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The Government established that prepaid health insurance companies will have to contribute, like social works, to the Solidarity Redistribution Fund

The Government has ordered that Prepaid medical companies must contribute in the same proportion as social works to the Solidarity Redistribution Fundthrough Decree 600/2024 published this Wednesday in the Official Gazette.

The Executive’s decision implies the unification of the percentage of contributions and contributions that all entities that offer health coverage must make to the Solidarity Redistribution Fund at 15%, which until now for prepaid health insurance companies was stipulated at 20%.

Besides, Article 19 bis of Law 23,660, which provided for an additional contribution of 20% to the Fund when entities received income in addition to the original contributions, was repealed.

The regulation justified the measure based on the fact that all entities participating in the Fund “receive 100% of the benefits and resources generated by said fund”, but “a discrepancy was revealed in the extent to which these entities do not integrate the total of their perceptions, generating imbalances and contradicting the principles of equity”.

Before this panorama, The Government considered it necessary to raise “the need to correct this dissonance to ensure fair and equitable participation of all entities for the benefit of strengthening the aforementioned Solidarity Redistribution Fund.”

In this regard, the official text states that “the proposed simplification seeks not only to improve the efficiency of tax collection, but also to promote equal conditions for all entities, regardless of the characteristics of the remunerations or the percentage of contributions.”

Continuing along these lines, he said that “the proposed modification simplifies the system of contributions and eliminates disparities related to gross monthly salaries, guaranteeing greater transparency and equity.”

The legislation also clarified the conditions under which health entities can offer superior plans, “thereby strengthening the system’s capacity to adapt to the changing needs of society.”

In this way, entities must include “at least, in their medical assistance coverage plans, the current Mandatory Medical Program” and the ‘Basic Benefits System for Comprehensive Enabling and Rehabilitation for People with Disabilities’.

In addition, agents “may request payment of a fee and take into account mandatory contributions and contributions to offer their beneficiaries superior plans,” while it was determined that “when, for any reason, the contracting of the plan ends, the beneficiary may choose any other Insurance Agent without time limitation.”

At the same time, the decree also modified the scope of the actions of Health Insurance Agents, establishing that they may not:

  • Make membership conditional on compliance with any requirement not provided for in the law or its regulations;
  • Make any discrimination in accessing mandatory basic coverage;
  • Take a psycho-physical examination or equivalent, whatever its nature, as a requirement for admission;
  • Establish grace periods
  • Unilaterally decide without cause to terminate the membership.

The Executive stated that “these changes will allow Prepaid Health Insurance Companies to speed up the registration process in the National Registry of Insurance Agents (RNAS) since, in this way, they will be able to receive contributions without intermediaries” and stressed that “this is another step to put an end, once and for all, to the famous ‘intermediations’.”

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According to the BO, the Decree proposes modifications to improve the equity and efficiency of the system of contributions to the FSR.

Other provisions

  • Social works are prohibited from discriminating against members when admitting or deregistering them.
  • It is established that social works cannot require medical examinations as a requirement for admission.
  • It is clarified that the rules on affiliation and cancellation do not apply to prepaid medical entities that offer superior plans.

Source: Ambito

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