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Government gives free rein to companies to set co-payment amounts

Government gives free rein to companies to set co-payment amounts
Government gives free rein to companies to set co-payment amounts

The cost of co-payments must be informed at the time of affiliation and their variation must also be reported 30 days in advance. However, there are benefits that were exempt.

Through Resolution 1926/2024 of the Ministry of Health, the Government made official the elimination of co-payments and limits for Health Insurance Agents and Prepaid Medicine Entities.

The measure eliminates co-payments for all health services covered by the Mandatory Medical Program (PMO) and its complementary regulations, with the exception of those listed in the Annex to the resolution.

Likewise, the official text highlights, The measure allows entities to freely set co-payments: “Health Insurance Agents and Prepaid Medicine Entities can now freely set co-payments for services that are not exempt.”

It also demands transparency: Entities are obliged to clearly inform beneficiaries and users about the co-payments associated with each medical service.both at the time of registration and in the event of any change during the registration period.

In this way, patients will no longer have to pay additional co-payments for most health services covered by the Mandatory Medical Program (PMO). ANDThis includes services such as doctor visits, diagnostic tests, and treatments. On the other hand, health entities, such as social and prepaid works, They may freely set the prices of co-payments for services. This means that co-payment prices could vary between different entities.

For this reason, it is timely, it is important that patients inform themselves about co-payments before using a health service. Health entities are required to clearly inform patients about the co-payments associated with each service.

Exempt services

  • Cervical cancer and breast cancer.
  • Preventive dentistry.
  • Sexual and reproductive health (Law No. 25,673).
  • Oncological treatments.
  • Services for people with disabilities.
  • Medical emergencies and code red.
  • Nursing practices.
  • 1000 Days Law: comprehensive health care during pregnancy and early childhood.
  • National Law of Comprehensive Response to HIV, viral hepatitis, other sexually transmitted infections and tuberculosis.
  • Comprehensive Protection System for Transplanted People (Law 26,928).
  • Organ, Tissue and Cell Transplant Law (Law 27,447).
  • Maternal and child plan: coverage during pregnancy and childbirth, from diagnosis to the first postnatal month.
  • Care of newborns up to one year of age.

All these services have 100% coverage both in hospitalization and in outpatient consultations.and are exempt from paying coinsurance for specific care and medications.

Source: Ambito

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