The terms under which companies will collect co-payments or co-insurance are established, as well as the practices and patients who are exempt. “They cannot be implemented unless they have attestation from the superintendent of health services,” the ministry said.
superintendent of health services (SSS) established Conditions for prepaid drug companies to collect co-pays or co-insuranceAs well as the discounts that have been given to practices and patients.
The measure was ordered through Resolution 2/2023 in compliance with the instructions issued by Resolution 1/2023 of the Ministry of Health, both published in the Official Gazette today.
Entities registered with the National Registry of Prepaid Medicine Entities (Rnemp) must submit plans with co-pays submitted for verification and registration and, with them, fee schedules with details of co-pay values. each benefit. Involved
“These co-payments should be within a defined limit and cannot be implemented unless they are verified by the superintendent of health services,” the ministry said in a statement.
Co-pay or co-insurance may be charged for certain first and second level care services only:
- First, there are medical consultations; Psychology; laboratory exercises, clinical-therapeutic tests; kinesio-physiotric exercises; speech therapy/phoniatric practice; Home care (green and yellow codes) and dentistry.
- The second level of benefits achieved by the standard are computerized axial tomography (CT); nuclear magnetic resonance (NMR); radio immunoassay (RIE); Biomolecular, genetic laboratory; nuclear Medicine; Imaging studies that require prior preparation and/or the use of contrast media; Diagnostic/therapeutic endoscopic practice, in all its modalities, whether central or peripheral, except those neurosurgical and cardiovascular.
Exemption from collection of coinsurance or copayments
The resolution also establishes that the following are exempt from the collection of the co-payment: pregnant persons, boys and girls up to the age of three (Law No. 27,611); cancer patients, transplant recipients and people with disabilities in accordance with the rules applicable in each case; preventive programs; emergency practices and benefits and all cases that are excluded or may be excluded in future by application of specific coverage regulations.
For this purpose, Prepaid medical entities must meet and generateFor each of the comprehensive coverage plans marketed to the general public, Affidavit Form for Registration of Comprehensive Coverage Plans with Co-paymentWhich will be available on the institutional website of the Superintendent of Health Services, which will publish the list of reported co-payments.
In the lessons of the SSS resolution, it is recalled that Decree 743/2022 set a maximum limit, February 1, 2023 and for a period of 18 monthsFor an authorized increase in the value of installments of prepaid drug contracts outstanding by the contracting parties whose net income is less than six minimum, vital and mobile wages equal to 90% of the average taxable wage index of stationary workers. (Repte) published in the month immediately preceding.
As the net income of the contracting parties amounts to an amount that varies from month to month for most of them, “it is pertinent to regulate the manner in which the above limit should be verified and applied,” it said. .
The Ministry of Health established the Compulsory Medical Program in 2002. (PMO), which laid down essential basic benefits to be guaranteed to health insurance agents and prepaid medicine entities.
In this PMO, the coinsurance that health insurance agents and prepaid medicine entities receive for certain medical practices was established along with their respective costs.
In view of the lack of updating of established coinsurance values, in 2017 the amount of required fees was revised and their automatic updating was provided in the same terms and percentages established for minimum, critical and mobile pay.
Already in 2022, Decree 743 provided that prepaid companies must offer on January 1 “identical coverage plans that they currently have without co-pays, including co-pays on the first and second level benefits” is (at a cost of at least 25%) less than the plan without co-pays”.