SOCIAL ARTWORKS

Decree 576/93

Regulation of the Social Works System and the National Health Insurance System.

Bs. As., 1/4/93

I look at the Nros Laws. 23.660 and 23.661 and Nros Decrees. 358/90, 359/90 and 9/93, and

CONSIDERING:

Decrees No. 358 and 359/90 respectively regulated the Social Works Acts (23.660) and National Health Insurance Acts (23.661).

That, subsequently, Decree No. 9/93 is issued in line with deregulation policies aimed at the optimization of the efficiency of the care services provided by social works, attentive to their basic social function.

That through this regulation the freedom of choice of the participant is promoted, the greater competition between social works and the control of their functioning by the beneficiaries themselves.

That the above is complemented by the proper regulation of state control of social works as agents of the National Health Insurance System.

To systematize the contributions to the Social Works in general and to the solidarity fund of Redistribution in particular.

It is also appropriate to identify unified mechanisms for collecting information, registration and membership.

That, in addition, complementary guidelines were established for the National Health Insurance System and the operation of the NATIONAL ADMINISTRATION OF THE HEALTH FOLLOW-UP (ANSSAL).

That, therefore, it is up to the replacement of the regulations in a timely manner approved, replacing it by which it is approved by this Decree.

That the General Directorate of Humanitarian Affairs of the Ministry of Health and SOCIAL has taken the intervention of its competence.

That the present is dictated in the use of the emerging powers of article 86, paragraph (2) of the NATIONAL CONSTITUTION.

Therefore,

THE PRESIDENT OF THE ARGENTINA NATION

RIGHT:

Article 1 . Approve the regulation of the Social Works system and the National Health Insurance System, which, as Annexes I and II respectively, is part of this Decree.

Art. 2o . Destroy the Nros Decrees. 358 and 359/90.

Art. 3o . Communicate, publish, give to the National Directorate of the Official Register and archvese. . MENEM. . Julio C. Aráoz.

Annex I

LAW REGLAMENT 23,660

ARTICLE 1 . Includes all of the social works registered under the law of Law 22,269, regardless of their origin and nature and those authorized as a result of the legislation in force.

(a) The social works included in this paragraph are those that had their union origin, were recognized by Law 18.610, continued to be incorporated into the system under the conditions laid down by Law 22.269 and inserted into the regime of Law 23.660 and fulfilled the provisions of Articles 2, 7 and 11 and concordants of it.

(b) It is understood by institutes of mixed administration to those who were characterized as such by their Laws of Creation, those that maintain their validity, with their subsequent modifications and those detailed in Articles 37, 38, 39 and 40 of Law 23,660.

The other entities established by the Act which, because of their main object, are covered by the regulation, shall be in conformity with the requirements of Act No. 23,660.

(c) Unregulated

(d) Unregulated

(e) The social works of the management staff and those of the professional associations of entrepreneurs registered under the law of Law 22,269, which have been operational at the time of the entry into force of Law 23,660, will continue to carry out their activities in accordance with their statutes and functioning to the provisions of the Act, this regulation and the provisions of the DINOS.

(f) The continuation of social works constituted by agreement with private or public enterprises shall be subject to what the parties agree. In the event of a decision on their continuity, they must adapt their operation to the provisions of laws 23.660, 23.661 and this regulation.

(g) DINOS shall establish the requirements to be fulfilled by the entities covered by Article 1 (g) to be incorporated into the law of Law 23,660.

(h) The DINOS shall establish the requirements to be fulfilled by the entities covered by article 1 (h) to be incorporated into the Act No. 23,660.

ARTICLE 2 . Whatever the origin and legal nature of social works, they are subjects of law and obligations with total separation and independence from another legal person. The implementing authority shall provide rules for the clear designation of social works without the possibility of confusion with other legal entities or associations.

