de las distintas Obras Sociales no es 100 %, por ello los profesionales están facultados a cobrar distintas sumas en concepto de coseguros, los cuales están regulados por el Ministerio de Salud y aplicados según valores del Programa Médico Obligatorio. A modo informativo, detallamos las prestaciones con los valores reconocidos y sus límites:

COSEGUROS Presentando la documentación correspondiente, se reintegra por:

Consultas Ambulatorias en el momento y en la ventanilla de este Fondo Solidario/ Un máximo de cuatro consultas mensuales por beneficiario y seis por grupo familiar. Superado este límite, deberá presentarse resumen de Historia Clínica.

Consultas domiciliarias en el momento y en la ventanilla de este Fondo Solidario. / Un máximo de dos consultas mensuales por beneficiario y cuatro por grupo familiar. Superado este límite, deberá presentarse resumen de Historia Clínica.

Análisis Bioquímicos en el momento y en la ventanilla de este Fondo Solidario. / Un monto fijo por orden de práctica / Sin límites mensuales. Y a partir del año en curso se reintegra el 50% del valor Ley 8271, por cada extracción sanguínea.

Diagnóstico por Imágenes en el momento y en la ventanilla de este Fondo Solidario (alta y baja complejidad). / Un monto fijo por orden de práctica / Sin Límites Mensuales.-

Kinesiología – Fisioterapia en el momento y en la ventanilla de este Fondo Solidario. / Con un máximo de 25 sesiones por año calendario. En casos de accidentes o secuelas de Accidente Cerebro Vascular se solicitará resumen de Historia Clínica para mayor cantidad de sesiones.

Psicología – Psicopedagogía – Psiquiatría – Terapia de Grupo en el momento y en la ventanilla de este Fondo Solidario. / Con un máximo de 4 sesiones mensuales y 30 al año calendario.

Fonoaudiología – Terapia Ocupacional en el momento y en la ventanilla de este Fondo Solidario. / Con un máximo de 25 sesiones por año calendario. En casos de secuelas de Accidente Cerebro Vascular, Cirugías oncológicas, etc., se solicitará resumen de Historia Clínica para mayor cantidad de sesiones.

Otras Prácticas Médicas en el momento y en la ventanilla de este Fondo Solidario. / Un monto fijo por orden. / Sin límites mensuales.

Odontología en el momento y en la ventanilla de este Fondo Solidario. / Un monto fijo por código odontológico y en radiología panorámica odontológica / Sin límites mensuales.

Para hacer efectivo dicho reintegro deberá presentar:

-Recibo oficial de lo abonado, (concepto y valores) en todos los casos.-

-Fotocopia de la práctica realizada, o copia de la ficha odontológica, exceptuando las consultas.-

Medicamentos en forma directa en la farmacia, presentando recetario del Fondo Solidario, junto a la receta de la Obra Social, obteniendo de esta manera un 25% de descuento. En el caso de hacerlo por vía de reintegro, presentando fotocopias de la receta, y adjuntando ticket original, factura o recibo oficial de lo abonado. / Hasta un 25% del total de lo facturado, independientemente de los valores o porcentajes reconocidos por Obra Social.

foobra

 

Presentando la documentación correspondiente y en original, se reintegra por:

Consultas Ambulatorias Monto fijo con un máximo de cuatro consultas mensuales por beneficiario y seis por grupo familiar. Superado este límite, deberá presentarse resumen de Historia Clínica.

Consultas domiciliarias. Monto fijo con un máximo de dos consultas mensuales por beneficiario y cuatro por grupo familiar. Superado este límite, deberá presentarse resumen de Historia Clínica.

Análisis Bioquímicos. Cobertura directa, hasta un 50% con la orden autorizada y en laboratorio designado. Por reintegro, hasta un 50 % del total facturado y en un todo de acuerdo a los valores de convenio con el laboratorio contratado. / Sin límites mensuales.

Diagnóstico por Imágenes (alta y baja complejidad). / En forma directa, hasta un 50% con la orden autorizada, en el Instituto Radiológico o Diagnóstico Médico por Imágenes (Mar del Plata). Por reintegro, hasta un 50 % del total facturado y en un todo de acuerdo a los valores de convenio con el Instituto Radiológico. / Sin límites mensuales.

Kinesiología – Fisioterapia En forma directa 100% de cobertura con la orden autorizada y con el prestador designado. Por reintegro, monto fijo por sesión en forma ambulatoria y en domicilio (debe presentarse historia clínica justificando la atención domiciliaria). Con un máximo de 25 sesiones por año calendario. En caso de secuelas de Accidente Cerebro Vascular, se solicitará resumen de Historia Clínica para mayor cantidad de sesiones.-

Psicología Se reconoce por reintegro monto fijo por sesión, y hasta 4 sesiones por mes.

Psicopedagogía Se reconoce por vía de reintegro monto fijo por sesión, hasta 4 sesiones mensuales y presentando la correspondiente derivación del pediatra e informe del profesional psicólogo tratante.

Psiquiatría Por vía de reintegro, monto fijo por consulta y sesión psiquiátrica unificada para control de medicación y tratamiento, cuando se complementa con tratamiento psicológico. Se reconoce una consulta mensual a estos valores. En caso de consultas posteriores, se reconoce el valor de consulta habitual.

