"Article 1.-Introducense the following |! |" ((modificaciones en la ley Nº18.933: 1) in article 2: to) replace, in the letter j), the conjunction "and" and |! | the comma (,) that precedes him, by a semicolon (;).
((b) replace, in the letter k), the final dot (.), |! | by a semicolon (;).
((c) Agreganse, then of the letter k), the |! | (((letters l), m) and n): "l)"sales agent"expression, by the person |! |" natural enabled by a health institution |! | Social security to intervene at any stage |! | related to the negotiation, subscription, |! | modification or termination of the contracts of health |! | pension;
(m) the term "base price", the price |! | assigned by the institution to each health plan. Is |! | apply identical price basis to all persons |! | hire the same plan. The final price that is paid to |! | the institution of health welfare plan |! | hired, excluding the additional benefits, be |! | you get by multiplying the respective base price by the |! | factor that corresponds to the Member or beneficiary of |! | (conformidad a la respectiva tabla de factores, y n) expression 'factors table' by one |! | table drawn up by the health welfare institution |! | whose factors are the terms of the plan |! | of health for each group of people according to age, sex and |! | status of fee-paying or load, in relation to a group |! | of reference defined by the Superintendent, in |! | general application instructions, which will assume the |! | unit value. This table represents a mechanism |! | agreed variation of the price of the plan throughout the |! | cycle of life, which is known and accepted by the |! | Member or beneficiary at the time of signing the |! | contract or incorporated into it, as appropriate, and that |! | not can vary as long as the person |! | remain attached to that plan. "."
(2) in article 3: a) Insert, in the first paragraph, the next |! | number 9 bis, new: "9 bis.-ensure that the practical application of |! |" contracts concluded between health-care providers |! | and the social security health institutions does not affect the |! | benefits to which they are entitled the affiliate or its |! | beneficiaries. "."
b) Agreganse, in the very first paragraph, to |! | continuation of the number 15, the following 16 numbers and |! | 17, new: ' 16.-keep a record of sales agents, |! | " overseeing the exercise of its functions and apply |! | the penalties established by law.
17 require of providers, whether |! | public or private, the delivery of certification |! | medical required to decide with regard to the |! | origin of benefits regulated by this law. |!| The Superintendent shall take measures |! | necessary to maintain the confidentiality of the tab |! | Clinic.
People who engage in misrepresentation in the |! | certification of diseases, injuries, States of |! | health, on the dates of diagnosis or |! | benefits granted will be sanctioned with penalties |! | provided for in article 202 of the criminal code. "."
(3) replace, in paragraph first item |! | 21, the verbal form "awarded" by "Finance".
(4) replace the subparagraph first of article 22, |! | by the following: ' article 22.-the institutions will aim |! | " exclusive financing of benefits and |! | health benefits, as well as activities that are |! | related or complementary of that end, which in no |! | case may involve the execution of such benefits |! | and benefits or participate in the management of |! | providers. "."
(5) Insert, in article 24, the following |! | Second, new subparagraph passing current subparagraphs |! | second and third to be third and fourth sub-paragraphs |! | respectively: "(La entidad deberá: a) report to the Superintendent the identity of |! |" the partners, shareholders and their drivers, whenever |! | holding a stake equal to or greater than 10% of the |! | capital or have the ability to choose at least to a |! | (miembro deel directorio, y b) prove to its partners, shareholders and |! | drivers are not found in any of the |! | situations provided for in article 24 bis of this |! | law. "."
(6) Agreganse, then of article 24, the |! | following articles 24 bis and 24 ter, new: "article 24 bis.-may not be directors, |! |" managers, administrators, guardians or representatives |! | legal of a health insurance institution, the |! | following persons: 1. those who have been convicted of any crime |! | that worth disturbing, to the compliance of the |! | condemns;
2. the failed not rehabilitated or who have |! | prohibition or inability to trade, and 3. that, within five years preceding |! | the appointment, have been directors, managers, |! | Administrators, guardians or legal representatives of |! | a legal entity sanctioned by any |! | Superintendent with the revocation of his authorization of |! | existence, finding such revocation to firm, to not |! | be that they have saved their responsibility in the way that |! | prescribed by law.
Article 24 ter-persons wishing |! | develop the activity of sales agent must |! | entered in the register that takes the |! | Superintendency. Stakeholders must comply with |! | the following requirements: 1. be foreigners living in Chile or Chilean |! | with alien meat a day;
2 be of age;
3 demonstrate knowledge sufficient envelope |! | Institutions of social security health system, and 4.-be in possession of license of education |! | average or equivalent studies.
To apply for the registration of an agent of |! | sales in the record indicated in number 16 of the |! | Article 3, must demonstrate the compliance of the |! | requirements previously set out, in the form and |! | opportunity determined by Superintendence |! | general application instructions.
It is prohibited to exercise, at the same time, the |! | functions of sales in more than one institution agent |! | of health insurance, except for express clearance of the |! | Superintendency.