ARTICLE 3 s The "other social benefits" that social works must be granted are those not covered by the medical care coverage regulated by articles 25, 26, 27, 28 and concordants of Law 23.661. The National Directorate of Social Works shall establish the rules and priorities under which "other social benefits" should be provided, the financing of which should be covered by the surplus of resources that are primarily required to be used for the benefits of health-care services and administrative expenses.

The social works will present to the DINOS the programmes of other social benefits that provide their beneficiaries with the cost and specifying the origin of the resources to attend to it.

DINOS may approve or reject, in whole or in part, the proposals if the expected funding affects the resources to be allocated for the benefits of health services and administrative expenses, thereby violating the percentage set out in Articles 5 and 22 of Law 23.660.

The quality of natural agents of the National Health Insurance System which the Law recognizes to the Social Works, preserving their legal individuality, implies that they must guarantee their beneficiaries in the terms of Article 7 of Law 23.660, the provision of health services in accordance with the rules, provisions and requirements established by the Health Secretariat and the ANSSAL.

ARTICLE 4o . Unregulated.

ARTICLE 5o de Gross resources referred to in this Article include those who perceive social works for any concept, excluding:

(a) The amounts included in the performance of donations charges in respect of health-care benefits.

(b) The amounts from financial support granted.

(c) The amounts from the benefits of other social services.

Faccinate the DINOS to establish and enforce, in the term and in the conditions stipulated, the mechanism that guarantees the implementation of the provisions of the 2nd. Article 5 of Law 23,660, as well as to resolve any interpretations and/or doubts that may arise.

ARTICLE 6 . Unregulated.

ARTICLE 7o s Sanctions for the breach of the obligations referred to in the Article shall be processed and applied in accordance with the provisions of Law 23,661 and its regulation, without prejudice to the personal and solidarity responsibility of the members of the governing bodies, in the terms of Article 13.

ARTICLE 8 . Social works shall be obliged to admit the affiliation of any beneficiary of those covered by Article 8 of Law 23.660 and the other beneficiaries of the national health insurance system included in Article 5 of Law 23.661 up to the maximum of 20% of the total membership in this first stage. The incumbent beneficiaries have in all cases the option of giving up the corresponding social work. No beneficiary may be affiliated with more than one social work or insurance agent either as a beneficiary or not a holder.

The mandatory percentage of acceptance may be modified by Resolution of the Ministry of Health and Social Action.

The National Institute of Social Services for Retired and Pensioned Persons will receive only those who are in charge of their current legislation.

Any retiree or pensioner may choose between the National Institute of Social Services for Jubilee and Pensionees and any other social work.

If you are registered with the National Institute of Social Services for Retired and Pensioned and in another social work, you must choose a social work.

ARTICLE 9o . The subjects mentioned in Article 9 (a) and (b) of Law 23.660 enter the system as non-holder beneficiaries.

Social works are obliged to admit the affiliation of the beneficiaries and adherents together with that of the beneficiary in accordance with this regulation.

The status of the non-holder beneficiary shall be maintained as long as it is not appropriate to be the holder beneficiary. Marriages in which both spouses are beneficiaries, holders may join a single insurance agent, accruing their contributions and contributions.

Non-title beneficiaries shall enjoy the benefits recognized to the beneficiary from the time they credit such a character and, where appropriate, the other conditions set out in subparagraph (a), as set out by the DINOS. The persons specified in subparagraph (b) shall acquire the same recognized right to the beneficiary when they meet the requirements of the DINOS.

The DINOS will determine the precautions to be observed by the Social Works to enable the entry of other ascendants and descendants for the consanguinity of the beneficiary. To enter the System the adherents must pay the value of the corresponding module.

ARTICLE 10. La The application authority determines the criterion to be followed in each of the cases provided for in this article.

ARTICLE 11. . The DINOS drafts a model of type of status with the minimum conditions to which the statutes of social works should be adapted within the time period specified by the Directorate. The statutes should provide for the participation of beneficiaries in the administration of social work.

ARTICLE 12. Unregulated.

ARTICLE 13. . Persons who, in accordance with Article 12 of Law 23.660, are appointed to direct and administer social works, must previously provide the DINOS with the following documentation.

