Regulatory Framework for Prepaid Medicine. Sanctioned: May 4, 2011 Enacted: May 16, 2011
The Senate and Chamber of Deputies of the Argentine Nation, meeting in Congress, etc., are sanctioned by law: REGULATORY FRAMEWORK FOR MEDICINE PREPAY CHAPTER I GENERAL PROVISIONS
ARTICLE 1-Object. The purpose of this law is to establish the regulatory regime for pre-paid medical firms, voluntary membership plans and super-plan or complementary plans for higher services marketed by Health Insurance Agents. (ASS) referred to in laws 23,660 and 23,661. Cooperatives and mutuals, civil associations and foundations, and union social works are excluded.
ARTICLE 2-Definition. For the purposes of this law, any natural or legal person, regardless of the type, legal figure and denomination they adopt whose object is to provide prevention, protection, or other legal person, is regarded as Prepaid Medicine Companies. treatment and rehabilitation of human health to users, through a voluntary association modality through payment systems of accession, whether in own effectors or through third parties linked or contracted to the effect, be individual or corporate procurement.
ARTICLE 3-Limitations. They cannot be held as holders, founders, directors, administrators, members of the supervisory boards, syndicates, liquidators or managers of the entities covered by this law: 1) Those affected by the inabilities and incompatibilities established by Article 264 of Law 19,550; 2) Those who are legally disabled to carry out public office; 3) Those who have been declared responsible for irregularities in the government or administration by a firm sentence of the subjects included in the article 1 of this law. CHAPTER II OF THE AUTHORITY OF APPLICATION
ARTICLE 4-Application Authority. It is the Authority of Application of this law the Ministry of
Health of the Nation. As regards the consumer relationship and the defence of competition, the implementing authorities shall be those established by laws 24.240 and 25.156 and their amendments, as appropriate.
ARTICLE 5-Objectives and Functions. They are objectives and functions of the Application Authority: (a) Enforce compliance with this law and its regulations in coordination with the health authorities of each jurisdiction; b) Create and maintain the National Register of the subjects included in the first article of this article. law and the National Register of Users, to the sole effect of being used by the public health system, as regards the application of this law, in no case should contain data that may affect the right to privacy; To determine the technical, financial solvency, management capacity, and lending conditions, as well as formal charges payable to institutions for registration in the Register provided for in the preceding paragraph, ensuring free competition and market access, in order not to prejudice the general economic interest; Audit compliance by the persons covered by Article 1 of this Law, the benefits of the Mandatory Medical Program (PMO) and any other that has been incorporated into the contract; authorization to operate the subjects included in the article 1 of this law, assessing the the characteristics of the health programmes, the antecedents and responsibilities of the applicants or members of the administrative body and the requirements laid down in point (c); (f) Authorising and supervising the models of contracts to be concluded by the subjects included in the article 1 of this law and the users in all manner of hiring and plans, in the terms of the article 8 of this law; g) Authorizing in the terms of this law and reviewing the values of the (h) the payment of the fees and their modifications to the persons referred to in Article 1 (h) of the services provided and invoiced by Public Hospitals or other national, provincial or municipal public sector effectors, according to the values established by the current regulations; (i) Implement the necessary mechanisms in each jurisdiction, to ensure the availability of up-to-date and necessary information so that individuals can consult and decide on the registered entities in the Registry, their conditions and plans of the services provided by each of the (ii) the provision of services, as well as on aspects relating to their effective enforcement; necessary mechanisms in each jurisdiction to receive claims made by users and providers of the system, referred to conditions of attention, operation of services and non-compliances; (k) Establish a categorisation system; and accreditation of the subjects covered by Article 1 of this Law as well as the establishments and suppliers of their own or contractors assessing structures, procedures and results; Affidavit to the subjects included in the article 1 of this law demographic, epidemiological, financial and economic-financial, without prejudice to the provisions of Law 19.550; m) Transfer in the event of bankruptcy, closure or cessation of activities of the subjects covered by Article 1 of this Law the health coverage with its affiliates to other registered providers in the Register that have similar coverage of health coverage and quota. The transfer shall be agreed within the framework of the Permanent Council of Concertation defined in Article 27 of this Law and shall be carried out in accordance with criteria of proportional distribution according to actuarial calculation,
ARTICLE 6-Permanent Commission. Create as an organ of articulation of the functions set forth in this law a Permanent Commission that will be constituted by three (3) representatives of the Ministry of Health and three (3) of the Ministry of Economy and Public Finance. CHAPTER III OF THE BENEFITS
ARTICLE 7-Obligation. The subjects included in the article 1 of this law should cover, as a minimum in their plans for medical care coverage, the Mandatory Medical Program in force according to the Resolution of the Ministry of Health of the Nation and the System of Basic Benefits for Persons with Disabilities provided for in Law 24,901 and its modifications. The persons covered by Article 1 of this Law may only offer partial coverage plans in: (a) dental services exclusively; (b) Medical emergency services and medical transfers of persons; (c) Those who are develop their activity in a single and determined locality, with a user register of less than five thousand. The Application Authority may propose new partial coverage plans on a proposal from the Standing Committee provided for in Article 6 of this Law. All partial coverage plans should be in line with the requirements of the Application Authority. In all medical-care coverage plans and in partial coverage, the information to the users must clearly explain the benefits that it covers and those that are not included. In all cases, the prescription of medicinal products must be carried out in accordance with Law 25,649. CHAPTER IV OF THE CONTRACTS
ARTICLE 8-Models. The subjects covered by Article 1 of this Law may only use models of contracts previously approved by the Application Authority.
