Hear
The Government ordered release the amounts that social works and prepaid companies can charge as co-payments or coinsurance for providing benefits that are part of the Mandatory Medical Plan (PMO). It is about the additional amounts to social security contributions or contributions that, depending on the health plan contract – not all of them contemplate it -, members are charged for certain services.
The decision was established through resolution 1926 of the Ministry of Health, published today in the Official Gazette, and is based on the deregulations provided for by DNU 70 of December. In fact, as explained in the Superintendence of Health Services, In the case of prepaid ones, in practice the release already applies beforehand.
Based on the new resolution, which will be effective from tomorrow, Entities must inform their members of the increases 30 days before beginning to apply them. Therefore, if an increase were decided this week, the new value could be collected only at the end of July. In the case of new contracts, the resolution signed by the Minister of Health, Miguel Russo, specifies that The amounts must be reported at the time of affiliation. Furthermore, it is established that all values must be reported by the entities to the Superintendency which, in turn, will make them public through its website.
The aforementioned DNU, which was issued days after the presidential inauguration of Javier Milei, provided at the time for the total deregulation of the quotas, something that will be in full force again in July, after having been overcome – with an approved agreement between the parties. in Justice – the Conflict that arose in mid-April between prepaid companies and officials over the level of increases that occurred in the first months of the year.
In the recitals of the measure published today, the deregulations established by that measure of the Executive Branch are recalled and it is pointed out that, given the liberalization of prices, the regulations referring to co-payments “have lost practical and legal validity, which makes the issue under study is abstract and lacks relevance and concrete applicability in the current legal reality.” In practice, in fact, the official website where the maximum values that could be charged according to the benefit were published had no update from March. In any case, in the sector they point out that the formal step of a regulatory measure was needed.
Years ago it was established that the maximum amounts to be collected They would be readjusted with each increase in the minimum, vital and mobile wage, in the same percentage as the increase in that variable. These limits were published on an official page. That site today contains the values in force as of last March (it was not updated for subsequent months, despite the fact that the minimum wage rose in April and May). Among the figures explained, for the care of a general clinical doctor or a pediatrician, for example, there could be a co-payment of up to $2019, while for specialist doctors the figure was $3786.
Beyond revoking the caps on the amounts that prepaid companies could charge in plans with co-payments, the new rule confirms that For certain practices and treatments, coinsurance collection is not permitted; This occurs, for example, in preventive dentistry, in preventive programs for cervical and breast cancer, in oncological or disability treatments, in services linked to organ, tissue and cell transplants, and in the maternal and child plan. that of care in the first 1000 days of life.
According to the authorities of the Superintendency, the changes that are being promoted in terms of deregulation of the system “promote free competition between agents of the health insurance system and that the beneficiaries choose more freely.
The decision of the Health authorities is known days after The prepaid companies began to communicate what increases they will apply to their installments next month, based on the agreement reached after the Government denounced the companies in court for alleged cartelization for setting prices in the first months of this year.
The agreement between officials and directors of the entities, signed at the end of May and approved days ago by Judge Juan Rafael Stinco, head of Civil and Commercial Court No. 3, contemplates that there will be free quota increase from next month and, furthermore, that a mechanism will be implemented by which balances are determined in favor of the affiliates. By this last provision, During the next 12 months, an amount will be deducted from the fee payable by the affiliates.
As for the fee increases, Among those communicated to members are those of Swiss Medical (6.7%); Galen (7.5%); Medife (4.2%); Accord Health (8.8%); Italian Hospital (9.37%); Omint (8.5%) and Medicus (8.08%). OSDE, meanwhile, which invoices June services in July, announced an increase of 4.2%, equivalent to May inflation; for July services, for which it will charge in August, the decision has not yet been announced.
In respect of the balances in favor of the affiliates, that are conceptually derived from increases greater than inflation as of DNU 70, the amounts that will be considered do not contemplate the entire difference that would arise from the assumption in which the contributions had followed inflation month by month, given the modality of the calculation established by the Superintendency. According to an example used in the “Implementation Act” linked to the agreement between the parties, in the case of a fee that was $100,000 in December and $286,017 in May (a cumulative increase of 186%), The balance in favor of the affiliate is, updated according to the fixed-term deposit rate of Banco Nación, of $89,609.56. The first compensation, which will be an amount that will be deducted from the July fee, is $6,495.54; the second, $6,657.93; the third, $6,824.38, and each of the following will always be 2.5% higher than the immediately preceding one.