(a) Accreditation of the royal residence.

(b) Negative certificate of general inhibition of property issued by the Register of Property with jurisdiction in the address of the person concerned.

(c) Negative certificate of the National Register of Repetition and Criminal Statistics.

(d) Affidavit detailing the goods that make up your heritage at the date of submission, in closed and signed envelope.

ARTICLE 14. . The DINOS and ANSSAL will facilitate the creation of associations of social works. To this end they will exchange criteria with the conductions of the various social works involved, for the purpose of demonstrating the reasons of territorial, operational and financial character that justify the birth of the association.

ARTICLE 15. Unregulated.

ARTICLE 16. Los The contributions and contributions that, by legal necessity, are made on the basis of the remuneration of the worker in favor of the health system, belong to him and can be disposed of for the free choice of the insurance agent, as they are part of his deferred and solidarity salary.

Workers and employers, individually or collectively, may agree with each other or with the respective insurance agent an additional contribution.

Social works may receive additional voluntary contributions and contributions.

ARTICLE 17. Unregulated.

ARTICLE 18. . Please note that the provisions of the third and fourth paragraphs of Article 18 of the Law are limited to reduced working days.

ARTICLE 19. . When a beneficiary chooses another social work, the social work of origin transfer to the Solidarity Fund the corresponding proportion to the beneficiary of the resources included in Article 16 last paragraph of Law 23.660, excluding legacies and donations, through the procedures and mechanisms established by the implementing authority.

ARTICLE 20. . The liquidating entity of the foreseeable assets shall transfer to the appropriate insurance agent, of the foreseeable assets, the resources belonging to the beneficiaries of Article 8 (b) and (c), within fifteen (15) days after each expired month.

When the participant chooses a Insurance Agent other than the National Institute for Social Services for Retired and Pensioned, the latter shall transfer, in the same time, the amount equivalent to the cost of the Special Medical Care Scheme module for liabilities, which is guaranteed to all passive beneficiaries, which will be approved by the Ministry of Health and Social Action.

Until the special module for passive beneficiaries is approved by the implementing authority, INSSJP will transfer to the chosen Social Works, the amount of $ 20.- for each beneficiary.

Based on the validity of the special health care package for liabilities, its value will be determined by joint resolution between the Ministry of Health and Social Action and the Ministry of Economy and Public Works and Services; at least the cost of the module to be determined by the first.

ARTICLE 21. El The control and verification regime will be governed by the existing rules for SUSS, DINOS and ANSSAL.

ARTICLE 22. Unregulated.

ARTICLE 23. Unregulated.

ARTICLE 24. . Facultase the DINOS to establish the requirements to be met by the debt certificates for submission.

ARTICLE 25. Unregulated.

ARTICLE 26. Unregulated.

ARTICLE 27.

1o) The social works will send within the sixty (60) days of the yearly memory and balance provided for in paragraph 1, duly certified.

2nd) Unregulated.

3rd) The proposed intervention of paragraph 3 will be raised through the Ministry of Health and Social Action Coordination and Administration.

4th) Unregulated.

5o) Unregulated.

(6) Unregulated.

ARTICLE 28.

(a) Unregulated.

(b) Unregulated.

(c) In addition to the generic provisions of this subparagraph, special serious offences are considered when it is found that:

I. The Social Work does not provide mandatory basic benefits in accordance with the provisions of the implementing authority.

II. The Social Work has not assigned the percentage of articles 5 of the Act 23,660.

III. The Social Work did not comply with the monthly remission of 70% of what was collected in each jurisdiction to meet the health needs of the beneficiaries residing therein as provided for in article 5 of Law 23,660.

IV. The Social Work exceeds the percentage for administrative expenses set out in article 22 of Law 23,660, did not correct it during several fiscal years or did not respond to the appeals of the enforcement authority.

V. Unjustified rejection of new affiliates.

ARTICLE 29 TO 44. Unregulated.