The breach by agents of |! | sales of the obligations imposed on them by law, |! | general application instructions, resolutions and |! | opinions that say the Superintendent, will be |! | sanctioned by this with censure, fine of up to fifteen |! | monthly tax units or cancellation of its |! | entry in the register. The non-payment of fine |! | It will enable the Superintendent to cancel the |! | registration.
The sales agent who has cancelled its |! | registration, may apply to the |! | SVS your re-enrollment, after |! | within two years from the date on which the |! | resolution that decreed the cancellation has been |! | rendered. "."
(7) replace, in paragraph 1 of subsection first |! | of article 26, the expression "quotes by |! |" regularize"by"excesses of contributions".
(8) replace article 28, with the following: "article 28.-the SVS, in case of |! |" cancellation of the registration of a health institution |! | Social security, shall, by resolution established, do |! | effective guarantee and spend it to payment of the |! | obligations which, according to the law, should be |! | solved guaranteed. "."
(9) replace the heading of the paragraph 3 of the |! | Title II, by the following: "the affiliate and the |! |" quotes".
((10) in article 33: at) replaced the first paragraph by the following: "article 33.-for the granting of the |! |" benefits and health benefits that standard this law, |! | persons referred to in article 29 shall |! | an indefinite term contract, with the |! | health institution pension they choose. "."
(b) add, then the letter to), the |! | next letter to bis), new: "(a bis) supplementary health Plan, which may be |! |" contain one or more of the following modalities for the |! | granting of allowances or benefits: A.-Plan free choice: one in which the election |! | the health provider is determined at its discretion by |! | the Member or beneficiary, without the intervention of the |! | Health social security institution.
For purposes of the granting of benefits |! | health in the form of free choice which |! | financial hedging is effected by means of the |! | refund, should the institution of health welfare |! | pay them according to the plan, without subjecting it to the |! | providers maintain agreements with the institution or |! | are attached to it.
B Plan closed: one whose structure only |! | includes the financing of all the attentions of |! | health through certain providers |! | individualized plan, not providing access to |! | benefits in the form of free choice.
However, the Superintendent may determine, |! | using general instructions, cases |! | exceptional in that the Member or beneficiary may |! | be serviced by a different provider to the |! | individualized plan, in which eventuality |! | It is entitled, as a minimum, to financial coverage |! | that should give the national health fund in the |! | form of free choice.
C Plan with preferred providers: one whose |! | structure combines the attention in the form of |! | freedom of choice and the financing of benefits to |! | through certain providers previously |! | individualized plan.
Closed schemes and plans with lenders |! | preferred govern to the following rules:
1. whenever the health plan associate the |! | conferral of a benefit to a particular lender |! | or network of service providers, must be indicated under this plan the |! | name of the institutional providers through |! | which benefits will be awarded, whether |! | outpatient or hospital.
In addition, the institution of health welfare |! | You must identify in the plan providers that |! | subsidiary will provide the health care to its |! | beneficiaries, in the event of configure one |! | failure.
Is set to a failure of the service providers |! | individualized plan, when they encounter |! | Unable to perform some benefits |! | that you are part of the closed or preferential offer.
2. in the case of benefits which are granted in |! | virtue of referral referred to the numeral |! | foregoing, the amount of the co-payment affiliate may not |! | be higher than which would have corresponded him if any |! | been served by the network provider. Any |! | difference will be funded by the health institution |! | Social security.
The social security health institutions cannot |! | excepcionarse of responsibility that for them emanates |! | contracts of health in regards to access, |! | opportunity and financial coverage, attributing it to |! | lenders.
3. in the plans with preferred lenders, the |! | free choice mode only operates if the |! | beneficiary voluntarily opt for it and not can, |! | as a result, be used by the institution of |! | Health insurance to supplement the inadequacies of the |! | lender individualized in the preferential offer of the |! | plan.
4 health contracts should ensure the |! | urgent care of benefits comprising |! | its offer closed or preferential, identifying the plan |! | the health providers with whom has |! | agreed to the granting of such care and the |! | procedures to access them.
Also, should make explicit the coverage as is |! | grant to the attentions of urgency, whether these be |! | performed by the providers mentioned in paragraph |! | previous or other than.
Contracts of health shall establish the |! | right of the affiliate that, on the occasion of an emergency, |! | you are logged in to a different lender of the |! | referred to in paragraph first of this paragraph, to be |! | transferred to any individual providers |! | in the plan, and the institution of health right |! | Pension to transfer the patient to one of these |! | providers, subject to the following rules: a. will be up to the attending physician in the |! | setting the timing from which |! | the patient is able to be |! | transferred.
b If the patient or their family members decide the |! | transfer to a provider that is part of the offer |! | closed or preferential, accessing the planned coverage |! | in the plan, since the time of the transfer. Yes, by the |! | contrary, however the medical definition, |! | they opt for the maintenance in the establishment or the |! | transfer to another that does not form part of the closed deal |! | or preference, may not require the planned coverage |! | in the closed or preferred plan.
In all these cases, to resolve discrepancies, |! | shall apply the procedure referred to in the final subparagraph |! | of article 9 of the law Nº19.966.
