The Government advanced this Tuesday in forcing prepaid medicine companies to offer their clients health coverage plans with values at least 25% lower than those offered so far and with different copayments or coinsurance for practices and specialties.
The decision, emanating from Decree 743 of November 2022, was made official through resolutions 1 and 2 of the Ministry of Health and the Superintendence of Health (SSS), respectively, by which companies registered “in the National Registry are instructed to of Prepaid Medicine Entities (Rnemp) must present, for verification and registration, the plans with the co-payments offered and the rate charts with the detail of the values for each service included”.
“These co-payments must fall within a defined range and may not be applied until they are verified by the Superintendency of Health Services,” said the Ministry of Health. Copayments or coinsurance may only be charged for certain first and second level services.
Among the first, there are medical consultations; psychology; laboratory practices, diagnostic-therapeutic tests; kinesio-physiotric practices; speech therapy/phoniatric practices; home care (green and yellow codes) and dentistry.
The second level benefits achieved by the standard are Computerized Axial Tomography (CT); Nuclear Magnetic Resonance (NMR); Radio Immuno Assay (RIE); Biomolecular, genetic laboratory; Nuclear medicine; Imaging studies that require prior preparation and/or use of contrast media; Diagnostic/therapeutic endoscopic practices, excluding those neurosurgical and cardiovascular, in all its modalities, whether central or peripheral.
The resolution also establishes that the following are exempted from the collection of co-payments: pregnant persons, girls and boys up to three years of age (Law No. 27,611); cancer patients, transplant recipients and people with disabilities, in accordance with the regulations applicable in each case; preventive programs; emergency practices and benefits and all those cases that are excepted or may be excepted in the future by application of specific coverage regulations.
For this purpose, prepaid medicine entities must complete and generate, for each of the comprehensive coverage plans that they market to the general public, the affidavit form for the registration of comprehensive coverage plans with copayment, which will be available on the institutional website of the Superintendence of Health Services, which will publish the lists of informed co-payments.
In the recitals of the SSS resolution, it is recalled that Decree 743/2022 set a maximum limit, as of February 1, 2023 and for a period of 18 months, to the authorized increases in the value of the quotas of the Prepaid medicine contracts owed by contracting parties who have net incomes of less than 6 Minimum, Vital and Mobile Salaries, equivalent to 90% of the Average Taxable Remuneration Index of Stable Workers (Ripte) of the immediately preceding month published.
As the net income of the contracting parties constitutes an amount that varies from month to month for most of them, “it is up to regulate the way in which the above-mentioned ceiling must be verified and applied,” he added.
Likewise, the aforementioned decree provided that prepaid companies must offer as of January 1 “identical coverage plans to the one they currently have without copayments, with the inclusion of copayments on first and second level benefits (at a price of , at least 25%) less than the plan without copayments”. (DIB)