Medical Assistance Program Application
Medical Professionals On a Mission Inc. Medical Assistance Program (MAP) offers timely financial support to patients in the Caribbean with medical expenses not covered by their insurance. It is usually necessary to transport these patients out of their island to seek lifesaving treatment or surgical procedures in another country. Immediate family members of the Board of Directors of MPOM and the selection committee are not eligible to apply for assistance.
In order to qualify for the Medical Assistance Program, the patient must lack sufficient funds to pay for their treatment/procedures because of a natural disaster or other hardships. Patients must write a statement telling us about their situation and have their primary care doctor fill out the Physician’s Certification of Medical condition form.
The brief summary should include the country the patient is from, the country the patient is going to, the name, address, and contact for the treating institution. For travel/housing patients must provide the travel dates, airlines, intended length of stay, date of travel, and contact information for the travel agent, airline, or hotel. Completed applications will be reviewed by a selection committee and the applicant will be informed of the committee’s decision in a timely manner. Any approved funds will be paid to the medical institution, airline, travel agency of hotel on the patient’s behalf. *Please note, MAP funds will not be given directly to the patient or family member. Medical services, treatment, and/ or therapies must be administered by a licensed medical professional at an approved institution.
Required Documents:
– copy of valid passport ID (and visa if a visa is required for travel to that country)
– copy of insurance card
– completed & signed Physician form
– most recent bank statements, income statement, or tax returns
Exclusions:
– Dental care (annual cleaning, fillings, x-rays, etc) and Orthodontic treatment (braces, Invisalign,
checkups, etc). All dental care and orthodontics are excluded unless they are related to a serious
medical conditions such as cleft palate, cancer, etc.
– Homeopathic and herbal supplements or treatments
– Clinical trials
-Cosmetic surgery
– Hyperbaric oxygen treatments
– Sperm banking/ egg retrieval, Infertility treatments, pregnancy/ birthing
– Behavioral therapy
– Cost of gas, mileage, or food
– Autopsy, burial costs, and costs of repatriating deceased persons.
Please complete an online application below or print and fill out a paper application.
Please complete an online application below by clicking on the links or print and fill out a paper application.