The Ministry of Health advanced this Monday in the deregulation of health companies prepaid medicine and published the resolution through which frees co-payments inside of the Mandatory Medical Programexcept for some treatments.
According to the size of the portfolio that Mario Russo manages, users will no longer be able to be guided by the tariff table that was within the Mandatory Medical Program (PMO) and each medical company may set the amounts.
According to Resolution 1926/2024 of the Ministry of Health, published this Monday in the Official Gazette, “the current tariffs for coinsurance established for the medical-care benefits contemplated in the PMO and its complementary regulations, which They are not exempt according to the current regulatory framework; those that may be freely set by the entities.”
Likewise, it is established that “the values of the coinsurance associated with each medical benefit must be duly and reliably informed to the beneficiaries and/or users at the time of affiliation. The variation in coinsurance values during the course of membership must be reliably informed 30 days in advance to the beneficiaries and/or users.”
In the foundations of the Health resolution, it is stated that free competition “requires a transparent market in which consumers can directly compare the available offers, allowing them to make informed decisions when evaluating the plans offered and choosing the best option.”
“It is imperative to proceed to eliminate all interference by the enforcement authority in the coinsurance values for both Health Insurance Agents and Prepaid Medicine Entities.allowing those to be set freely, with the objective of guaranteeing greater competitiveness and transparency in the Health Subsystem, ensuring at the same time that users clearly know which services may require an additional cost,” it is added in the recitals of the measure. .
Benefits that are exempt
- Cervical and breast cancers
- Preventive dentistry
- Sexual and reproductive health Law No. 25,673
- Oncology
- Disability
- Emergencies/Code Red
- Nursing practices
- Comprehensive Health Care and Care during Pregnancy and Early Childhood. – Law 1000 days
- National Law of Comprehensive Response to HIV, viral hepatitis, other Sexually Transmitted Conditions and Tuberculosis
- Comprehensive Protection System for Transplanted People (Law 26,928)
- Organ, Tissue and Cell Transplant Law (Law 27,447)
- Maternal and child plan (coverage will be provided during pregnancy and childbirth from the moment of diagnosis until the first month after birth
- Care of the newborn until one year of age. All with 100% coverage both in inpatient and outpatient settings and exempt from payment of all types of coinsurance for specific care and medications. This coverage includes: a) Pregnancy and childbirth: consultations, diagnostic studies exclusively related to pregnancy, childbirth and the postpartum period, since other types of studies will have the coverage that governs the rest of the PMO, Obstetric Psychoprophylaxis, medications only related to pregnancy and childbirth, 100% Coverage b) Children: Perinatological studies will be mandatory to detect phenylketonuria, congenital hypothyroidism and fibrocystic disease in the newborn. Follow-up and control consultations, period immunizations, 100% coverage of the medication required for the first year of life as long as it appears on the list of essential medications) in order to stimulate breastfeeding, formula or formula milk will not be covered. another type, unless expressly medically indicated, with evaluation of the medical audit.
With official information.
I.G.
