2023 began with a new regime of segmented increases and copayments

The prepaid medicine companies will have to attach the rate charts with the detail of the copayment values ​​for all services.
The prepaid medicine companies will have to attach the rate charts with the detail of the copayment values ​​for all benefits.

The Superintendence of Health Services, with the objective of reducing the costs of prepaid medicine users, regulated the measures for the segmentation of the increases according to the income of the holder of the service and the creation of plans with copayments whose value must be at least 25% lower than those currently offered by companies.

Each prepaid medicine company must present an affidavit for verification and registration by the Superintendency, which will be available on the institutional website of the Superintendency, for each of the new plans with comprehensive coverage and copayments, whose final value for the user must be at least 25% lower than current proposals without copayments.

They will also have to attach the rate tables with the detail of the copayment values ​​for all benefitsaccording to resolution 2 of the Superintendency, and this body will publish the values ​​reported by each company on its institutional website.

These plans, with a lower value, will be identical to those already offered by prepaid, with the difference that copayments may be charged – that is, pay an extra sum at the time of receiving care– in 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 medium; among other.

Anyways, the rule excludes pregnant people and girls up to three years of age from paying the copayment; cancer and transplant patients, people with disabilities or those who are in preventive programs or receive benefits and emergency practices.

The monthly increases of these bonuses or copayments will be capped at the Health Cost Index, as provided in the same resolution.

The calculation of this indicator is influenced by the costs of the sector in human resources (component that represents 52.4% of the calculation of the index), medicines (12.2%), medical supplies (17.2%) and other supplies and expenses ( 18.2%).

Some prepaid companies such as Medicus (Flex Plan) and Galeno already offered cheaper plans with copaymentsprior to the resolution, which will extend these schemes to all companies.

On the other hand, the Superintendency also made available a form this month for prepaid medicine users to certify their income, given the segmented increases that will be applied as of February 1, 2023 and for a period of 18 months. .

On November 10, through decree 743/2022, The Government established a new formula for updating prepaid medicine quotas that will take into account the evolution of wages.

The new differentiated scheme will be applied as of next month, after authorizing monthly increases in prepaid payments of 6.9% last December and in the current month of January.

Users who have monthly net income less than six times the Minimum, Vital and Mobile Salary -an amount currently equivalent to $371,718- may not receive increases in their fees that are greater than 90% of the Average Taxable Remuneration index of Stable Workers (ripte).

This new scheme will cover more than 1,600,000 people who contract prepaid directly or who choose to derive their contributions from obras sociales to entities that sign agreements with companies, who do not have the capacity to negotiate the service they contract.

Does not include those who receive coverage through corporate plans that their employers underwrite through private contracts negotiated between the parties, whose plans will be governed by other increase schemes.

Taking as a reference the Ripte calculated at the end of December, the increase to be applied to the prepaid will be 4.91% in February for those who receive up to six minimum wages.

Meanwhile, for holders who exceed said limit, the prepaid will apply monthly increases that will be governed according to the Health Cost Index, which will imply, in February, an increase of 8.21%.

The regulations did not specify whether those who request the monthly increase cap will be able to access any of the new plans with copayments.

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