The prepaid criticized the changes in the private medicine system: “We are going to apply fines if clients falsify their income statement”
The companies of private medicine questioned the latest changes established by the national government for benefits and which include, on the one hand, a new formula that will limit the rate of monthly increases that coverage plans may have, and on the other, the obligation to offer their clients a subscription at least 25% cheaper than the cheapest plan in your portfolio.
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Companies are required to offer 25% cheaper plans to certain users who request them. In return, they will be able to charge extras for some benefits
The president of the Argentine Health Union (UAS) Claudio Belocopittwarned that the companies in the sector will carry out their own reviews to corroborate that the declarations of income made by those who want to have the bonus in the value of their coverage -only cases with family remunerations of less than 6 minimum wages are admitted- do not “falsify” or underreport in order to have that bonus.
“Clearly under no circumstances do we share that this is right,” said Belocopitt, referring to the co-payment scheme that will be put into effect from now on and that was recently regulated by the Superintendence of Health Services. “Companies, using all existing mechanisms, such as the Nosis or the Truthfulwe are going to do our own reviews to analyze if the subject has the economic reality that he claims to have ”, he mentioned.
“The companies, using all the mechanisms that exist, such as Nosis or Veraz, we are going to do our own reviews to analyze if the subject has the economic reality that he claims to have” (Belocopitt)
“We have to take into account that for us the granting (of this subsidized scheme) is a economic impact very forceful. You have to avoid fraud in sworn statements ”, he continued in dialogue with infobae and other media.
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“With the list that the Superintendency gives us (of users who ask to have the bonus) we are going to do sampling, we want to verify, we have some ways to do it. And if appropriate, we will call and tell you which are the cases that do not close”, assured the businessman.
“The system is going to charge less than what corresponds to a State decision. The first concept that we have to be clear about is with all the letters: do not falsify affidavits because it is a cause of termination of contract”said the also president of Swiss Medical, and mentioned as an alternative the possibility of applying fines.
“Clearly what was clear and validated with the authorities is that the income is that of the family group. Otherwise it could be that an individual who wins 400 thousand pesos is left out of the subsidized system and a married couple that wins 700 thousand stay inside. The income of the family group will be taken into account,” said Belocopitt.
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“Since up to now there is no State money at stake, the question is how much work are they going to dedicate to verifying if the statements it’s right or wrong. Here there is money at stake, it is money that comes from the private health system, not from the State, ”she remarked.
The system regulated by the Superintendence of Health Services implies a formula that determines every month what should be the maximum increase in the cost of prepaid medicine plans, which should be equivalent to 90% than the Ripte index (which reflects the evolution of formal wages) for the previous month.
“The first concept that we have to be clear about is with all the letters: do not falsify sworn statements because it is a cause for contract termination” (Belocopitt)
This cap will apply to those with incomes less than the 6 minimum wages, vital and mobile. To determine if a client can enter the new scheme, they must submit an affidavit to the superintendence every month specifying the total household income, according to the UAS. If you do not exceed that threshold of 6 SMVM, you will have the subsidized scheme within your reach. The scheme will last 18 months.
Another measure that was taken in parallel was to establish that companies must offer a coverage plan with copayments that has a price at least 25% lower than the cheapest plan they had in their service.
Regarding this aspect, the president of UAS mentioned that the private medicine provider companies will make the decision to offer “more or less plans according to their business needs”. On the other hand, he postulated that the benefits will be the same but “not identical”, since some providers would not be included. “I can’t force someone to work with me,” Belocopitt said. “We are going to try to make it as similar as possible,” he mentioned.
In general terms, the main director of the UAS questioned “the rule change game for the sector”. “The system is in crisis and we have a greater responsibility, which is that the system is sustainable and solid to serve our affiliate segment. We have to be sure that we are going to be solvent to continue operating, otherwise we will act accordingly, ”he warned.