5. the term of the agreement between the institution of |! | Health insurance and the closed institutional lender or |! | preferred, or any modification to these you |! | Insert, will not affect the amount that, by virtue of the |! | plan copagar hired, corresponds to the beneficiaries |! | by received, until the attentions of |! | the respective annuity.
At the end of this year the institution of |! | Health insurance you can adapt the contract, Dante |! | the fee paying, in the respective letter, inform the |! | circumstances of term or having |! | modified the referred agreement. In addition, the institution |! | knowledge of the affiliate will be adaptations |! | proposed to the existing plan and health plans |! | alternative equivalent to those conditions. Both |! | the adequacy of the plan as the alternative plans that |! | the institution offers to the fee-paying may contemplate the |! | granting of benefits by a different provider of |! | He identified in the current plan before the |! | adaptation. "."
((c) add, in) (f) of the second paragraph, the |! | following new paragraph: "Notwithstanding the foregoing, in the case of |! |" preexisting declared, the future |! | Member may, in certain, ask for cases by |! | writing, with a copy to the administration of funds and insurances |! | Social security in health, granted by the institution |! | for these pathologies, for another eighteen months, the |! | coverage offered by the national health fund in the |! | Free choice of law Nº18.469 mode. Thing |! | earlier, in order to be accepted in the |! | respective institution of health insurance. The |! | Superintendent shall be regulated through instructions of |! | general application, the operation of provisions of this |! | paragraph. "."
(d) add, in the third paragraph, below |! | of the separate dot (.), which happens to be followed dot (.), |! | the following: "the plans in which the price is a |! |" percentage equivalent to the legal health quote |! | only shall in the case of contracts which are |! | regarding the final paragraph of article 39 of this law and of |! | those entered into by two or more workers, in the |! | that benefits other than those that are agreed are |! | they could get with the single individual quote. Yes the |! | the plan price is agreed at UF or |! | as a percentage equivalent to the legal trading of |! | health, is, moreover, expressed its equivalence in |! | legal tender on the date of signing of the |! | contract. "."
(e) Agreganse, then of the final subsection, the |! | following new sub-paragraphs: "whenever a member or beneficiary request to |! |" an institution of health social security benefit |! | either by virtue of a contract of health, be |! | It means that it allows it to require of the |! | health providers, whether public or private, delivery |! | the medical certification required for |! | decide with respect to the origin of such benefit. The |! | Health insurance institution shall adopt the |! | necessary measures to maintain the confidentiality of |! | These certifications.
If the institution of welfare health considers |! | that the information provided by the provider is |! | incomplete, inaccurate or fears founded as not be |! | adjust to the truth, it may designate a medical surgeon |! | independent of the parties so check |! | personally the clinical tab. If the revision |! | turns out that it is not granted coverage |! | requested financial, health institution |! | Social security will report such circumstances to affiliate, |! | that may appeal to the Superintendent, in order |! | that the dispute is resolved. The surgeon |! | that you designate must be registered in a registry that |! | the Superintendent will take to these effects.
The health-care providers should give |! | compliance with the requirement referred to in subsection |! | anteprecedente, and should allow the review of the |! | tab clinic, within a period of five working days. |!| The health insurance institution shall maintain the |! | information received in reserve, according to thing |! | provisions of the law Nº19.628.
The Superintendent shall monitor the |! | appropriate exercise of this power and solve the |! | conflicts which may arise between providers and |! | ISAPRES. "."
(11) replacements subparagraphs second to sixth of the |! | Article 33 bis, by the following: "in addition, exclusion may not agree is of |! |" benefits, except for the following: 1. for the purpose of beautifying plastic surgery u |! | other benefits for the same purpose.
For the purposes of the provisions of this paragraph no |! | shall be deemed having purposes of beautifying the |! | plastic surgery aimed at correcting malformations or |! | deformations suffered by the creature during the |! | pregnancy or birth, or the intended to repair |! | deformation suffered in an accident, which has neither |! | a purpose strictly curative or healing;
2. private nursing care, except that was |! | in the case of benefits which are in the tariff of |! | benefits of the free-choice modality to be |! | mentioned in the Nº18.469 law;
3. hospitalization for purposes of rest;
4 benefits covered by other laws to the |! | the covered amount. At the request of the affiliate, the |! | Health social security institution must collect the insurance |! | of the traffic accidents to which the Act applies |! | Nº18.490 directly in the Compañía de Seguros |! | corresponding;
5.-requiring a beneficiary as |! | consequence of their involvement in acts of war;
6 diseases or health conditions |! | pre-existing non declared, except that it accredits fair |! | cause of error.
For the purposes of this law, means are |! | pre-existing diseases, pathologies or |! | health conditions that have been known by the |! | Affiliate and medically diagnosed prior to |! | the subscription of the contract or to the incorporation of the |! | beneficiary, if any. Such health history |! | they must be faithfully reported by affiliate |! | in a document called Declaration of health, along |! | with the other background of health requiring the |! | Health social security institution. The Declaration of |! | Health must be signed by the parties before |! | the conclusion of the contract or to the incorporation of the |! | beneficiary, if any. The Declaration of health form |! | essential part of the contract; However, the lack of |! | such a declaration shall not invalidate, but will boast of |! | right that the institution of health welfare resigned |! | the possibility of restricting coverage or put |! | term to the Convention by the omission of any |! | illness or pre-existing health condition.