ARTICLE 9-Termination. Users may at any time terminate the contract concluded, without limitation and without penalty, and must notify this decision to the other party with thirty (30) days in advance. The subjects included in the first article of this law can only terminate the contract with the user when he incurs at least three (3) consecutive fees or when the user has distorted the affidavit. In the event of non-payment, after the default established and prior to the termination, the subjects included in the article 1 of this law must communicate in a feisty form to the user the constitution in arrears intimated to the regularisation within the term of ten (10) days.
ARTICLE 10. -Shortcomings and Jurada Declaration. Contracts between the subjects included in the article 1 of this law and the users may not include periods of absence or wait for all those benefits that are included in the Mandatory Medical Program. The other loan arrangements and the time provided for in the contract as a period of absence should be sufficiently explicit in the contract and approved by the Application Authority. Preexisting diseases can only be established from the user's affidavit and cannot be the criterion of user rejection. The Authority shall authorise
duly justified differential values for the admission of users presenting pre-existing diseases, in accordance with the rules laid down by the Regulation.
ARTICLE 11. -Adverse Admission. Age cannot be taken as a criterion for refusal of admission.
ARTICLE 12. -People Over 65 Years Old. In the case of persons over sixty-five (65) years, the Application Authority must define the percentages of increased risk costs for the different age ranges. For users older than sixty-five (65) years older than ten (10) years in one of the subjects covered by Article 1 of this Law, they cannot be applied for the increase by reason of their age.
ARTICLE 13. -Death of the Holder. The death of the owner does not imply the expiration of the rights of his family group members of the contract.
ARTICLE 14. -Family Group coverage. (a) The primary family group shall be composed of the spouse of the titular member, the unmarried children up to the age of 21 (21) years, not emancipated by age or professional activity, commercial or employment, the children single persons over 21 years of age and up to and including twenty-five (25) years, who are at the sole expense of the titular member who is the subject of regular studies officially recognised by the relevant authority, the disabled children and Member of the family, older than twenty-one (21) years, the children of the spouse, the children whose guardian and protection has been agreed by judicial or administrative authority, meeting the requirements laid down in this subparagraph; (b) The person living with the affiliated member in fact, whether or not he is a different sex and his children, according to the accreditation to determine the rules. The benefits will not be limited in any case for pre-existing conditions or for periods of absence, nor can they give rise to differentiated quotas.
ARTICLE 15. -Corporate Recruitment. The user who is a member of group or corporate contracting that has ceased his employment relationship or bond with the company that made the contract with one of the subjects included in the article 1 of this law has the right to continuity with their seniority recognized in any of the plans of one of the subjects included in the article 1 of this law, if requested within sixty (60) days from the end of their employment relationship or bond with the company or corporate entity in which he performed. The subject covered by Article 1 of this Law must maintain the provision of the Plan until the expiration of the period of sixty (60) days.
ARTICLE 16. -Contracts In Force. The entry into force of this Regulation cannot create any kind of prejudice to the situation of users with existing contracts.
ARTICLE 17. -Quotas of Plans. The Application Authority shall monitor and ensure the reasonableness of the contributions of the loan plans. The Application Authority shall authorize the increase of the quotas when the same is founded on variations of the cost structure and reasonable actuarial calculation of risks. The subjects included in the article 1 of this law can establish differential prices
for the loan plans, at the time of their recruitment, according to age groups with a maximum variation of three (3) times between the price of the first and the last age group. CHAPTER V OF PROVIDERS
ARTICLE 18. -Tariffs. The Enforcement Authority should set the mandatory minimum tariffs to ensure the efficient performance of public and private providers. The lack of compliance with tariffs or the default on the payment to the providers makes the subjects included in the article 1 of this law of the penalties provided for in article 24 of the present.
