ACT 20.015 AMEND LAW Nº18.933, ON HEALTH INSTITUTIONS |! | PENSION Having present that the H. National Congress has |! |given its approval to the following Bill: " Article 1.-Enter the following |! |amendments in the law Nº18.933: 1) In Article 2: (a) Replace, in point (j), the conjunction "and" and |! |the comma (,) above, by a semicolon (;). b) Reposition, in the letter k), the endpoint (.), |! |by a semicolon (;). c) Add, following the letter k), the |! |following letters l), m) and n): "l) The expression" sales agent ", by the person |! |natural enabled by a Health Institution |! | Pension to intervene in any of the stages |! |related to negotiation, subscription, |! |modification or termination of health contracts |! |previewal; m) The expression "base price", for the price |! |assigned by the Institution to each health plan. It |! |will apply identical base price to all people who |! |hire the same plan. The final price to be paid to |! |the Health Institution Pension for the plan |! |hired, excluding the additional benefits, will be |! |you will obtain by multiplying the respective base price by the |! |factor corresponding to the affiliate or beneficiary of |! |compliance to the respective factor table, and n) The expression "factor table" by that |! |table elaborated by the Health Institution Retirement |! |whose factors show the price ratio of the plan |! |health for each group of people, according to age, sex and |! |listing or loading condition, with respect to a group |! | a reference defined by the Superintendence, in |! |general application instructions, which will assume the |! |unit value. This table represents a mechanism |! |agreed plan price variation throughout the |! |life cycle, the one that is known and accepted by the |! |affiliate or beneficiary at the time of signing the |! |contract or join it, as appropriate, and that |! |cannot suffer variations as long as the person |! |remains attached to that plan. " 2) In article 3: a) Intercalase, in the first paragraph, the following |! |number 9a, new: " 9 bis.-Velar why the practical application of |! |the contracts concluded between the health providers |! |and the Institutions of Health Care do not affect the |! |benefits which are entitled to the affiliate or their |! |beneficiaries. "b) Add, in the same indent first, to |! |continuation of number 15, the following numbers 16 and |! | 17, new:" 16.-Maintain a sales agent registration, |! |audit the exercise of their duties and apply them |! |the sanctions that the law establishes. 17.-Require of the providers, be these |! |public or private, the delivery of the certification |! |medical that is necessary to decide regarding the |! |provenance of benefits regulated by this law. |! | The Superintendence will have to adopt the measures |! |necessary to maintain the confidentiality of the tab |! |clinic. The persons who incur falsehood in the |! |certification of diseases, injuries, states of |! |health, in the dates of the diagnoses or in |! |benefits granted will be sanctioned with the penalties |! |provided in article 202 of the Code Criminal. "3) Substitute, in the first paragraph of the article |! | 21, the verbal form" will grant "for" financing ". 4) Replace the first paragraph of Article 22, |! |by the following: " Article 22.-The institutions shall have by object |! exclusive the financing of the benefits and |! |health benefits, as well as the activities that are |! complementary to that end, which in no |! |case may involve the execution of such benefits |! |and benefits nor participate in the administration of |! |lenders. " 5) Intercalase, in article 24, the following |! |second, new, passing the current incisos |! |second and third to be third and fourth incisos, |! |respectively: " The entity shall: a) Report to the Superintendence the identity of |! |the partners, shareholders and their controllers, provided that |! |hold a participation equal to or greater than 10% of the |! |capital or have the ability to choose at least one |! |directory member, and (b) Credit that its partners, shareholders and |! |controllers are not in any of the |! |situations provided for in Article 24a of this |! |law. " 6) Add, following Article 24, the |! |following Articles 24a and 24b, new: " Article 24a.-They may not be directors, |! |managers, administrators, proxies or representatives |! |legal from a Health Care Institution, the |! |following persons: 1.-Those who have been convicted of a crime |! |that they deserve a penalty, up to the fulfillment of the |! |condemn 2.-The failed failed or those who have |! |prohibition or inability to trade, and 3.-Those who, within the preceding five years |! |the appointment, have been directors, managers, |! |administrators, proxies or legal representatives of |! |a legal person sanctioned by some |! | Superintendence with the revocation of your authorization to |! |existence, finding that revocation to firm, to no |! |be that they have saved their responsibility in the way that |! |prescribes the law. Article 24 ter.-People who wish |! |develop sales agent activity should |! |enroll in registration that carries the |! | Superintendence. The interested parties must comply with |! |the following requirements: 1.