Prepaid medical entities must offer coverage plans at values ​​25 percent lower than current plans

Through Decree 743 published on November 6, 2022 in the Official Gazette, it was established that prepaid medical entities must offer coverage plans at a price of -at least- 25 percent less than the plan without copayments. , with the inclusion of copayments on first and second level benefits, as of January 1, 2023. In this way, those with a lower rate of use are given the possibility of accessing a cheaper plan.

According to the provisions of the Superintendence of Health Services in Resolution 2 – by instruction of the Ministry of Health of the Nation through Resolution 1, published today in the Official Gazette – the entities registered in the National Registry of Prepaid Medicine Entities (RNEMP) must submit, for verification and registration, the plans with the co-payments offered and, together with the plans, they must submit the rate charts with the detail of the co-payment values ​​for each benefit included. These co-payments must fall within a defined range and may not be applied until they have been verified by the Superintendence of Health Services.

Entities registered in the RNEMP may only collect copayments or coinsurance for the following first and second level care services:

First level benefits: Medical consultations; Psychology; Laboratory practices; Diagnostic-Therapeutic Tests; Kinesio Physiatric Practices; Phonoaudiology/Phoniatrics Internship; Home care (green and yellow codes); and Dentistry.

Second level features: 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 3 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; practices and emergency services; and all those cases that are excepted or could be excepted in the future due to the 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.

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