The Superintendency of Health Services (SSS) established a new resolution on age groups and values of prepaid fee. The resolution, published in the Official Gazette on August 2, 2023, establishes the following:
- Prepaid companies may establish differential fee values within the same plan, depending on age groups.
- Coverage plans must admit the affiliation of users of any age.
The maximum variation allowed between the price of the first and last age group is three times.
Prepaid: What does the new resolution of the Superintendency of Health Services establish about age groups and prepaid fee values?
The new resolution establishes that prepaid companies may establish differential fee values within the same plan, depending on age groups, as long as the duty of information to the user at the time of contracting is fulfilled, explicitly and completely.
The resolution also establishes that coverage plans must admit the affiliation of users of any age, without exception.
Prepaid: What is the maximum variation allowed between the price of the first and last age group?
The maximum variation allowed between the price of the first and last age group is three times.
Prepaid: What happens when the member changes age group within their coverage plan?
When the member changes the age group within his or her coverage plan, the fee value provided for the new age group may only be applied if the percentage or amount of increase was duly informed to the user.
Prepaid: Can bonuses be granted at the time of membership?
Yes, prepaid bonuses can be granted at the time of affiliation, whether expressed in nominal form or as a percentage of said value, provided that, throughout the contractual relationship, the value actually paid by the affiliate respects what is established in the article. 17, last paragraph, of Law No. 26,682.
Prepaid: Can the user be required to change their plan because they have entered a certain age group?
No, the user cannot be required to change their plan because they have entered a certain age group.
Prepaid: What happens to members who are over 65 years of age?
For members over 65 years of age who are already affiliated with the entity, with more than 10 years of continuous seniority in it, the increase cannot be applied to them due to their age.
Only the increases provided for in these regulations may be applied to members who are over 65 years of age and do not have ten years of continuous seniority in the same entity.
Prepaid: What are the maximum values of the fees that can be applied to members over 65 years of age?
In the case of people between 65 and 69 years of age, the increases will be:
- 30% for those with less than six months of service.
- 27% for one year.
- 24% for two.
- 21% for three.
- 18% for four.
- 15% for five.
- 12% for six.
- 9% for seven.
- 6% for eight.
- 3% for nine.
For people aged 70 to 74, these increases will go from 60% to 6%; and for those over that age, from 100% to 10%.
These responses are based on the information provided in resolution 2407/2023 of the Superintendency of Health Services.
Written by Carlos Gimenez, for Noticias Argentinas agency
Source: Ambito