Without limiting the foregoing, the institution of |! | Health insurance shall be obliged to pay to attend de |! | benefits for illnesses or health conditions |! | pre-existing declared, in the same terms not |! | stipulated in the contract for benefits originated |! | no pre-existing health conditions or diseases |! | covered by the plan, if it proves that the omission be |! | It was just cause of error or when has elapsed |! | a period of five years, from the subscription of the |! | contract or since the incorporation of the beneficiary, in |! | If necessary, unless the beneficiary has required attention |! | medical pathology or health condition |! | pre-existing. In these cases, nor shall the |! | termination of the contract of health.
Bad faith shall be presumed if the institution proves |! | pathology or pre-existing health condition |! | It required medical attention during the above five |! | years and the affiliated knowingly hid it to end of |! | favour of this legal provision. In these cases, |! | the health insurance institution can terminate |! | the agreement, in the terms laid down in article |! | 40;
7 benefits provided outside the territory |! | National;
8. all benefits and medications, in |! | the latter case of ambulatory character, not |! | (contemplados en el arancel a que se refiere la letra d) |! | of article 33. Without the consent of the institution of |! | Health insurance shall not approval of |! | benefits, unless the Superintendent tells you in |! | exceptional cases and insofar as is de |! | benefits where there is scientific evidence of its |! | effectiveness. In such cases, the cost of providing |! | the institution may not be superior to which would have |! | reciprocated by the provision to which it approves.
There may be no waiting periods during the |! | which allowances and benefits are not payable |! | agreed, except those relating to pregnancy and a |! | pre-existing diseases, in the terms indicated in |! | Article 33, letter f). "."
(12) Incorporanse following articles 33 ter and |! | 33 c, new: "article 33 ter-by payment or granting of a |! |" benefit under the contract of health, the |! | Health social security institution, by the single Ministry |! | law and for all purposes, be subrogates to the |! | Member or beneficiary in the rights and actions which |! | It has against third parties, due to the facts that |! | they made necessary the respective provision, until |! | amount corresponding to what the health insurance institution has paid u |! | awarded.
Article 33 c-all the different benefits |! | to those referred to in the explicit health guarantees |! | that gives the health welfare institution shall |! | be included in the supplementary health Plan. "."
(13) replace, in the second paragraph of the article |! | 34, the conjunction "and" that precedes the figure "38", by |! | a comma (,); and add, then the |! | Figure, the expression "38 bis and 38 ter", preceded by |! | a comma (,).
(14) amended article 38, as follows: to) deleted, the final sentence of the second paragraph, |! | the text of which is as follows: "However, the parties may |! |" negotiate the contract of health maintenance for awhile |! | determined, during which the affiliate may not |! | exercise their right to evict it. "."
(b) replace the third subparagraph by the |! | following paragraphs third and fourth, new: "annually, in the month of the contract, |! |" Institutions may review contracts for health, |! | being able to modify only the base price of the plan, with the |! | limitations referred to in article 38 bis, in |! | General terms and conditions that do not import discrimination |! | between members of a same plan. Revisions not |! | they may take into consideration the State of health of the |! | Member and beneficiary. These general terms and conditions |! | they must be the same they are offering to that |! | date to the new contracting in the plan. |!| Violation of this provision will result in that the |! | contract is understood to be valid under the same conditions |! | General, without prejudice to any other sanctions that are |! | they can be applied. The proposed adaptation should be |! | communicated to the plaintiff by registered letter |! | issued with at least three months in advance to the |! | expiration of the period. In such circumstances, the |! | a member may accept the contract with the adequacy of |! | price proposal by the health institution |! | Social security; in the event that nothing says, it means |! | that it accepts the proposal of the institution. In the same |! | opportunity and shape that communicates the adequacy, |! | the health welfare institution must offer one or |! | more alternative plans, whose base price is equivalent |! | to the one in force, unless in the case of the price of the plan |! | at least that her offer; You must offer identical |! | alternatives to all plan members whose price |! | fits, that, if you reject the adequacy, |! | You can accept one of the alternative plans to be |! | offer them either choose to disaffiliate from the institution of |! | Health social security. Only plans that may offer |! | available to all affiliates and price |! | It must correspond to the modified basic price by the |! | tables of risk according to age and sex.
Without limiting the foregoing, modifications of |! | the contractual benefits may be paid by mutual |! | agreement of the parties and give origin to the subscription of |! | a new health plan from among them who is |! | commercializing the institution of health welfare. "."
c) replaced in fourth paragraph, which has gone to |! | being fifth, the word "former" by "third party".
(d) delete the fifth paragraph.
(e) add, in the final paragraph, before point |! | final (..), the following sentence: "within three months |! |" following from that that has not been paid |! | the quote".
