Prepaid and social works. Since when will free competition govern and how will it work, according to the regulations that will be made official in the next few hoursBy Silvia Stang

The option that workers may exercise to derive their mandatory salary contributions to a prepaid payment without the intermediation of a social work It will take effect from next April. Furthermore, since then, those who have a new employment relationship They should no longer be maintained for a full year in the union entity of the activity corresponding, but from the first moment they will be able to choose.

Sources from the Superintendency of Health Services told LA NACION that in the coming week the regulations will be made official of the articles of the decree of necessity and urgency (DNU) 70 referring to the subject. And there it will be established, they stated, that the free option extended to private entities will begin to govern from the first day of the second month following publication in the Official Gazette of the regulatory standard itself.

DNU 70, signed by Javier Milei a few days after assuming the presidency last December, provided the incorporation of prepaid medicine entities to the regime of law 23,660, of social works, which implies that they are enabled to receive contributions from the social security system. However, almost two months after the publication of the decree, the decision, which is highly sensitive for the unions, has not yet been put into practice.

The regulations necessary to finally implement the liberalization of the destination of contributions will finally be known while it is being developed. a new chapter in the conflictive relationship between the CGT leadership and the Government: last Thursday The meeting of the minimum, vital and mobile wage council did not come to fruition and, subsequently, Milei stated that he will not provide a new amount by decree establishing an award, as was done on other occasions during the last decades. The union’s claim was an 85% increase in the basic salary, the amount of which is frozen at $156,000 since last December.

As confirmed by the Government, when the deregulation that establishes free competition is operational, the beneficiaries will be able to choose between refer the contributions to a social work or a prepaid “that is registered for this purpose” when starting a new job, “without any type of intermediation.” And then, as is happening now but only between union entities, the right of free choice can be exercised once per year.

The free option for an entity to derive salary contributions may be made from the very beginning of an employment relationship.G-Stock Studio – Shutterstock

From the Health area they affirm that the changes “aim to end social works that are rubber stamps and that only function as black boxes of politics, because they do not provide benefits, but rather “They are only in the middle to keep some percentage.”

Sector sources consulted by LA NACION indicated that, depending on the case, the commissions charged by the intermediation are between 5% and 10%. In any case, in companies they relativize the immediate impact that the elimination of this bureaucratic step of outsourcing would have on the quotas. On the one hand, because the change occurs in the context of the sharp increases in the prices of health plans, which Only in the first quarter of the year will they accumulate between 100% and 120%. And, on the other hand, because the regulations will establish that, of the money they receive – including the excess part of the contributions and contributions – the prepaid companies must deposit 20% in the Solidarity Redistribution Fund, which is used in the social work system to cover certain high-cost medical practices and treatments.

The regulations will also define that the beneficiaries of the free option system will be “workers who provide services in a dependent relationship, whether in the private sector or in the public sector, and national retirees and pensioners.” Notwithstanding the latter and in response to LA NACION’s consultation, the Superintendency clarified that the modifications do not imply changes for those who are in the PAMI (yes, in any case, they do for retirees who are in union social works).

Marches and countermarches

The free option between social works was provided three decades ago, during the government of Carlos Menem. In 1998, a decree established the obligation to remain at least one year, from the beginning of an employment relationship, in the social work of the activity linked to employment. In 2001, another measure by the Executive Branch expanded the right to option and removed that initial permanence requirement.

In the first quarter of this year the increases in prepaid installments will accumulate up to around 120%Shutterstock – Shutterstock

But in 2021, the then president Alberto Fernández replaced it. All of this, in any case, was always without allowing direct competition from prepaid companies, which did begin decades ago to “capture” contributions from workers, but not directly, but rather through contracts signed with social works, something that adds costs to the system without contributing more or better benefits For the users.

From April there will be free option from the very beginning of an employment relationship and, according to official sources, even those who are now in their first year in a job, They will no longer have to wait for that deadline to expire.

Released prices

DNU 70 also freed the prices of private sector health plans, Therefore, the increases are no longer subject to the approval of the Health authorities, as was the case until last year. On this point, the regulations will clarify that the changes to the law regulating the activity (which is not repealed, but rather modified only in some aspects) are applicable only to voluntary members of the plans (not to those who join using the salary contributions).

It will also be ratified that the Superintendence of Health Services will not have the power to set quota values and that, in the event of bankruptcy, closure or cessation of activities of a prepaid medicine company, “the enforcement authority will not transfer health coverage with its affiliates to other providers.”

In addition to confirming that the State no longer has interference in the values ​​that prepaid companies charge their affiliates, it is confirmed that nor will it intervene with the establishment of mandatory minimum tariffs for providers of health services.

While the price regulation mechanism of the plans was in effect – according to which until 2023 increases of percentages equivalent to the increase registered by an official health cost index could be applied -, the prepaid companies had to increase the fees paid to clinics, sanatoriums or other medical centers or diagnostic practices, in a percentage of no less than 90% of the level of the increases in their own prices to affiliates.

In recent months, the crisis in the health sector began to show itself in problems with benefits Ricardo Pristupluk – Archive

Until last January, when quotas rose around 40%, the entities continued to apply the criteria described in the previous paragraph (they committed, in fact, to improving tariffs by 36%). Now, however, The tariffs are defined in individual negotiations between each financing entity and each provider, something that, according to representatives of this last sector, harms smaller effectors.

In the last times, the crisis of the private health system It manifested itself strongly in different events that affected members, with delays in assigning appointments, departure of doctors and other providers from the cards, collection of co-payments or contribution bonuses at the time of care, freezing of reimbursement amounts and new limits on certain coverages.

The release of prices came after a year in which, with a general inflation of 211.4% reported by Indec and an even greater increase in benefit costs, according to the activity’s managers, The values ​​of health plans accumulated a total increase of 137%, under a regime of regulations that, through an electoral campaign, included months of freezing quotas for members who met a series of conditions.

The strong increases that have been applied since January of this year generated several complaints in the Justiceia and there have already been several precautionary measures that order companies to refrain from collecting fees with the intended increases, although they only have effect in particular for the person who made each claim.

Silvia Stang

Themes

Business CommunityHealthCGTInflation and pricesJavier Milei

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