To try to clarify doubts and define how the increases will be from this year for private medicine, today a key meeting will be held between the representatives of the prepaid companies with the authorities of the Superintendence of Health Services (SSSalud).
Until last night the difference was on the determination, according to the income for a lower increase (4.91%) or higher (8.21%) in the sense if the salary of the main affiliate or the family group was taken into account.
For the time being, the net (out-of-pocket) income declared by the affiliate for the period December 2022 is taken to be less than 6 SMVM (Minimum, Vital and Mobile Salary) equivalent to $371,718. A procedure that must be through the Sworn Declaration of Income Certification.
official measures
The Superintendence of Health Services, with the “objective of reducing costs” for prepaid medicine users, has already regulated the measures for the segmentation of the increases according to the income of the holder of the service and the creation of plans with copayments whose value must be at least 25 percent less than those currently offered by companies.
Each prepaid medicine company must present an affidavit for verification and registration by the Superintendency, which will be available on the institutional website of the Superintendency, for each of the new plans with comprehensive coverage and copayments, whose final value for the user must be at least 25 percent lower than current proposals without copayments.
They will also have to attach the rate tables with the detail of the co-payment values for all benefits, according to resolution 2 of the Superintendency, and this body will publish the values reported by each company on its institutional website.
These plans, with a lower value, will be identical to those already offered by the prepaid, with the difference that copayments may be charged – that is, paying an extra sum when receiving care – in certain first and second level benefits.
Among the first, there are medical consultations; psychology; laboratory practices, diagnostic-therapeutic tests; kinesio-physiotric practices; speech therapy/phoniatric practices; home care (green and yellow codes) and dentistry.
The second level benefits achieved by the standard are Computerized Axial Tomography (CT); Nuclear Magnetic Resonance (NMR); Radio Immuno Assay (RIE); Biomolecular, genetic laboratory; Nuclear medicine; Imaging studies that require prior preparation and/or use of contrast medium; among other.
In either case, the rule excludes pregnant people, girls up to three years of age, from paying the copayment; cancer and transplant patients, people with disabilities or those who are in preventive programs or receive benefits and emergency practices.
The monthly increases of these bonuses or copayments will be capped at the Health Cost Index, as provided in the same resolution. The calculation of this indicator is influenced by the costs of the sector in human resources (component that represents 52.4% of the calculation of the index), medicines (12.2%), medical supplies (17.2%) and other supplies and expenses ( 18.2%).
For all
Some prepaid already offered cheaper plans with copayments, prior to the resolution, which will extend these schemes to all companies.
On the other hand, the Superintendency also makes available from this month a form for prepaid medicine users to certify their income, given the segmented increases that will be applied as of next February 1, 2023 and for a period of 18 months. .
The new differentiated scheme of increases will be applied from next month
On November 10, through Decree 743/2022, the Government established a new formula for updating prepaid medicine quotas that will take into account salary evolution.
The new differentiated scheme will be applied as of next month, following authorizing monthly increases in prepaid payments of 6.9% last December and in the current month of January.
Users who have monthly net income less than six times the Minimum, Vital and Mobile Salary -an amount currently equivalent to $371,718- may not receive increases in their fees that are greater than 90% of the Average Taxable Remuneration index of Stable Workers (ripte).
This new scheme, they say, will cover more than 1,600,000 people who contract prepaid directly or who choose to derive their contributions from social works to entities that sign agreements with companies, who do not have the capacity to negotiate the service they contract .