ARTICLE 19. -Contract Models. The models of contracts between the subjects covered by Article 1 of this Law and the providers should be adapted to the models established by the Application Authority. CHAPTER VI OF THE OBLIGATIONS
ARTICLE 20. -Public Hospitals. Although I do not measure prior agreement, the subjects covered by Article 1 of this Law must pay to the public hospital or other national, provincial or municipal public sector effectors, and those of Social Security, the benefits and billed, according to the values established by the Superintendence of Health Services for Health Insurance Agents. They must have the corresponding validation in accordance with the rules laid down in the rules. It is expressly excepted from prior authorization or validation, the situations of urgency or health emergency of the users, in which the patient's attention will be taken, having a period of three (3) days for later validation. In the event of a controversial rejection of a benefit by a public hospital or other effector, the intervention of the Application Authority may be required.
ARTICLE 21. -Minimum Capital. Prepay Medicine Companies that act as health care coverage entities should constitute and maintain a Minimum Capital, which is set by the Application Authority. The Health Insurance Agents referred to in Article 1 of this Law are governed, in this respect, by the resolutions emanating from the Application Authority.
ARTICLE 22. -Heritage and Accounting Information. Health Insurance Agents who place on the market voluntary membership plans or superators or supplementary plans for higher services should carry a differentiated system of patrimonial and accounting records for the purposes of audit and control of contributions, contributions and other resources provided for by laws 23,660 and 23,661.
ARTICLE 23. -Accession Plans and Solidarity Fund for Redistribution. For voluntary membership plans or supplementary or supplementary plans for higher services marketed by the Health Insurance Agents, no contributions will be made to the Solidarity Fund for Redistribution, nor will they receive any refund or other type of payment. contributions from the Administration of Special Programs. CHAPTER VII
OF THE SANTIONS
ARTICLE 24. -Sanctions. Any infringement of this law shall be sanctioned by the Application Authority in accordance with the following: (a) Receipt; (b) Multa whose minimum value is equivalent to the three-quota value which the infringer places on the market and the maximum value shall not be exceed 30% (30%) of the turnover of the previous year; (c) Cancellation of the registration in the Register. This sanction can only be applied, in case of extreme gravity and recidivism. For the purposes of substantiation of the summary, law 19,549 of administrative procedures shall apply. Every sanction can be appealed to the National Appeals Chamber, in the Contentious Federal Administrative Board. The action must be brought and founded within ten (10) working days of the notified body to the authority issuing the decision, who shall forward the proceedings to the competent court without further processing. Without prejudice to the penalty imposed, the subject must provide the required supply as a matter of urgency. CHAPTER VIII OF THE FINANCIAL
ARTICLE 25. -Resources. The resources of the Ministry of Health in relation to this law are constituted by: (a) An annual tuition paid by each entity, the amount of which shall be set by the regulations; (b) The fines paid by the persons covered by the article 1 of this law to the Application Authority; c) The donations, legacies and allowances received; d) Any other income compatible with its nature and purposes. CHAPTER IX SPECIAL PROVISIONS
ARTICLE 26. -Right of Users. Without prejudice to other implementing rules, users enjoy the following rights: (a) the right to emergency services: users are entitled, in case of doubt, to receive emergency benefits; (b) Right to equivalence: users have the right to an adequate equivalence of the quality of the services contracted during the entire relationship; contract.
ARTICLE 27. -As a consultative body, a Permanent Council of Concertation, integrated ad honoem by representatives of the Ministry of Health, of the Law Enforcement Authority 24,240, of the subjects covered by the article 1 of this Law, the users and representative entities of the providers at the national or provincial level or the Autonomous City of Buenos Aires. The Ministry of Health shall dictate the rules of operation of the said council.
ARTICLE 28. -Public Order. This law is of public order, governed throughout the national territory and will take effect from its publication in the Official Gazette.
ARTICLE 29. -Regulations. The Executive Branch must regulate this law within one hundred and twenty (120) days from its publication.
ARTICLE 30. -The subjects included in the article 1 of this law shall have a period of one hundred and eighty (180) days from the publication of the present for adaptation to the present normative framework.
ARTICLE 31. -Contact the national executive branch. GIVEN IN THE SESSION HALL OF THE ARGENTINE CONGRESS, IN BUENOS AIRES, ON THE FOURTH DAY OF MAY OF THE YEAR TWO THOUSAND ELEVEN. -REGISTERED UNDER NO. 26,682-JULY C. C. COBOS. -EDUARDO A. FELLNER. -Enrique Hidalgo. -Juan H. Estrada.
Date of publication: 17/05/2011