(f) Agreganse at the end the following new subsections: "equal time will be the institution of health |! |" Social security to report non-payment of the contribution and |! | of its possible consequences, their members |! | self-employed and paying volunteers.
The non-designated in the |! | two preceding subparagraphs, shall be punished by the |! | SVS fine, under the terms of the article |! | 45 of this law. In the case of workers |! | independent contributors volunteers or workers |! | who, having been dependent, are in |! | situation of unemployment, the lack of notification |! | timely, in addition, shall prevent the institution of health |! | Social security put an end to the contract by non-payment of the |! | quote or charge interest, adjustments and penalties. "."
(15) Agreganse, then from article 38, the |! | following articles 38 bis and 38 ter, new: "article 38 bis.-freedom of institutions |! |" from health insurance to change base prices of |! | health plans in accordance with the third subparagraph |! | of article 38 of this law, shall be subject to the |! | following rules: 1. before 31 March each year, the ISAPRES |! | They shall inform the Superintendent price basis, |! | expressed in u.f., of each of the |! | health plans that are effective the month of |! | January of the year in course and their respective portfolios to that |! | date.
To express prices in u.f. |! | base of health plans that are |! | established in currency of legal tender, the institutions |! | will use the value of health insurance that such |! | monetary unit is December 31 of the year |! | earlier.
2. at that time, it will also inform |! | the variation which will experience the price base of all and |! | each of the contracts whose annuity is met between |! | from July of the year in course and June of the year |! | following. Such variations may not be superior to |! | 1.3 times the weighted average of the variations |! | percentage of base prices reported by the |! | respective health insurance institution, neither |! | less than 0.7 times said average.
The weighted average of the variations |! | percentage of price base shall be calculated by adding the |! | variations of the price of each of the plans whose |! | annuity are met in the months referred to in paragraph |! | above, weighted by the percentage of participation |! | their respective portfolio in the total sum of |! | beneficiaries of these contracts. In both cases, be |! | It will consider the existing portfolio to the month of January of the year |! | in course.
3. in addition, the annual variation of prices |! | basis of the plans created between February and June of the year |! | in the process, both months inclusive, shall conform to the |! | rule indicated in paragraph first numeral 2 |! | foregoing, at the end of the respective year.
4. the institution of health pension may opt |! | by not adjusting prices based on those plans of |! | health where the lower limit of the variation, which |! | referred to in paragraph 2, is equal to or less than 2%. Bliss |! | option must be communicated to the Superintendent in the |! | equal opportunity referred to in the paragraph 1 of this |! | article.
5. in no case the ISAPRES may offer |! | rebates or decreases the price base of the |! | plan in question informed the Superintendency to |! | existing members or contracting new de |! | that plan.
6. you may not offer or agree on alternative plans |! | with less than a year of marketing or, |! | compliance with the indicated term, not have people |! | assigned to the members or beneficiaries whose |! | annuity is fulfilled in the period indicated in paragraph |! | 2. the same prohibition will apply when you |! | term to the contract and the person enroll again in |! | the same institution of health welfare.
The Superintendent shall supervise the |! | compliance with this standard, and may rescind |! | price increases that do not conform to the designated |! | above, without prejudice to the sanctions |! | which it deems appropriate, all of which will be informed to the |! | general public, through publications in journals of |! | national circulation, electronic media, or others that are |! | determine.
As indicated in the preceding paragraphs shall not be |! | applicable to contracts for the health insurance scheme whose |! | price is expressed in a percentage |! | equivalent to the legal trading.
Article 38 ter-to determine the price the |! | Affiliate must pay to the health institution |! | Pension by the plan, the institution must |! | apply to base prices resulting from the provisions |! | in the previous article, the factors that |! | corresponding to each beneficiary, according to the |! | respective factors table.
The Superintendent be fixed by instructions |! | of general application, the structure of the tables of |! | factors, establishing the types of beneficiaries, |! | Depending on your sex and status of fee-paying or load, and the |! | age ranges to be used.
Each age range the Banking Superintendent in |! | the instructions referred to in the preceding paragraph are |! | It will be subject to the following rules: 1. the first section will begin from birth and |! | It will be extended until less than two years of age;
2. the following sections, from the two years of |! | age and up to less than eighty years of age, will comprise |! | a minimum of three years and a maximum of five years;
3. the Superintendent shall, from the eighties |! | years of age, the sections that apply.
4. the Superintendent shall set, ten |! | years, the maximum ratio between the factor lower and |! | highest of each table, differentiated by sex.
5. in each section, the factor corresponding to a |! | load shall not exceed factor corresponding to |! | a fee paying same sex.
In the framework as provided in the preceding paragraph, |! | the social security health institutions will be free to |! | determine the factors of each table that use. In |! | Anyway, the table of a given health plan not |! | It may differ for beneficiaries while it |! | are attached to the same, or may be altered for |! | those who join it, unless the modification |! | consist of permanently decrease factors, |! | total or partially, which will require authorization |! | prior of the Superintendency; This decrease will be |! | applicable to all health plans that use this |! | table.
