With Decree 743 published on 6 November 2022 in the Official Gazette, it was established that prepaid healthcare institutions must offer mandatory coverage plans priced at –at least– 25% less than the usual plan. The detail in this new scheme is inclusion quotas on first and second level services.
In this way, those with a lower usage rate are given the opportunity to access a cheaper plan.
According to the provisions of the Superintendency of Health Services in Resolution 2 – on the provision of the Ministry of Health of the Nation with Resolution 1, published this Tuesday in the Official Gazette – subjects registered in the National Register of Prepaid Healthcare Entities (RNEMP) must present, for verification and registration, the plans with the compensation offered and, together with the projects, they must submit the tariff tables with details of the investment values for each benefit included. These co-payments must fall within a defined range and cannot be applied until they have been verified by the Superintendence of Health Services.
Subjects enrolled in the RNEMP can only collect fees or co-insurance for the following first and second level assistance services:
tier-one benefits
- Medical consultations
- Psychology
- laboratory practices
- Diagnostic-therapeutic tests
- Kinesio Physiatric Practices
- Speech therapy/phoniatrics practices
- Home care (green and yellow codes)
- Dentistry.
Second tier benefits
- Computed tomography (CT)
- Nuclear Magnetic Resonance (NMR)
- Radio immunoassay (RIA)
- Biomolecular and genetic laboratory
- Nuclear medicine
- Imaging studies that require prior preparation and/or the use of contrast medium
- Diagnostic/therapeutic endoscopic practices, excluding neurosurgical and cardiovascular ones, in all its modalities, both central and peripheral.
The resolution also establishes that the following are exempt from the collection of tickets:
- Pregnant women, girls and boys up to 3 years (Law n. 27.611)
- Cancer patients, transplant recipients and people with disabilities, in accordance with the regulations applicable in each case
- preventative programs
- Practices and emergency intervention
- And all those cases that are excluded or could be excluded in the future due to the application of specific coverage rules.
To that end, prepaid medical entities must complete and generatefor each of the global coverage plans marketed to the public, the affidavit form for registration of full coverage plans with co-paymentwhich will be available on the institutional website of the Superintendence of Health Services, which will publish the lists of informed contributions.
NS
Source: Clarin