Fonoaudiología – Terapia Ocupacional Por reintegro, monto fijo por sesión. / En los dos casos, con un máximo de 25 sesiones por año calendario. En casos de secuelas de Accidente Cerebro Vascular, Cirugías oncológicas, etc., se solicitará resumen de Historia Clínica para mayor cantidad de sesiones.

Otras Prácticas Médicas Deberá presentarse la solicitud del profesional médico y el presupuesto correspondiente. / Sin límites mensuales.

Odontología

Odontología General: la cobertura de odontología terapéutica (arreglos, extracciones, etc.) se cubre por vía de reintegro, sobre valores convenidos con la Asociación Odontológica.

Prótesis: Cobertura directa, con orden autorizada previamente y con los prestadores de Asociación Odontológica de acuerdo al listado vigente de profesionales. Por vía de reintegro, de acuerdo a los valores de convenio con prestador contratado.

Ortodoncia Fija: Cobertura directa del 70% hasta los 18 años de edad, con la orden autorizada por el FoSoLyF y con el prestador asignado. Por reintegro, hasta los 18 años de edad, según monto determinado.

Ortodoncia Removible: Cobertura directa del 70% hasta los 13 años de edad, con la orden autorizada por el FoSoLyF y con el prestador asignado. Por vía reintegro, hasta los 13 años de edad, y un monto determinado.

Ortodoncia Fija Adultos: Cobertura directa del 50 %, de 19 años en adelante, con la orden autorizada del FoSoLyF y con el prestador asignado. Por reintegro, un monto determinado.

Optica: Cobertura directa del 100 %, en cristales blancos y del 70 % en lentes de contacto en graduaciones superiores a dos dioptrías, con Orden autorizada del FoSoLyF y con el prestador asignado. Cuando es necesario el uso de cristales especiales, deberá presentarse resumen de historia clínica que justifique su solicitud. Por vía de reintegro, de acuerdo a los valores de convenio con prestador contratado.

Medicamentos: Por reintegro, hasta un 40% del total de lo facturado, deberá presentarse receta original con troqueles y factura o ticket del valor que se abonó.

fopreven

A los compañeros Jubilados y pensionados afiliados

Desde la secretaría de obra Social, invitamos a nuestros compañeros a sumarse al programa de GIMNASIA DE MANTENIMIENTO en Su Sindicato y con Profesores Especializados en gimnasia para la 3º edad.

Según la Organización Mindial de la Salud, la actividad física es indispensable para alcanzar el bienestar en cualquier edad porque:

– Aumenta la capacidad respiratoria

– Fortalece el sistema inmunológico.

– Mejora la circulación sanguínea.

– Previene las enfermedades cardiovasculares.

– Reduce en un 50% el riesgo de cáncer de colon y la diabetes de tipo 2.

– Ayuda a controlar el peso y reduce en un 50% el riesgo de obesidad.

– Reduce el riesgo de muerte prematura cardovascular.

– Aumenta el colesterol bueno y disminuye el malo.

– Disminuye los triglicéridos.

– Ayuda a mantener una adecuada postura corporal.

– Mejora la autoestima y la confianza.

centrocultura

 

NUEVAS PRESTACIONES DEL Fo.SO.L.yF.

Servicio de Urgencias y Emergencias.

Con el espíritu de ampliar los servicios y dar a nuestros compañeros/as las mejores herramientas para el cuidado de su salud, es que hemos celebrado un nuevo Convenio que entró en vigencia en julio de 2009; comprendiendo a todos los afiliados/as al FoSoLyF, con domicilio en el Partido de General Pueyrredón, y que se encuentren en condiciones reglamentarias de gozar beneficios. Este nuevo servicio se brindará a través de la empresa AVANT SALUD S.R.L., brindando distintos tipos de atención que se detallen según sus características:

Atención domiciliaria / Urgencias, Emergencias.

El comañero/ra y su grupo familiar contará con una asistencia inmediata de los consultorios móviles en los casos de urgencias y emergencias; la cobertura comprende las 24 hrs. los 365 días del año, incluyendo fármacos y material descartable utilizados en la atención y el traslado post-emergente.

Atención domiciliaria / Visita médica.

El compañero/ra y su grupo familiar a cargo contará con asistencia de los consultorios móviles para consultas domiciliarias, esto significa afecciones que impiden el trslado del paciente al consultorio pero que no requieren urgencia para su atención.

Consultorios externos. El Compañero/ra y su grupo familiar a cargo puede acceder a consultorios ubicados en calle Santiago del estero 2151 1er. PISO por consulta espontánea donde se le brindará atención primaria y de enfermería. Los consultorios brindarán sus servicios de médicos de lunes a viernes de 9 a 20 hrs. y los días sábados de 9 a 13 hrs.

De igual manera nos encontramos en tratativas para llevar servicios similares para las delegaciones con el objeto que tengan las mismas prestaciones y que serán implementados a la brevedad.

PARA ACCEDER A ESTE SERVICIO DEBE RETIRAR UN BONO EN LA SEDE DEL Fo.So.L.yF.

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