CASH ASSISTANCE PROCESS

List of required documents (if assistance applies):

ATTENTION: Each service is different, so we recommend reviewing which documents you must submit for each of your requests.

* The invoice must include the itemized breakdown and unit cost of each service.

* In the case of consultations, do not include derived services.

Document Descriptions:

a) Medical Report (less than 3 months old) signed by the attending physician.
b) User Report with the diagnosis or symptoms of the illness, signed.
c) Invoice PDF and XML with itemized amounts and unit cost of each service, as well as the applicable tax according to your tax regime.
d) Medical Prescription with pre-prescribed medications. If using a network physician, the medical order may be replaced by the outpatient consultation format.
e) Medical Order for Studies with the user's name.
f) Exam Results or Interpretation with the user's name.
g) Current bank statement in the name of the MMS account holder (same as the bank account holder), detailing bank name, account number, branch, interbank CLABE, and RFC. MMS is not responsible if the account changes and no notification is given or the new account is not provided.

Where do I submit this request?

Once you have all the documentation for your cash assistance request, please send it to the following email address:

CC: asistenciaenefectivo@mmsantander.com.mx

Essential forms for your request (if assistance applies):

• Medical report form, less than 3 months old (duly completed and signed by the attending physician).
PRINT MEDICAL REPORT FORM

• User report form with the diagnosis or symptoms of the illness (duly completed and signed).
PRINT USER REPORT FORM

• User report form - Pet.
PRINT USER REPORT FORM - PET

• Dental record form.
PRINT DENTAL RECORD FORM

• TAX STATUS CERTIFICATE.
IMPRIMIR CONSTANCIA DE SITUACION FISCAL MULTISERVICES MEDICOS SANTANDER

• GENERAL BILLING GUIDE - INFORMATIONAL FLYER 220724 MX ADDRESS.
PRINT GENERAL BILLING GUIDE - INFORMATIONAL FLYER 220724 MX ADDRESS

• USER REPORT.
PRINT USER REPORT

• HEALTHCARE PROVIDER REPORT.
PRINT HEALTHCARE PROVIDER REPORT

Documentation required to process the cash assistance request:

■ FOR CONSULTATIONS (IF ASSISTANCE APPLIES):
• Physician's fees receipt with the applicable tax breakdown according to their tax regime. Do not include medications in the receipts.
• User report with the diagnosis or symptoms of the illness, signed.
• Medical report (less than 3 months old) signed by the attending physician.
• Copy of bank statement in the name of the MMS account holder (same as the bank account holder), detailing bank name, account number, branch, interbank CLABE, and RFC. MMS is not responsible if the account changes and no notification is given or the new account is not provided.

■ FOR LABORATORY STUDIES (IF ASSISTANCE APPLIES):
• Coverage will be limited to the usual customary expenses of the region, and the contracted assistance will apply.
• Provider invoice with the itemized unit cost of each service.
• Copy of study results.
• Medical order.
• User report with the diagnosis or symptoms of the illness, signed.
• Medical report (less than 3 months old) signed by the attending physician.
• Copy of bank statement in the name of the MMS account holder (same as the bank account holder), detailing bank name, account number, branch, interbank CLABE, and RFC. MMS is not responsible if the account changes and no notification is given or the new account is not provided.

■ COVID TEST (IF ASSISTANCE APPLIES):
• Coverage will be limited to the usual customary expenses of the region, and the contracted assistance will apply.
• Provider invoice with the itemized unit cost of each service.
• Copy of study results.
• Medical order.
• User report with the diagnosis or symptoms of the illness, signed.
• Medical report (less than 3 months old) signed by the attending physician.
• Copy of bank statement in the name of the MMS account holder (same as the bank account holder), detailing bank name, account number, branch, interbank CLABE, and RFC. MMS is not responsible if the account changes and no notification is given or the new account is not provided.

■ FOR X-RAY STUDIES, ULTRASOUNDS, MAMMOGRAMS, PAP SMEAR, HOLTER, ELECTROCARDIOGRAM, AND SPIROMETRY (IF ASSISTANCE APPLIES):
• Coverage will be limited to the usual customary expenses of the region, and the contracted assistance will apply.
• Provider invoice with the itemized unit cost of each service.
• Copy of study results.
• Medical order.
• User report with the diagnosis or symptoms of the illness, signed.
• Medical report (less than 3 months old) signed by the attending physician.
• Copy of bank statement in the name of the MMS account holder (same as the bank account holder), detailing bank name, account number, branch, interbank CLABE, and RFC. MMS is not responsible if the account changes and no notification is given or the new account is not provided.

■ FOR GROUND AMBULANCE SERVICE DUE TO ILLNESS (IF ASSISTANCE APPLIES):
• Provider invoice with the itemized unit cost of each service.
• You must submit the ambulance medical report FRAP (Pre-hospital Care Registration Form).
• Signed user report with the diagnosis or symptoms of the illness.
• Copy of bank statement in the name of the MMS account holder (same as the bank account holder), detailing bank name, account number, branch, interbank CLABE, and RFC. MMS is not responsible if the account changes and no notification is given or the new account is not provided.

