A year ago, the Supreme Court found that Isapres cannot charge a fee based on the table of factors for children under two years of age, since in this age group health insurance is defined by the Explicit Health Guarantees (GES) as defined by the then highest court decided to declare increases in private health insurance void. It was a decision that is part of the decision by factor table and awaits implementation once the short bill submitted by the administration on the issue reaches agreement in Congress.
However, pending a solution to this issue, the Isapre Esencial has already announced measures on the matter.
The private health insurer, part of the Chilean German Welfare Company, which controls the Clínica Alemana, recently reported that it had decided to “suspend the payment of the health insurance plan for unborn children and children under two years of age until they reach the said age.” .” from January 2024 and that the suspension value will appear in the month of February, as the measure affects salaries for the first month of the year, as reported in a communication to its clients.
The company explained that the decision was taken based on the fact that it wanted to provide certainty following the uncertainty that surrounded the sector following the Supreme Court ruling. “(In) the various interactions with our customers (we see) that the discussions that have been going on for more than a year around the table of factors and their impact on children under two years of age have led to confusion and uncertainty for us .” Beneficiaries,” commented Isapre, which began operating on the market in April last year.
“We confirm the seriousness with which we have planned this action and have informed the regulatory authorities, in particular the Superintendency of Health, in a timely manner to ensure that it complies with the Health Contract Regulations.” Likewise, we will pay attention to everyone “To make adjustments as indicated to us under the Short Law or other regulations,” Esencial added.
According to the company, the measure will affect around 6% of customers in the future, including those who join isapre.
“The suspension affects the collection of the health insurance plan of all beneficiaries under the age of two. The collection remains suspended as long as the beneficiary is in the specified age group,” the company reiterated.
With regard to the form and deadlines, the isapre explained that the member does not have to carry out any administrative actions and that it is his responsibility to communicate the change to the employers if necessary.
In the statement, isapre also explained that it is prepared in the event of possible returns required by the short law: “We have taken all safety precautions so that in the event of a possible return we can fully comply with what the authority orders.”