The possibility of transferring contributions to a social work or to a prepaid card that workers choose from the beginning of the employment relationship remains unchanged, as announced by the presidential spokesperson, Manuel Adorni. several questions which is expected to be clarified and specified with the DNU 70/2023 legislation.
The first is yes it will be mandatory or not for prepaid companies to act as social works. The point is fundamental because the “business plan” would change of the private medical company, now focused on older, high-income members.
Secondly, to make this decision, the legislation must clarify whether with 9% of the salary (3% of the worker and 6% of the employer) in the case of workers with an employment relationship, the advance payments must guarantee a global and supportive coverage.
Currently, a worker earning $300,000 or $600,000 has the same medical coverage as the social service on the basis of a card that includes clinics, sanatoriums, laboratories, doctors and pharmacies with discounts that may vary depending on the social service.
In the case of single-tax payers, the contribution to the social service is a fixed sum according to the categories. Among the lowest categories the contribution is $6,457 per month.
Of the 9% of the gross salary that goes to social work as a contribution, 15% goes to them Solidarity Fund for redistribution finance “the reimbursement of services with a high economic impact and which require coverage over a long period of time, in order to ensure the granting of equal health services, guaranteeing beneficiaries the obtainment of the same type and level of services”. Furthermore, it is responsible for subsidizing the poorest social works so that they can comply with the Compulsory Medical Program (PMO).
The transfer of contributions from a social work – after one year of belonging to the original social work – to a prepaid one has been in force for several years. This is the case with many smaller social works They have deals with prepaid companies. That is, it is not a direct affiliation but an indirect one through the intermediation of a social work, generally small social works, which receive a commission through this intermediation. With direct affiliation, these small social works would tend to disappear. But I wouldn’t add more members to the prepaid ones because most of the workers are already paid high income They are affiliated with private medicine through the collection of compulsory contributions, which has been called the “skimming” of the system. And low-income affiliates they wouldn’t be “profitable” for prepaid ones given the high costs and fees of private medicine.
Currently, advance payments received by social service members contribute to Redistribution Fund 20% of the contribution goes to social work. And they don’t contribute the excess amount to that Fund. According to the presidential spokesperson, the contribution to the Fund would be 20% on all contributions.
In these cases, the employee’s mandatory net contribution goes to the prepaid plan and, depending on the medical plan chosen, the enrollee must cover the difference between that net contribution and the cost of the plan. On average, an individual health plan exceeds $100,000, a figure that doubles for a family group, when for a salary of $600,000 the net contribution could be around $42,000.
That’s why prepaid companies that want to act as social works They want to know if they will be able to have universal coverage plans for low-income memberswith the collection or not of copayments, with lists of doctors, clinics and discounts on the purchase of drugs that are differential, lower, compared to members with higher incomes.
According to specialist Rafael Martinez, “for prepaid medicine companies, which will be part of the same healthcare system as social works, the 9% ceiling in the collection of monthly fees from their members would not apply, since the obligation they have to request authorization from the Superintendency of Health Services to increase prices”.
All these points and many others will have to be specified in the rules which can be challenged judicially by social works of trade union origin.
Source: Clarin