Annex II

LAW REGLAMENT 23,661

ARTICLE 1 . The beneficiaries of the National Health Insurance System that opt according to Decree No. 9/93 may join any of the agents registered in the National Register of Insurance Agents which determines the first article of Decree 9/93, without prejudice to the provisions of the regulation of Article 8 of Law 23.660. Each beneficiary cannot be affiliated with more than one (1) Insurance Agent.

The members of the social works under article 1 (e) of Act No. 23.660 may opt for any of the social works covered by that paragraph in the same manner as those set for the other members.

Insurance Officers may not subject to membership in compliance with any requirement not provided for in the Act or regulation, or make any discrimination to access compulsory basic coverage.

Psychophysical or equivalent examination is prohibited, regardless of nature, as a requirement for admission.

Insurance agents may not impose periods of deprivation, except as provided for in the regulation of Article 5 (c) of Law 23.661, or unilaterally decide without cause the termination of the participant.

The Ministry of Health and Social Action to promote freedom in the Social Works System and National Health Insurance by maintaining the controls that the Act provides for the purpose that the health of the beneficiaries is the objective and end of the social policy implemented through the Ministry of Health and the National Health Insurance Agency.

ARTICLE 2 . Insurance agents must guarantee their beneficiaries, at least the coverage levels, they will be specified by the Ministry of Health and Social Action.

In order to be considered insurance agents, other entities that are not social works intend to adhere to the system should have legal status and as a principal object the provision of the benefits referred to in Law 23.661.

They must also demonstrate the capacity to provide such benefits, and must be registered in the terms of Article 17 and in accordance with Law 23,661 and this regulation.

The Ministry of Health and Social Action will determine the individual value (capita) of health care plans that arise from coverage levels. These values are set by beneficiary (titular, members of their primary family group and other dependants).

The Ministry of Health and Social Action, by joint resolution with the Ministries of Economy and Public Works and Labour and Social Security, may modify the procedures, financing and collection systems when they consider it appropriate for the efficient functioning of the System.

Within 90 days the Ministry of Health and Social Action will coordinate with ANSSAL and social works the necessary aspects for the operation of this regulation. This period may be modified in less or more by the Ministry of Health and Social Action to provide the system with sufficient flexibility to allow a harmonious transition without prejudice to the participants of social works.

ARTICLE 3o . Unregulated.

ARTICLE 4o . Unregulated.

ARTICLE 5o ) a) Beneficiaries under Article 8 of Law 23,660 may join any of the agents covered by Decree 9/93 and in accordance with this regulation. The faculty to choose the insurance agent shall belong to each beneficiary. The family group and adherents will have the social work chosen by the holder. Beneficiaries may change as a Insurance Agent once an anniversary year. Once the change request has been filed, the participant may not retract. These conditions may be modified in particular cases when cases of force majeure are credited, as determined by ANSSAL. The decision may be appealed to the Ministry of Public Health and Social Action.

The National Institute of Social Services for Retired and Pensioned Persons will only receive the beneficiaries concerned by its current legislation.

Contributions and contributions to the system shall be regulated in accordance with Articles 16, 19 and 20 of Law 23,660, their concordants and regulations, according to the applicable regime, irrespective of the insurance agent to which they are affiliated.

(b) Self-employed workers in the National Retirement and Pension Scheme and their beneficiaries may join a Insurance Officer, who may choose between any of them, without prejudice to the regulation of Article 8 of Law 23.660. To that end, they will be properly registered with the ANSES and will be up to date with the payment of their forecasting obligations at the time of their affiliation with the Insurance Agent.

The minimum amount to be made by self-employed workers will be equivalent to the value of the basic benefit, as appropriate to contribute to the Solidary Redeployment Fund.

(c) Persons provided for in Article 5 (c) may join any insurance agent, without prejudice to the regulation of Article 8 of Law 23,660. They shall make at least one contribution equivalent to the value of the basic benefit plus that corresponding to the Solidary Redeployment Fund. Insurance agents, in these cases, may only make periods of absence for the first affiliation.

