EPS Sura user and don’t know what’s going to happen? We answer several questions

EPS Sura user and don’t know what’s going to happen? We answer several questions
EPS Sura user and don’t know what’s going to happen? We answer several questions

EPS Sura is present in 91 municipalities in Colombia (56.1% Antioquia, 14.7% North, 10.8% Center, 10.6% West and 7.8% Eje Cafetero). /Gustavo Torrijos.

Photo: Gustavo Torrijos Zuluaga

EPS Sura requested this Tuesday his withdrawal from the health system through a figure known as “progressive dismantling. This EPS has more than 5 million members, the majority in Antioquia and in the contributory regime, being the third largest in the country, only surpassed by Nueva EPS and Sanitas (today intervened and under the control of Supersalud). Given the news, it is normal to ask yourself some questions.

In The viewer you can understand some of the key aspects of this decision.

If I am a member, what will happen to me?

At the moment, absolutely nothing. EPS Sura has guaranteed that it will remain the EPS of its members until the last moment. This means, according to the entity, that “it will continue to meet the needs of its members in medical coverage, with the same quality and commitment that characterizes us, until the competent authorities grant the necessary regulatory approvals.” That is, people who already have scheduled appointments or procedures will have no problem continuing to access them.

In addition, procedures and follow-ups for chronic diseases will continue without any difficulty, the EPS promised. For now, members will not have any impact and will be able to continue going to it.

How long will EPS Sura continue?

The EPS notified this Tuesday that it delivered the documents to Supersalud for its exit from the system through an organized and staggered dismantling. Within the next 65 business days, EPS Sura must wait for comments and approval from Supersalud. Only from there could the clearing program begin, which would not be immediate. (See: The response of Gustavo Petro’s government to the decision of EPS Sura).

EPS Sura has assured that in its withdrawal proposal delivered to Supersalud it includes “some recommendations that, if accepted, allow us to continue meeting service expectations, and carry out a coordinated and planned transition, which guarantees the complete delivery of the information clinic and favors the continuity of treatment, according to the health needs of the population.” This is done with the aim of not affecting users.

So, there is no fixed estimated time for Sura to stop being EPS, since this is subject to Supersalud accepting the clearing program and that program being fulfilled on estimated dates. However, it is assured that it will be staggered and progressive.

Can Supersalud deny Sura’s request to leave the system?

Yes, the authorities can ask questions, make requests and deny EPS Sura’s request to leave the health system. However, the insurer points out that if this happens, “there would be an impact on the system. The calculations we have carried out show that EPS SURA would have no way of assuming the liabilities that arise in the future, which would directly affect the timely provision of health services to members and the network of providers, given the impossibility of complying with the obligations of the EPS.”

If Supersalud accepts the departure of EPS Sura, what next?

EPS Sura assures that its proposal for progressive dismantling includes a staggered and progressive delivery of its members and their information to the entity that would be in charge of their insurance. That is, the EPS withdrawal process implies that its more than 5 million members would have to move to other EPS that Supersalud would authorize. (Can see: EPS Sura: what will happen to the complementary plan?)

The request includes the organized transfer of patients to other EPS, a payment plan for debts accumulated with suppliers, as well as a work transition strategy for employees and collaborators. All of this, EPS Sura insist, would occur in a phased and progressive manner, if their request is accepted.

Why is EPS Sura withdrawing from the health system?

The reasons for the withdrawal of EPS Sura from the system are explained, according to the entity, in the “difficult” financial outlook. For EPS Sura, “the health system in Colombia faces financing challenges such as the insufficiency of the Capitation Payment Unit (UPC), the increase in the aging rate of the population, in addition to the insufficiency and lack of opportunity in the transfer of the established Maximum Budgets, as well as the debts accumulated under this concept.”

Some figures help to understand it: in 2023, for example, EPS Sura allocated 102 pesos for Health care and 4.9 pesos for EPS operating expenses (technical and administrative) for every 100 pesos received. In addition, its financial results between 2022 and 2023 reflected a loss of $360 billion pesos and the company closed 2023 with equity of $4.2 billion.

If I am a member, can I transfer to another EPS now?

Yes. Nothing prevents members of Sura or any other EPS from choosing to join another EPS. Affiliates in the General Social Security Health System can make the change after having completed one year of permanence in their EPS or without completing the year of permanence to make family unification, or when their EPS no longer provides service in their place of residence. residence, or when cases of poor provision or suspension by the EPS or its provider network occur.

To make your transfer request, your health condition does not matter: no EPS can refuse to affiliate a person because they suffer from some pathology, whatever it may be. You have to remember, however, that to join another entity there are several requirements. First, the EPS you choose must be authorized in your department, and if it is, it cannot be subject to any special measures by Supersalud. (Can see: The numbers of Sura, a health giant that withdraws from the system)

Remember that today there are 7 EPS with an intervention measure by the authorities: Asmet Salud EPS (with about 1.6 million members); Emsanar (1.7 million members), Famisanar (2.9 million members) and Savia Salud (1.6 million), in addition to EPS SOS, Sanitas and Nueva EPS. None of these EPS are authorized to receive members until their financial situation improves, which is what intervention seeks.

Citizens will be able, through the internet, to transfer or change their health promoting entity (EPS), through the portal www.misegurosocial.gov.co

What happens with prepaid health insurance?

Absolutely nothing. EPS Sura’s decision today only affects EPS, and not its complementary health plans. Users of these plans will not have any changes.

If I am an employee of Sura, what will happen to my employment?

EPS Sura assured that “it has different lines of business that allow us to manage employability. We have an action plan that integrates programs to develop competencies and skills that allow people to assume new roles,” that is, we will seek to ensure that the EPS employees today can be relocated to other jobs. However, the entity clarifies that these are evaluations that it carries out every day, so some other decision regarding this issue is not ruled out.

 
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