Each health plan may have only built one |! | table of factors. Health institutions |! | Social security may not establish more than two tables of |! | factors for all of the health plans are |! | are in marketing.
Without prejudice to the provisions of subsection |! | precedent, the social security health institutions |! | they may establish new tables every five years, |! | from the last reported to the |! | Superintendent, keeping in force the previous |! | in health plans that have incorporated them.
The social security health institutions will be |! | forced to apply from the month in which compliance with the |! | annuity in accordance with the respective table, the |! | increase or reduction factor corresponding to a |! | beneficiary because of his age, and to report to the |! | fee paying respective by registered letter issued |! | on the same occasion referred to in subsection |! | third of article 38. "."
(16) replace article 40, by the following: ' article 40-the institution may only please |! | " term to the contract of health when the fee-paying incurred |! | in any of the following non-compliances |! | contract: 1. falsifying or not deliver reliable all |! | the information in the statement of health, in the |! | terms of article 33 bis, unless the affiliate or |! | beneficiary demonstrate just cause of error.
The simple omission of a pre-existing condition not |! | It will give the right to terminate the agreement, unless the |! | Health social security institution demonstrate that the |! | omission causes damage and that, to have known |! | the disease, would have not hired.
The Faculty of the institution of health welfare |! | put an end to the contract of health, means no |! | prejudice to its right to apply the exclusion of |! | coverage of benefits generated by the |! | non-declared pre-existing disease.
2. failure to pay contributions on the part of the |! | contributors voluntary and independent, both those |! | that are of such quality to become like those that the |! | subsequently acquired by a change in your situation |! | labor. To exercise this ability, will be indispensable |! | having reported the non-payment of the contribution in the |! | terms of the final paragraph of article 38.
3 impetrar formally or get unduly, |! | to it or to any of its beneficiaries, benefits |! | not satisfying them or who are older that |! | proceed. Same sanction will apply if it benefits |! | to a third party alien to the contract.
4. omit contract to a relative |! | (beneficiario de los indicados en las letras b) and c) of the |! | Article 6 of the law Nº18.469, with the aim of harming |! | to the health welfare institution.
To exercise the option provided for in subsection |! | preceding the institution of health welfare must |! | notified in writing of such decision to the fee-paying, case in |! | which the benefits, with the exception of the |! | benefits derived from pre-existing illnesses not |! | declared, will remain in charge of the institution, |! | until the end of the month following the date of its |! | communication or up to the end of the disability |! | Labor, where the fee-paying found in |! | This situation and provided that this term is superior to the |! | above. Without prejudice of thing |! | arranged on) (g) of article 33 of this law.
The fee-paying may apply to the Superintendency |! | of this decision, within the period of validity of the |! | benefits referred to in the preceding paragraph. Made the |! | claim, the contract will remain valid until the |! | resolution, with the exception of benefits |! | derived from preexisting non-declared.
The right to the health welfare institution to |! | put an end to the contract expire after ninety |! | days since to take knowledge of the fact |! | establishing the cause of termination. For these |! | effects, in the case of pre-existing diseases, |! | the period shall run from the time that the institution |! | of health welfare receipt history |! | clinicians who demonstrate the existing character of the |! | Pathology; in the case of non-payment of the contribution, |! | from the thirty days following the date on which |! | He communicated the debt under the terms of the eleventh subparagraph |! | Article 38; in terms of wrongful obtaining of |! | benefits, since the institution of health |! | Pension record you such an event, and the omission of a |! | family beneficiary, since the institution take |! | knowledge of it. "."
(17) add, in article 41, the following |! | final, new subparagraph: "However, in the event that a beneficiary |! |" acquire the legal status of fee-paying, may choose |! | by staying at the institution celebrating a contract |! | in accordance with this law. The institution |! | It will be obligated to sign the respective contract of |! | health insurance scheme and to offer health plans in |! | current marketing, especially those whose |! | price adjusts to the amount of his legal contributions, without |! | which may be imposed him other restrictions than those |! | are already applicable or required a new |! | Declaration of health. "."
(18) Insert, after article 41, the |! | next article 41 bis, new:
"Article 41 bis.-in the event that the fee-paying |! |" die once after one year |! | uninterrupted contractual benefits, the |! | Health insurance institution shall be obliged to |! | keep, for a period not less than one year |! | Since the death, the benefits of the |! | contract of current health to date that was verified |! | that circumstance, all declared beneficiaries |! | by him, understanding incorporated in these son |! | being born and that it would be his beneficiary |! | legal live the deceased at the time of his birth.
The benefit specified in this article be |! | It will be subject to the following rules: 1. where appropriate, the health institutions |! | Social security shall have the right to receive quotes |! | from health of pensions or |! | remuneration payable by the beneficiaries |! | indicated in paragraph first, during the period in |! | that it governs the benefit provided in this article.
2 at the end of the benefit period, the |! | Institution shall be obliged to provide to the beneficiary the |! | same health plan, and must pay this value than |! | results from multiplying the base price of the plan by the |! | factor that corresponds to their sex and age.