-Be Chilean or foreign-based in Chile |! |with foreign meat a day; 2.-Be older; 3.-Credit sufficient knowledge about |! |the system of Pension Health Institutions, and 4.-Be in possession of an education license |! |media or equivalent studies. To request the registration of an agent of |! |sales in the register indicated in the number 16 of the |! |article 3rd, must be credited the compliance of the |! |requirements preceedently indicated, in the form and |! |opportunity to determine the Superintendence by |! |general application instructions. It is forbidden to exercise, simultaneously, the |! |functions of sales agent in more than one Institution |! |of Health Pension, except express authorization of the |! | Superintendence. The breach by the agents of |! |sales of the obligations imposed on them by the law, |! |instructions of general application, resolutions and |! |opinions that the Superintendence will pronounce, will be |! |sanctioned by this one with censorship, fine of Up to fifteen |! |monthly tax units or cancellation of your |! |registration on the record. The non-payment of the fine |! |will enable the Superintendence to cancel the |! |registration. The sales agent who has been cancelled his |! |registration on the register, will be able to request the |! | Superintendence its reregistration, after the end of the period of two years counted from the date on which the |! |resolution which decreed the said cancellation has been left |! |executed. "7) Replace, in the numeral 1 of the first indent |! |of article 26, the expression" quotes by |! |regularise "by" excess of quotations ". 8) Replace Article 28, by the following: " Article 28.-The Superintendence, in case of |! |cancellation of the registration of a Health Institution |! | Pension, shall, by means of a resolution founded, make |! |effective the guarantee and allocate it to the payment of the |! |obligations which, according to the law, must be |! |fixed with the guarantee. "9) Replace the heading of the 3rd paragraph of the |! | Title II, by the following:" From the affiliation and the |! |quotations ". 10) In Article 33: (a) Substitute the first subparagraph, by the following: " Article 33.-For the granting of the |! |benefits and health benefits that rule this law, |! |the persons referred to in Article 29 shall |! |subscribe to an indefinite term contract, with The |! |pension institution you choose. ". b) Add, following the letter a), the |! |next letter to bis), new:" a bis) The Supplementary Health Plan, which may |! |contain one or more of the following modalities for the |! |granting of benefits or benefits: A.-Free plan choice: the one in which the election |! Health provider is discretionally resolved by |! |the affiliate or beneficiary, without intervention of the |! | Health Care Institution. For the purposes of granting the benefits |! |health in the free choice mode whose |! |financial coverage is done by way of the |! |refund, the Health Care Institution must |! |pay them according to plan, without make it conditional on the |! |providers maintaining agreements with the Institution or |! |be attached to it. B.-Plan closed: the one whose structure only |! |contemplates the financing of all the attention of |! |health through certain providers |! |individualised in the plan, not preventing the access to |! |the benefits under the free modality choice. However, the Superintendence will be able to determine, |! |by general instructions, the cases |! |exceptional in which the affiliate or beneficiary will be able to |! |be attended by a provider other than the |! |individualised in the plan, eventuality in which |! |will be entitled, at least, to the financial coverage |! |that must grant the National Health Fund in the |! |free choice mode. C.-Plan with preferred providers: that whose |! |structure combines attention under the mode of |! |free choice and profit financing to |! |through certain previously |! |individualised providers in the plan. Closed plans and plans with providers |! |preferred will be subject to the following rules: 1.-Each time the health plan associates the |! |grant of a benefit to a given provider |! |or network of providers, must be indicated in said plan the |! |n The name of the institution or the institutional providers through the |! |which the benefits will be awarded, be these |! Also, the Health Institution Pension |! |must identify in the plan the providers that |! |subsidiary will provide the health care to their |! |beneficiaries, in the event of being configured a |! |insufficiency. An insufficiency of the or the providers |! |individualised in the plan is configured, when they are |! |unable to perform any of the capabilities |! |that are part of the closed or preferred offer. 2.