2024-09-03 12:55:00
Government authorized prepaid company Differential increases based on plan conditions or where the health plan is offered; However, it also stipulates that the increased fee must be The period shall not exceed 5 days from the date of announcement monthly inflation They must detail the fees they charge users.
The measure was passed on September 3 this year Resolution 2155/2024 Published in the official gazette, confirmed Increase in cost of insurance plans offered by prepaid health companies ‘could be applied in a variety of ways’ Depending on the conditions of the plan (with or without co-payments) and the region or region where care is provided.
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In turn, it determined that these entities “must notify the Health Services Regulatory Authority of such increases, specifying the criteria used in each region or region and whether a co-payment system exists.”
In this sense, the official text explains, “differentiation of quota values according to plan type and region is allowed” “Contributes to more appropriate application of rate hikes.”
It is worth noting that since July, the prices of prepaid drugs have been “freely” adjusted.
For example, quotas for September are expected to vary between companies, but quota increases are expected to range between 4.5% and 6%. This is the third month that prepaid companies have been free to set the fees they charge members without the control of public organizations.
At what specific time do prepaid companies have to report increases to their plans?
Regarding the prescribed time limit for quota value adjustment, regulations stipulate that “Within 5 days after the release of the latest Consumer Price Index (CPI) Conducted monthly by the National Statistics and Census Service”, stating that “it must be carried out in a clear and conspicuous manner, Details the percentage increase applied and the new value of the monthly fee.
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This measure is based on the idea that “using updated data not only increases the transparency of the adjustment process; it also helps better understanding Users understand the rationale behind the changes.
At the same time, it is also believed that “the consistency between adjustments and the latest economic indicators will help maintain The balance between entity financial sustainability and users’ ability to pay.
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Additionally, the regulations state that companies “must provide their members with a detailed breakdown of the concepts included in the monthly charges and adhere to the following minimum requirements: a) the base cost of the contract plan, b) the additional costs covered specifically, c) Adjustments for age or risk factors, d) contributions, donations and/or capitation, and e) taxes and/or applicable fees.
In this regard, he made it clear that a breakdown must be provided.
- in a clear and understandable way,
- use simple language and
- Avoid unnecessary technical details
At the same time, the regulations clarify that “if the invoice concept changes, related parties must be notified at least 30 days in advance and the reasons for the change must be explained.”
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The government’s decision is based on the fact that “the detailed classification of billing concepts will enable users to Compare more effectively the different options available on the market Prepaid health care, facilitates selection of the plan that best suits your needs and budget, and promotes more informed and effective competition.
In the same sense, it was considered that “there is a need to establish minimum standards for the information that must be provided to users in order to guarantee uniformity and clarity in the communication of costs associated with health services, which would contribute to the establishment of a more orderly market.
What sanctions will be imposed on medical companies that do not comply with the resolution?
The SSS resolution warns that “failure to comply with these provisions will be considered Serious violations will be punished Law No. 26,682” and provides that “it will take effect from the first working day after its promulgation”.
Official documents justifying the implementation of these regulations stated that “the implementation of these measures Will encourage competition between entities Indicates that benefits system users and ensures that rate adjustments are fairly understood and accepted.
Likewise, he recalled, “Regulators have a responsibility to ensure that business practices are clear, ethical and designed to create maximum value for consumers in a free and competitive market environment.”
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