The National Institute of Social Services for Retired and Pensioned Persons will only receive those who are in charge of their current legislation.

The persons covered by the National Programme of Assistance to the Disabled shall be incorporated into the National Health Insurance in accordance with the conditions and modalities established by the Ministry of Health and Social Action of the Nation, at the time of the implementation of the aforementioned programme, with the funds provided by the National Treasury, in accordance with the forecast made in the General Budget of the Nation.

ARTICLE 6 . Unregulated.

ARTICLE 7o . Unregulated.

ARTICLE 8o . Unregulated.

ARTICLE 9o . Unregulated.

ARTICLE 10. . The directors shall be appointed by the Ministry of Health, directly to the representatives of the State, on the proposal of the C.G.T., the representatives of the organized workers, that of the Federal Health Council on the proposal of the same, and on the proposal of the organizations that nucleate the other sectors, according to the procedure established by the Ministry of Health.

ARTICLE 11. Unregulated.

ARTICLE 12. Unregulated.

ARTICLE 13. Unregulated.

ARTICLE 14. El The Ministry of Health and Social Action determines the rules for the constitution and opportunity of operation of the ANSSAL Advisory Council.

ARTICLE 15. Unregulated.

ARTICLE 16. Las Mutual entities of Law 20,321 may be integrated into National Health Insurance, provided that their statutes, regulations and registrations have been duly approved by the competent authority in accordance with applicable law. In this case they will only enjoy the exemption from fees and contributions provided for in Article 39 of Law 23.661.

All insurance agents shall ensure statutory participation of beneficiaries in their administration.

ARTICLE 17. de For the purposes of obtaining registration in the National Register of Insurance Agents, those entities that must be registered in the Social Works registry provided for in article 27, paragraph 4, of the Law 23,660 shall submit the record of such registration and shall provide the following information:

1 Updated pattern of beneficiaries by discriminating headlines, primary family burden, dependants, adherents and persons covered by article 5 (b) and (c) of Law 23.661, with sex indication, date of birth, nationality, identity card and address.

2 Territorial distribution by jurisdiction of beneficiaries of the coverage provided by the insurance agent.

3 Register of employers with domiciles and registration number in the ANSES and in the General Tax Office.

4 Composition of assets and inventory of assets.

5 Cost-medical-assistance coverage, coverage and programme extension plans, other benefits.

6 Statute, accession agreement, organic-functional structure, and administrative expenditure structure.

The ANSSAL shall set a period of up to 180 days from the date of submission of the application for registration within which each insurance agent shall complete the information in detail. During that period the registration will be subject to the character of prospective.

The information provided should be updated on the periodicity established by ANSSAL.

Social works and associations of social works currently registered shall be re-registered in the National Register of ANSSAL Insurance Agents in the time and conditions provided for in this regulation.

The ANSSAL Board shall establish the information to be required for registration in the National Register of Insurance Agents of Social Work Associations, as well as social works not covered by Law No. 23.660 that adhere to the National Health Insurance System.

The ANSSAL Board may arrange for cancellations in the National Register of Insurance Agents of those who do not conform to the provisions of Law 23.660 regarding the application of their gross resources in accordance with the provisions of Articles 5 and 22 of the aforementioned legal body.

The ANSSAL Board may arrange cancellations in the National Register of Insurance Agents at their request. Cancellations may also be made when the budgets provided for in the respective accession agreements in the act of registration are made, the Insurance Agents covered by Act No. 23.660 shall expressly state whether they shall use the power to define the scope of operation referred to in the regulation of Article 8 of Act No. 23.660.

Providers of the services referred to in the Act may not be established as Insurance Agents with the exception of the Social Works with their own medical-assistance services.

ARTICLE 18. de In order to comply with article 4 of Law 23.660, social works conform to the provisions of Article 18 of Law 23.661.

ARTICLE 19. Unregulated.

ARTICLE 20. Unregulated.

