Formulario 1010: Formulario Único de seguros y prestaciones económicas

Daniel Martínez
Daniel Martínez

Need to register insured? Then read on and find out how to complete the Form 1010: Exclusive form for insurance and economic benefits.

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Form 1010

Also calling Exclusive insurance and economic benefits form, is a system designed for the registration of policyholders and rights holders of the various insurances managed by EsSalud.

EsSalud created several forms so that procedures and processes are carried out quickly, comfortably and efficiently, providing the applicant with a quality and efficient service.

The following link is to download Form 1010 in PDF format.

Guide to filling out the form

We already know a little about Form 1010, now we will show you how simple and easy the process is.

It is important to take into account the following aspects before starting to complete the form:

  • It is essential to register people’s data according to the identity document, as well as the signature of the legal representative.
  • The fields in the «USE OF ESSALUD» box and the two blue boxes in the upper right corner of the form must not be completed.

terms

  • The form must be completed in legible and printed letters
  • Forms with erasures or amendments will not be accepted.
  • In the case of financial benefits, you must confirm the payment with BBVA on the phone: 5950000.

health form

Based on these important aspects, we will outline the steps you must follow to complete it successfully:

  1. To begin, we must fill in the Table that I called «FOLLOWING HOLDER INFORMATION». We must first mark the type of identification document that the insured person has, then insert his number
  2. In the same box we must also provide the employer’s data, then we mark his type of document and then we write his number.
  3. We move on to the second table (Table II) called «REGISTRATION APPLICATION», We must indicate the type of registration (high, low, update), then indicate the type of document of the person to be registered (If it is the same insured holder, do not fill in these data), then we will write the number of that document.
  4. We must mark the condition of bond in relation to the insured holder.
  5. Then we will put the names and surnames of the person to be registered, indicate the gender, whether female or male, mark the person’s marital status, insert the date of birth, a contact phone number and a valid email address that is in use. .
  6. Then, the form asks for the indication of the residence address, in case it is different from the one registered in the DNI.
  7. We will put the type of area, urbanization, neighborhood unit, housing complex, cooperative, residential, community, among others, in addition to indicating a reference for the location of the address provided.
  8. Let’s fill in Table III called “APPLICATION FOR SPECIAL UNEMPLOYMENT COVERAGE RIGHTS (LATENCY)“In this part, we must inform the Name of the Company, the RUC to request the said coverage and we will record the date of completion, in case of termination of the employment contract or date of beginning of the removal.
  9. We will proceed to complete Table IV called «APPLICATION FOR ECONOMIC BENEFITS», For this we will mark the form of economic payment of benefits.Format
  10. When the payment of the economic benefit amount is made directly by the EsSalud, so let’s check the option «Direct payment».
  11. Let’s mark «Restitution» When EsSalud reimburse the employer for the amount of temporary disability or maternity allowance, which has been granted to the worker in a timely manner in her income.
  12. We will indicate the type of procedure, if it is disability and maternity, insert the start and end date, the subsidized days and the amount to be paid for the benefit.
  13. In the same table we must indicate the beneficiary’s data. In case of request lactation, we must put the mother’s name and if applicable burial, then we will enter the details of the person responsible for the funeral expenses.
  14. So the form shows us another box which is called «Sworn statement», where we must provide the projected net profit amount if you sign up for Independent Agrarian Health Insurance.sworn statement
  15. Let’s check the option YES or NOT, to authorize or deny EsSalud sending notifications of administrative acts by means of correspondence on the form.
  16. In the following table that appears, the type of bond or family relationship between the applicant for the procedure and the insured holder, whether spouse or wife in a stable relationship, the owner, father, mother, among others, must be informed.
  17. We should put the employer’s signature and stamp(The signature of the employer is only necessary when it comes to claims for disability or maternity allowance).
  18. In addition, we will put the person’s document type and number.
  19. Then, we will proceed with the consignment the signature of the registrant or applicant economic benefit.company
  20. Finally, we see a box called «OF USE OF ESSALUD», which should not be filled in, as these fields are only for the EsSalud team.use of essalud

If you followed the steps to the letter, you will have completed the form successfully.

What is Form 1010 for?

Form 1010 or better known as the Single Insurance and Economic Benefits Form, serves for the registration of insured owners and beneficiaries (updating, data modification, registration) of the different insurances managed by EsSalud.

It can also be used to claim special entitlement to unemployment coverage. Likewise, this form will be used to request the direct payment of economic benefits for breastfeeding, maternity, burial or some form of incapacity for work, obtaining the respective reimbursements.