■ FOR OUTPATIENT EMERGENCY MEDICAL ASSISTANCE DUE TO ILLNESS (IF ASSISTANCE APPLIES):
• Provider invoice with the itemized unit cost of each service.
• Copy of the results and interpretation of all tests performed.
• Medical report (less than 3 months old) signed by the attending physician.
• Signed user report with the diagnosis or symptoms of the illness.
• Copy of bank statement in the name of the MMS account holder (same as the bank account holder), detailing bank name, account number, branch, interbank CLABE, and RFC. MMS is not responsible if the account changes and no notification is given or the new account is not provided.

Important note: To be considered as such, the following conditions must be met:
     1. Having been treated in a hospital emergency area.
     2. Having required medications for stabilization.
     3. Being a medical emergency situation.
     4. Not exceeding a 24-hour hospital stay.

Exclusions:
     1. Medical care for psychological or psychiatric diagnoses, accidents, or maternity and related conditions is not covered.
     2. When a user attends only for a check-up in the hospital emergency area, it will be considered a regular consultation.
     3. Emergency medical consultations at private offices.
     4. Medications to take home provided during outpatient care will not be covered.

■ FOR MEDICATIONS (IF ASSISTANCE APPLIES):
• Medical order with pre-prescribed medications. If using a network physician, the medical order may be replaced by the outpatient consultation format.
• Signed user report with the diagnosis or symptoms of the illness.
• Medical report (less than 3 months old) signed by the attending physician.
• Provider invoice with the itemized unit cost of each service.
• Copy of bank statement in the name of the MMS account holder (same as the bank account holder), detailing bank name, account number, branch, interbank CLABE, and RFC. MMS is not responsible if the account changes and no notification is given or the new account is not provided.

■ FOR VISION (IF ASSISTANCE APPLIES):
• Signed user report with the diagnosis or symptoms of the illness.
• Medical report (less than 3 months old) signed by the attending physician.
• Optometric exam.
• Provider invoice with the itemized unit cost of each service.
• Copy of bank statement in the name of the MMS account holder (same as the bank account holder), detailing bank name, account number, branch, interbank CLABE, and RFC. MMS is not responsible if the account changes and no notification is given or the new account is not provided.

■ PARA SERVICES DENTALES (EN CASO DE QUE APLIQUE LA ASISTENCIA):
• Signed user report with the diagnosis or symptoms of the illness.
• Dental record form.
• Provider invoice with the itemized unit cost of each service.
• Copy of bank statement in the name of the MMS account holder (same as the bank account holder), detailing bank name, account number, branch, interbank CLABE, and RFC. MMS is not responsible if the account changes and no notification is given or the new account is not provided.

For a correct cash assistance request:

• Individuals invoicing a legal entity under tax regime 612 must withhold 10% of the payment amounts received.
NOTE: Invoices that do not itemize the applicable taxes are grounds for rejection (VAT, income tax, withheld VAT as applicable).

EXAMPLE OF MEDICAL FEES INVOICE:

• For independent personal services, the invoice must itemize the applicable taxes: VAT transfer at 16%, VAT withholding at 10.6667%, and income tax (ISR) withholding at 10% under tax regime 612.


• This applies to bachelor's degree professionals.

NOTE: Invoices that do not itemize the applicable taxes are grounds for rejection (VAT, income tax, withheld VAT as applicable).

EXAMPLE OF PSYCHOLOGY AND NUTRITION FEES INVOICE (EXAMPLE IF ASSISTANCE APPLIES):



• Individuals invoicing a legal entity under tax regime 626 must withhold 1.25% of the payment amounts received.

NOTE: Invoices that do not itemize the applicable taxes are grounds for rejection (VAT, income tax, withheld VAT as applicable).

EXAMPLE OF MEDICAL FEES INVOICE:



• For independent personal services, the invoice must itemize the applicable taxes: VAT transfer at 16%, VAT withholding at 10.6667%, and income tax (ISR) withholding at 1.25% under tax regime 626.

• This applies to bachelor's degree professionals.

NOTE: Invoices that do not itemize the applicable taxes are grounds for rejection (VAT, income tax, withheld VAT as applicable).

EXAMPLE OF PSYCHOLOGY AND NUTRITION FEES INVOICE (EXAMPLE IF ASSISTANCE APPLIES):

Response Times:

• Confirmation: Once your request reaches the Cash Assistance email, the area staff will send an acknowledgment of receipt.
• Decision: All your documents will then be reviewed. If rejected, you will be notified by email within no more than 24 business hours, indicating the reason for rejection.
• Payment time for approved requests: If your request meets all the requirements, the process will be completed within 3 business days, and payment will be issued to the account you provided within that period.

Important Information:

• All invoices must be made out to Multiservicios Médicos Santander, S.A. de C.V., in compliance with current tax requirements.
• Only expenses incurred within the Mexican Republic may be submitted, in MXN (Mexican pesos).
• Complete all forms in full for each cash assistance request, linking the invoices for each service received.
• Do not forget to submit your invoices within the active period. Due to tax regulations, we cannot pay for services that do not correspond to the current period (calendar year).
• The user's co-payment will be deducted from the established limits according to the contracted coverage, if applicable.

Multiservicios Médicos Santander Service Hours:

Monday to Friday from 7:00 a.m. to 9:00 p.m. and Saturdays from 7:00 a.m. to 5:00 p.m.
Teléfono: (899) 261 6600