The Government decided to enable prepaid and social works to freely set coinsurance prices within the Mandatory Medical Program (PMO), which were currently stipulated by the Superintendence of Health Services (SSS).
These are services that generally affect national social services and some prepaid customers, especially those with more basic plans.
It is worth clarifying the difference between coinsurance and copayments, the latter often applied outside the law (and in times of crisis for the sector, such as the end of last year). Coinsurance is “extras” authorized and, until now, regulated by the SSS.
In the sector there are doubts about the scope of the measure. While the Government assures that this is a decision that only applies to national social works, mutual societies and non-profit associations – because prepaid payments have already been completely deregulated by the DNU of Javier Milei from the end of 2023–, private medicine companies believe that it is enough. “They should have clarified it in this resolution, we believe so. The Superintendency itself confirmed it to us,” they say in the prepaid cards. spokespersons for the
“This model was created for national social works, which have mandatory benefits and with members with different needs than members of private medicine,” added private health sources.
Today’s Resolution 1926/2024 determined to leave “without effect the current tariffs for coinsurance established for the medical-care benefits contemplated in the Mandatory Medical Program (PMO) and its complementary regulations, which are not exempt according to the current regulatory framework ; those who They may be freely set by the entities.”
The official document argued that the decision is linked “with the objective of guaranteeing greater competitiveness and transparency in the Health Subsystem, while ensuring that users clearly know which services may require an additional cost.”
Until today, the Superintendency of Health Services was the one who set the values
As part of the reorganization of the health system that the National Government has been promoting, the rediscussion of its financing and the objective of promoting an improvement in the quality of health services, the Ministry of Health, through the Superintendency of Health Services ( SSS), established that the Agents of the Health Insurance System may freely set the coinsurance values of the different medical benefits included. Until today, the SSS was the one who set these values.
In this way, “they will be able to freely set the values of the coinsurance of the different medical benefits included,” which “will allow more and better offers for the beneficiaries,” according to the Executive.
In that sense, he pointed out that the new regulations do not affect the public system and assured that “These changes promote free competition among the Agents of the Health Insurance System and allow beneficiaries to choose more freely.”
“The new regulations – which do not affect the public system – will allow the coinsurance values to be updated in those benefits that are considered necessary. These changes promote free competition among the Agents of the Health Insurance System and allow beneficiaries to choose more freely,” official sources explained.
In this way, they said, the measure impacts all medical benefits except those that were already excepted, which are those linked to oncological treatments, disability, maternal and child plan, and those provided for in the regulations for the treatment of Hepatitis, HIV and communicable , and those included in the National Transplant Protection System.
“The resolution provides that the values of the coinsurance associated with each medical benefit must be duly and reliably informed to the beneficiaries 30 days in advance and, in addition, they will be published on the website of the Superintendency of Health Services,” they said from government.
Likewise, the resolution provides that the values of the coinsurance associated with each medical benefit must “be duly and reliably informed to beneficiaries 30 days in advance and, in addition, they will be published on the website of the Superintendence of Health Services.”
The decision represents a new deregulation of the health sector, which with the beginning of Javier Milei’s administration had had the liberalization of prices in prepaid medicine installments and which, after the excessive increases, required a precautionary measure to limit the scope of you upload them. However, it became void after the agreement with the companies on a reimbursement plan, so adjustments were once again allowed without restrictions.
In this regard, in the recitals of the resolution it was recalled that DNU 70/2023 “promoted the release of restrictions on the value of the contributions of the health plans of the prepaid medicine subsystem to increase the competitiveness of the Health Subsystem” and He clarified that the release in the price of co-payments also responds to the aforementioned decree.
- Preventive Program: cervical and breast cancers, preventive dentistry and sexual health.
- Oncology.
- Disability.
- 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:
- 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.
- Childish: 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.
- Emergencies/Code Red.
- Nursing practices.
- Comprehensive Health Care and Care during Pregnancy and Early Childhood. The so-called “1,000 Days Law”.
- National Law of Comprehensive Response to HIV, viral hepatitis, other sexually transmitted conditions, tuberculosis.
- Comprehensive Protection System for Transplanted People.
- Organ, Tissue and Cell Transplant Law.
With information from NA
