And it establishes that the entities registered in the National Registry of Prepaid Medicine Entities (RNEMP) They must submit, for verification and registration, the plans with the copayments offered and, together with them, the rate charts with the detail of the copayment values for each service included. Likewise, it provides that copayments or coinsurance may only be charged for certain first and second level services.
Copayments in prepaid medicine: these are the conditions
“These copays must fall within a defined range and may not be applied until they have verification of the Superintendency of Health Services“, indicates a statement on the subject.
Between the benefits first levelinclude medical consultations, psychology, laboratory practices, diagnostic-therapeutic tests, kinesio-physiotric practices and speech therapy or speech therapy, home care (green and yellow codes) and dentistry.
The second level benefits Computed axial tomography (CT), nuclear magnetic resonance (NMR), radio immunoassay (RIE), biomolecular genetic laboratory, nuclear medicine, imaging studies that require prior preparation and/or use of medium contrast and diagnostic/therapeutic endoscopic practices, excluding those neurosurgical and cardiovascular, in all its modalities, whether central or peripheral.
The resolution also establishes that there are exempt from the collection of co-payments: pregnant people, girls and boys up to three years of age (Law 27,611), cancer patients, transplant recipients and people with disabilities, in accordance with the regulations applicable in each case. Also, preventive programs, practices and emergency benefits and all those cases that are exempted or may be exempted in the future due to the application of specific coverage regulations.
For this purpose, the entities of prepaid medicine must complete and generate, for each of the comprehensive coverage plans that market to the general public, the affidavit form for the registration of comprehensive coverage plans with copayment, which will be available on the institutional website of the Superintendence of Health Services. There, the reported copayment lists will be published.
Caps on price increases
In the recitals of the SSS resolution, it is recalled that Decree 743/2022 set a maximum limit, as of February 1, 2023 and for a period of 18 months, to which Authorized increases in the value of prepaid medicine contract installments owed by contracting parties who have net income less than 6 Minimum, Vital and Mobile Salaries, equivalent to 90% of the Average Taxable Remuneration Index of Stable Workers (RIPTE) of the immediately previous month published.
Since the net income of the contracting parties constitutes an amount that varies from month to month for most of them, “it corresponds to regulate the way in which the aforementioned ceiling will be verified and applied,” he adds.
Likewise, the aforementioned decree provided that the prepaid must offer, as of January 1, “identical coverage plans to the one they currently have without copays, with the inclusion of copayments on first and second level benefits (at a price of at least 25%) lower than the plan without copayments”.
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