Hear
The Government ordered formally release the amounts that social and prepaid insurance companies can charge as coinsurance for a large part of the benefits included in 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 the validity of these extras -, members are charged for certain services.
The decision was established through resolution 1926 of the Ministry of Health, published today in the Official Gazette. It is based on the deregulations provided for by DNU 70 of December 2023. In fact, as explained in the Superintendency of Health Services, In practice, the prepaid ones were already released.
A novelty is that, based on the new resolution, which will be effective from tomorrow, Entities must notify their affiliates of changes to the amounts 30 days before applying them. Therefore, if increases were decided this week, the new values could be collected only within a month.
In the case of new contracts, the resolution signed by the Minister of Health, Miguel Russo, specifies that At the time of affiliation, the amounts of any coinsurance must be reported. In addition, it was established that all values must be communicated by the entities to the aforementioned 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 resolution published today, the deregulations established by that regulation 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 virtuality, 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 entities could charge in plans with co-payments, the new rule confirms that For certain practices and treatments, the charging of these additional fees is not permitted; This occurs, for example, in preventive dentistry, in preventive programs for cervical and breast cancer, in oncological or disability treatments, in benefits linked to organ, tissue and cell transplants, and in maternal and child plans. and care in the first 1000 days of life.
According to the authorities of the Superintendency, the changes that are being decided regarding the deregulation of the system “promote free competition between agents of the health insurance system and that the beneficiaries choose more freely.”
The resolution of the Health area is known days after The prepaid companies began to communicate what increases they will apply next month, based on the agreement reached after the Government denounced several companies in court for alleged cartelization (agreement to fix 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 the statements issued with a description of the percentages 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 the increases greater than the variation in prices applied since DNU 70, the amounts recognized do not contemplate the entire difference that would arise from the assumption in which the quotas had followed inflation month by month. According to an example described in the “Implementation Minute” of the agreement between the parties, in the case of a fee that in December was $100,000 and in May was $286,017, the balance in favor of the affiliate is, updated based on the deposit rate fixed-term loan from 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.