ARTICLE 21. Unregulated.

ARTICLE 22. Unregulated.

ARTICLE 23. . The collection and control of contributions, contributions and other resources to the Redeployment Solidarity Fund will be carried out through the rules issued by the implementing authority.

ARTICLE 24. el In the terms of art. 24, subparagraph (b), hereby 2 the Solidarity Fund for Redistribution shall finance:

(a) To those who choose to choose another social work that corresponds to it and whose contribution to the social work according to Law 23.660 is less than necessary to jointly cover the value of the capitas of it as holder and his family group, until the amount of the basic module is completed.

(b) To social works whose average income for contributions and contributions is lower than the basic module on the basis of updated ANSAL-recognized patterns and available resources.

(c) To finance the transformation of the system by requiring resolution from the Ministry of Health and Social Action.

(d) To finance the other cases established in article 24 (b) of Law 23661.

(e) ANSSAL must report monthly, with a delay of not more than 30 days, on the destination of funds to the Ministry of Health and Social Action.

(f) The application authority as soon as the design of the control mechanism on the obligation permits, implemented by the Tax General Directorate will implement the automatic distribution of the subsidies.

ARTICLE 25. Unregulated.

ARTICLE 26. Unregulated.

ARTICLE 27.

I) Under the terms of Decree 9/93, social works may not enter into lending contracts directly or indirectly with entities that have competence in the control of professional tuition or carry out deontological or group functions that involve both professionals and institutional lenders.

II) All restrictions limiting the freedom of contract between lenders and Social Works, as well as those that regulate borrowing tariffs of any kind, are left without effect.

III) Any direct or indirect form of administration or centralized collection of remuneration by the institutions referred to inc. I) and II of this Article is prohibited, except for those relating to registration, social quotas or similar concepts.

IV) Contracts between Social Works and lenders must comply with the standards of the national quality assurance programme and include accreditation criteria.

ARTICLE 28. . It will be up to the Ministry of Health and Social Action to update the mandatory benefits provided for in Article 3 of Decree 9/93. Agents may agree with their affiliates additional benefits on the mandatory ones. The Ministry of Health and Social Action may establish recruitment modalities.

ARTICLE 29. La The Health Secretariat of the Ministry of Health and Social Action shall issue the rules that establish the requirements to be met by the borrowers for registration in the National Registry of Providers, in accordance with the definitions and standards of accreditation and categorization for professionals and care establishments provided by the same Secretariat, in accordance with Article 31 of Law No. 23.661.

ARTICLE 30. La The Ministry of Health and Social Action Health Secretariat is empowered to dictate the rules that establish the conditions for incorporating the National Health Insurance, as borrowers, into hospitals and other care centers referred to in this article. It will also coordinate with the provinces the insertion of provincial hospitals into the Health System.

ARTICLE 31. Unregulated.

ARTICLE 32. Unregulated.

ARTICLE 33. Unregulated.

ARTICLE 34. . The modalities, nomenclators and retributive values established by Article 34 of Law 23.661, shall not be mandatory, having an exclusively indicative purpose for the agents and providers of the insurance, except for those determined by the Ministry of Health and Social Action Secretariat as binding.

ARTICLE 35. Unregulated.

ARTICLE 36. Unregulated.

ARTICLE 37. Unregulated.

ARTICLE 38. Unregulated.

ARTICLE 39. Unregulated.

ARTICLE 40. Unregulated.

ARTICLE 41. Unregulated.

ARTICLE 42. . The breaches committed by the Insurance Agents regarding the provision of services will be considered of utmost gravity. Failure to comply with the minimum assistance coverage for all beneficiaries, as well as the existence of a financial deficit that could compromise such coverage, will be punished by the cancellation of registration in the Register of Insurance Agents. Providers who commit fraud in the requirements for categorization and accreditation shall be excluded from the Register of Providers, without prejudice to the civil and criminal responsibilities to which they give rise.

ARTICLES 43 TO 52. Unregulated.