If the beneficiary does not wish to keep the same plan, |! | the health welfare institution must offer |! | another health in current marketing plan whose |! | price is set to the amount that he found out in the |! | Institution, according to the existing factors |! | in the health of the deceased fee-paying, or one plan |! | less, if so expressly requested by the beneficiary.
3. in the case of health which have been agreed in |! | pursuant to this provision may not agree are other |! | restrictions or exclusions than those that were |! | force in the contract that kept the fee-paying |! | died with the institution, or required a new |! | statement of health.
Persons referred to in subsection first this |! | Article may waive the benefit there established, |! | without prejudice to exercise at such an event, the faculty that |! | gives the second subparagraph of paragraph 2 of subsection |! | precedent. "."
(19) added, then article 42 E, |! | following paragraph 6, new, passing 6th paragraphs and |! | 7th become paragraphs 7 th and 8 th, respectively: "paragraph 6 of creation and administration of the compensation fund solidarity article 42 F-create a compensation fund |! |" Solidarity between health institutions, pension, whose |! | It is intended to show solidarity in health risks among |! | the beneficiaries of these institutions, with regard |! | to the benefits contained in the guarantees |! | Explicit in health, in compliance with the established in |! | This paragraph.
The referred Fund shall not apply to the |! | Institutions referred to in the final paragraph of the |! | Article 39 or whose portfolio is mostly |! | formed by workers and ex-workers of the |! | company or institution which established the institution of |! | Health insurance, and will be supervigilado and regulated by |! | the Superintendency.
Article 42 G-compensation fund solidarity |! | It will offset each other to health institutions |! | Social security, by the difference between the premium |! | community that is determined for the warranties |! | Explicit in health and the premium adjusted by risk than |! | appropriate, which shall be determined in accordance with the |! | Regulation.
For the calculation of the premium adjusted by risk, |! | only the variables of age and sex will be considered. |!| The premiums referred to in this article, will be put |! | knowledge of the health institutions |! | Social security so that, within the fifth day following, |! | manifest his remarks. If they say anything, be |! | They shall be accepted.
If any of them formulare observations, the |! | Superintendent must evacuate their opinion. De |! | keep the discrepancy, a Commission of three |! | Members will resolve the dispute without further recourse. The |! | Commission shall be composed of a representative of the |! | Superintendence of health, a representative of the |! | Health insurance, designated institutions in the |! | form that point the regulation, and a designated expert |! | by lot from a list of four who will provide |! | with two persons designated by the aforementioned |! | Superintendent and two health institutions |! | Social security. The Commission must resolve within the |! | 15 days following its establishment.
The fees of the expert will be in charge of the |! | Health social security institutions, in equal parts.
Article 42 h.-the Superintendent will determine the |! | or effective compensation amounts for each |! | Health social security institution.
The social security health institutions shall |! | each other transfers corresponding to the |! | compensation to be determined by the Superintendent of |! | In the term and procedure that is health |! | determine.
Article 42 i.-the Superintendent supervise the |! | compliance with the health institutions |! | Pension obligations which sets this |! | Paragraph.
In case that some health insurance institution |! | do not perform the compensation that this title is in |! | the opportunity that matches or is either less than the |! | determined by the Superintendency, said Agency, |! | without prejudice to the administrative penalties that |! | It will come, will make it out the warranty that is |! | Article 26 of this law. In this case, the institution |! | Health insurance will be forced to replace the amount |! | the warranty within a period of twenty days and if not |! | to do so, shall apply the system of supervision to |! | involving the articles 45 bis and 45 ter of this |! | same legal text.
Administrative or judicial resources that |! | deducted the social security health institutions regard |! | the origin or the amount of compensation, not |! | They suspended the effects of ordered.
Article 42 J.-for the purposes of the provisions on |! | This paragraph, the social security health institutions |! | they should send the information to the Chilean Superintendency |! | necessary to calculate payments and compensations |! | indicated, according to the general instructions |! | application is issued.
Article 42 K-regulations concerning this |! | Paragraph, shall be issued through the Ministry of health |! | and shall bear the signature, in addition, the Minister of |! | Hacienda. "."
(20) replaced article 43, by the following: ' article 43.-institutions should keep to |! | " available to the general public and their |! | beneficiaries, the following records: 1. name or business name and individualization of |! | their legal representatives;
2 address, agencies and branches;
3. date of registration in the Superintendency;
4. duration of the company;
5. balance sheet for the last financial year and the |! | States of location to be determined by the Superintendent;
6. standard heritage, liquidity index and |! | amount of the guarantee;
7 relationship of the fines applied by the |! | Superintendent in the last three-year period, with |! | indication of the amount and the reason;
8 list of current health plans |! | marketing, with its base pricing, |! | table of factors, allowances and benefits. |!| In the case of beneficiaries, institutions |! | must always be in a position to deliver such |! | information regarding their plans, and 9.-list of the sales agents of the |! | Institution of health insurance, by |! | cities.
The aforementioned information may be recorded in media |! | electronic or print, or both, total or |! | partially, and should be updated regularly from |! | agreement to what point the Superintendency. "."
