Saturday, February 4, 2023

Will not be able to collect co-pays without authorization from Prepaid Health

The Ministry of Health announced the conditions for the collection of coins and the corresponding rate chart. Who will be exempt?

for iProfessional

11/01/2023 – 18,35 hours

Will Not Be Able To Collect Co-Pays Without Authorization From Prepaid Health

The superintendence of health services (SSS) this Wednesday established conditions for prepaid drug companies to collect co-payments or co-insurance, Also practices and patients are exempted. The measure was ordered by Resolution 2/2023 in compliance with instructions issued by Resolution 1/2023 of the Ministry of Health (both published in the Official Gazette).

Rules oblige entities registered with the National Registry of Prepaid Medicine Entities (RNEMP) to submit for verification and registration, Plans with co-pays are offered and, with them, include rate charts detailing co-pay values ​​for each benefit.

“These reimbursements should be within a defined range And they cannot be implemented unless they have the verification of the superintendent of health services,” said the body in charge of Carla Vizzotti in a statement.

Prepaid: When will they be able to collect the co-payment?

Vale clarifies that co-pays or co-insurance may only be charged for certain Tier 1 and Tier 2 services.

  • among the first, medical consultations appear; Psychology; laboratory exercises, clinical-therapeutic tests; kinesio-physiotric exercises; speech therapy/phoniatric practice; Home care (green and yellow codes) and dentistry.
  • second tier profit Computerized axial tomography (CT) is accessed by standard; nuclear magnetic resonance (NMR); radio immunoassay (RIE); Biomolecular, genetic laboratory; nuclear Medicine; Imaging studies that require prior preparation and/or the use of contrast medium; Diagnostic/therapeutic endoscopic practice, in all its modalities, whether central or peripheral, except those neurosurgical and cardiovascular.
Source: Telam

Source: Telam.

Who is exempted from collection of co-payment?

The published resolution exempts from the collection of co-payment:

  • pregnant people
  • Girls and boys up to three years old (Law No. 27,611)
  • Cancer Patient
  • transplanted
  • people with disabilities

for this work, Prepaid medical institutions must complete and generate dues for each comprehensive coverage plan they market to the general public.Affidavit form for registration of comprehensive coverage plans with co-payments, which will be available on the institutional website of the superintendence of health services, which will publish the list of reported co-payments.

In the lessons of the resolution of the SSS It is recalled that Decree 743/2022 has set a maximum limit until February 1, 2023 and for an authorized increase in the value of installments of prepaid drug contracts payable by contracting parties with a net income of less than six minimum, significant and mobile wages, for a period of 18 months, to a wage indexation equal to 90% of the taxable. Average of fixed workers (rept) published exactly last month.

In this episode, it should be noted thatPrepaid associates earning less than six minimum wages (Approximately $371,718) A form has to be filled out in February to reduce the fee increase. This innovation arises after the government prescribed a new mechanism for updating the prices of such services, which considers the income of the entire household group while updating the amounts.

Till December 2022, the value of the monthly prepaid installments was updated based on the Health Cost Index. However, repeated increases made it necessary to revise the value addition method.

Nation World News Desk
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