How to carry out your processing process?

Registration of Beneficiaries

The requirements for registering Rightsholders are as follows:

Spouse

  1. O Form 1010 and Essalud attachments (Access the link provided at the beginning of the article to download).
  2. Civil marriage certificate, at least 2 months
  3. Copy of the DNI or other Identification Document of both, which are updated.DNI

Concubinage

  1. Send the Essalud Form 1010, duly completed.
  2. Have the Residence and Cohabitation Declaration.

Minor children

  • Photocopy of ID of the minor and the holder.
  • Form 1010 completed.

  • Notarial proof of paternity.
  • Submit the Insured’s Payment Bulletin.
  • Photocopy and original of the DNI of both.
  • Pregnancy control card, if you are also unable to have the latest ultrasound.

Grant Application

It is the amount to which the Insured are entitled, in order to compensate the loss of income as a result of the situation presented, be it maternity or lactation.

Maternity

Requirements:

  • Calculation of Maternity Allowance (Attached)
  • Form 1010 signed and duly filled with the requested information.
  • Show the Declaration of Maternity. (Format)
  • ID of the person who signs the refund request.

Format

Lactation

Requirements:

  1. Form 1010 duly signed by the insured.
  2. Show Identity Document in original and copy.
  3. If the application is submitted by someone other than the policyholder, you must have a copy of the DNI and show the original.

The person responsible for processing and collecting the subsidy, in this case, is the mother and, in the event of death, it will be the child’s parent or guardian.

Shelf life

As for Maternity Aid

This Grant Grant lasts 98 days, starting 49 days before the date of delivery, the mother can postpone the start of the rest with the help of the attending physician. If the delivery is multiple or the mother has a disabled child, the grant is extended for another 30 days.MOTHER

The first payment is made when the first 49 days are over, then the second payment is canceled at the end of the 98 days or 128 subsidized days (multiple births or children with disabilities) and the cancellation of the final full payment is made at the end of the maternity period .

The filing deadline is 98 days, after the child’s birth, plus 6 months. In the case of multiple births, it is 128 days after the child’s birth date plus 6 months.

Regarding the Lactation Subsidy

To apply for the breastfeeding allowance, you have 98 days plus six months, counting from the child’s birth date. In the case of multiple births, 30 days are added.

With your Form 1010 stamped and a copy of your identity, you can go to authorized banks and receive your grant.

Where and when to deliver?

The required grant application must be submitted in one of the following Insurance and Economic Benefits Offices (OSPE):

If you are in Lima, you can access the following offices:

  • Corporate: Av. Arenales No. 1302, Complexo Arenales. Of. 113-125-111.
  • Jesús María: Av. Arenales, Complexo Arenales, Of.128.
  • San Isidro: Av. Arequipa 2890, San Isidro.
  • Salamanca: Calla Paracas Nro. 181, Salamanca de Monterrico.
  • San Miguel: Av. La Marina nº 2299, San Miguel.
  • San Martín de Porres: Av. Perú Nro. 3869, San Martín de Porres.
  • Comas: Av. Universitaria Nro. 7355, Urb. Retablo, Comas.
  • San Juan de Lurigancho: Av. Cajaamarquilla Nro. 788, Urb, Zárate, San Juan de Lurigancho.
  • Huacho: Av. Francisco Vidal nº 707, Hospital Gustavo Lanatta Luja, Huacho.
  • Canete-. Jr. San Agustín No. 130, San Vicente de Cañete, Cañete.

Telephone: (001) 2656000. Opening hours are Monday to Friday from 8 am to 4 pm and on Saturdays from 8 am to 12 pm.TELEPHONE

Normative

Maternity

Terms:

  • The insured must have at least three consecutive months of contribution or four non-consecutive months, that is, within six consecutive months, which are prior to the month in which the benefit starts.
  • Three consecutive months or four non-consecutive months in the last twelve months prior to the month in which the benefit begins.
  • Employment relationship at the time the benefit was acquired and in the month of conception.
  • Have paid the required contribution for the design month before sending the application.

EsSalud

Lactation:

Terms:

  1. Have three consecutive months of subscription or four non-consecutive months within the six-month period prior to the month of delivery.
  2. The insured must have registered the child as the insured’s rights holder.
  3. The mother must be registered with EsSalud if she is not insured.
  4. The agricultural insured must have at least three consecutive months of subscription or four non-consecutive months in the last twelve months, before the month of delivery.
  5. If the baby is deceased, the posthumous registration must be made.

We hope the information has helped you! Greetings.

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