(21) replace the second paragraph of article 45, |! | by the following: "the fines referred to in the foregoing paragraph, no |! |" they may exceed a thousand units of building. In the case of |! | It is repeated infractions of the same |! | nature, within a period of twelve months, you can |! | apply a fine of up to four times the amount |! | maximum before expressed. "."
Replacements (22) first and second subparagraphs of the |! | Article 46 bis, by the following: "article 46 bis.-the institution seeking the |! |" cancellation of registration must be presented to the |! | Superintendent a declaration sworn, reduced to |! | public writing, which will be detailed the |! | currently enforceable obligations with contributors, |! | their charges and beneficiaries, with health-care providers, |! | with other social-security health institutions by |! | concept of the compensation fund transfers |! | Solidarity with the Superintendency. Together with |! | the filing of the application, the institution shall |! | communicate to their contributors and beneficiaries, according to |! | deadlines and procedures to secure the |! | Superintendent, his intention to close the record. |!| For the approval of the application, the institution |! | you will have to prove that another institution has accepted the |! | all their health contracts, including all |! | its members and beneficiaries, in accordance to thing |! | provided for in article 44 ter.
Not necessary the presentation of a |! | affidavit when the institution certifying that the |! | request for closure of record originated by a |! | fusion of two or more institutions of health welfare, |! | According to article 99 of the law Nº18.046. Once |! | issued the resolution which cancels a registration, the |! | Merged institutions must notify of this fact |! | Members, by registered letter issued |! | within the period of ten working day period from the |! | date of cancellation of the registration. Members of the |! | Merged institutions are entitled to evict |! | their contracts without expression of cause, within the six |! | months following the merger, and if anything they say within the |! | time noted, provisions shall be applicable in their regard in the |! | Article 38, second paragraph, of this law. In the same |! | term may evict their contracts members of |! | Institutions that are divided or transformed or, |! | for corporations, the shareholder change |! | or controller group. The Superintendent will determine the |! | mechanisms to inform members of such |! | modifications. "."
((23) amended article 48, in the following way: 1.-in the first subparagraph: to) replace your header with the following: "article 48.-cancelled the registration of a |! |" Health social security institution in the register and a |! | time made effective the guarantee of article 26, the |! | Superintendent shall pay the duties |! | cautioned that, within a period not exceeding a |! | ninety days. Such a guarantee will be used for |! | FIX: "."
((b) replace the number 2), by the following: "2) once solved appropriations referred |! |" of this subsection, and in the event of the existing (el número 1) |! | a remnant will proceed to the payment of subsidies |! | and reimbursements owed to contributors, loads and |! | third-party beneficiaries, surplus and excess of |! | contributions, contributions paid in the form |! | advance, contributions corresponding to the |! | Institution of health pension that were |! | contributors of the Member whose registration is |! | Gate, or to the national health fund, according to |! | appropriate, the above full or pro-rata, |! | as the case may be; "."
(((c) Suprimense the 4 numbers) and 5), passing the |! | (current 6) and 7 to be number 4) and 5), respectively.
2 Agreganse at the end the following subparagraphs, |! | New: "the debts referred to in subsection is |! |" (acreditarán deel siguiente modo: a) the Superintendent shall, through |! | electronic means, credits to date of |! | cancellation of the registration owed the institution of health |! | Social security.
For these purposes, institutions must |! | send to the Superintendent, with the periodicity that |! | This determines, the up-to-date and |! | detailed debts covered by the warranty. (b) made the communication referred to in the |! | literal precedent, interested parties have a period of |! | sixty days to assert their claims not |! | considered therein, or to claim the amount |! | informed.
(c) within from 15 days to the |! | the previous deadline, the Superintendency |! | calculate the payment corresponding to each of the |! | credits, according to the rules of the first subsection, and |! | knowledge of stakeholders will be the result |! | from this calculation, by registered letter.
Interested parties may challenge the calculations inside |! | ten days following notification, which are |! | It means the third business day following practiced to the |! | receipt of the letter by the post office.
(d) exhausted the time or resolved the disputes, |! | the Superintendent will pay debts in a term not |! | more than ninety days.
When the warranty is not enough to pay |! | members of a health institution debts |! | Pension whose registration has been cancelled and is |! | find declared bankruptcy, the administration of funds |! | and social security health insurance shall issue a |! | resolution containing the affiliate ID or |! | the lender and the amount owed. The resolution |! | you will need Executive merit and it will be forwarded to the trustee of the |! | bankruptcy, for the effects to be considered in payment |! | charged to the mass of the failed. The above is understood |! | without prejudice to the right of the affiliates and providers |! | to directly enforce their claims in the |! | bankruptcy.
In that part which has not been able to be solved |! | with the guarantee, the appropriations contained in the numeral 2 |! | of the first paragraph of this article shall be of the |! | privilege granted to the number 6 credits of the |! | 2. article 472 of the Civil Code, which, in any case, |! | will be paid in preference to those, govern all |! | the other provisions of article 2.473 thereof |! | Code. "."