-In case of benefits that are granted in |! |virtue of the derivation to which the numeral |! |precedent refers, the amount of the copay of the affiliate will not be able to |! |be superior to that which would have corresponded if there were |! |been attended by the provider of the network. Any |! |difference will be funded by the Health Institution |! | Pension. The Health Care Institutions will not be able to |! |except for the responsibility that for them emanates |! |from the health contracts in terms of access, |! |opportunity and financial coverage, attribute to |! |the providers. 3.-In plans with preferred lenders, the |! |free choice mode only operates in case the |! |beneficiary voluntarily chooses for it and cannot, |! |accordingly, be used by the Institution of |! | Health Pension for supply the inadequacies of the |! |individual provider in the preferred offer of the |! |plan. 4.-Health contracts must guarantee the |! |care of the benefits they make up |! |their closed or preferential offer, identifying in the plan |! |health the or the providers with which there is |! such attention and the |! |procedures to access them. Also, the coverage that is |! will be made explicit, will be granted to the attention of urgency, whether these are |! |made by the providers mentioned in the paragraph |! |previous or by other different ones. The health contracts must establish the |! |right of the affiliate who, on the occasion of an emergency, |! |has entered a provider other than the |! |mentioned in the first paragraph of this numeral, to be |! |transferred to any of the individualised providers |! |in the plan, and the right of the Health Institution |! | Predict to transfer the patient to one of these |! |providers, subject to the following rules: a.-Correspond to the treating physician in the |! |establishment determine the moment from which |! |the patient is in a position to be |! |transferred. b.-If the patient or his/her family decides the |! |transfer to a provider that forms part of the offer |! |closed or preferred, they will access the planned coverage |! |in the plan, from the moment of the transfer. Yes, by the |! |contrary, notwithstanding the determination of the doctor, |! |opt for maintenance in the establishment or by the |! |transfer to another who is not part of the closed offer |! |or preferred, they will not be able to require the intended coverage |! |in the plan closed or preferred. In all these cases, to resolve discrepancies, |! |the procedure provided in the final paragraph |! |of article 9º of the law Nº19.966. 5.-The term of the agreement between the Institution of |! | Health Pension and the institutional provider closed or |! |preferential, or any modification that these |! |introduce, will not affect the amount that, under the |! |plan contracted, corresponds co-pay the beneficiaries |! |for the attention received, until the compliance of |! |the respective annuity. Upon completion of such annuity the Institution of |! | Health Care will be able to adjust the contract, owing |! |inform the quoted, in the respective letter, the |! |circumstance of having been terminated or to have been |! |modified the referred convention. In addition, the Institution |! |will inform the affiliate of the adjustments |! |proposals to the current plan and the health plans |! |alternatives of conditions equivalent to that. Both |! |the adequacy of the plan as the alternative plans that |! |the Institution offers to the quoted will be able to contemplate the |! |grant of benefits by a provider other than |! |that identified in the plan in force before the |! |adequacy. ". c) Add, in point f) of the second indent, the |! |next paragraph, new: " Notwithstanding the above, in the case of |! |declared pre-existing diseases, the future |! |affiliate may, in qualified cases, request by |! |written, with copy to the Intrend of Funds and Insurance |! | Health Foresight, which the Institution grants |! |for those pathologies, for eighteen months more, the |! |coverage that the National Health Fund offers in the |! | Free Choice Mode of Law Nº18.469. The |! |previous, in order to be accepted in the |! |respective Institution of Health Care. The |! | Superintendence will regulate, by means of instructions of |! |general application, the operation of the willing in this |! |paragraph. " d) Add, in the third indent, below |! |from the point apart (.), which happens to be followed (.), |! |the next: " The plans in which the price is a |! |percentage equivalent to the legal health quote |! |will only proceed in the case of the contracts to which it is |! |refers to the final paragraph of article 39 of this law and of |! |those celebrated by two or more workers, in the |! |that they have agreed benefits other than the ones that are |! |could obtain with the single individual contribution. If the |! |price of the plan is agreed upon in promotion units or |! |as percentage equivalent to the legal quote of |! |health, you must also express your equivalence in |! |legal tender to the date of subscription of the |! |contract. ". e) Add, following the final paragraph, the |! |following new prompts: " Every time an affiliate or beneficiary requests a |! |a Health Institution Prejudice a benefit |! |anyone under a health contract, is |! |understand that the power to require the |! |providers, be these public or private, delivery |! |of the medical certification that is necessary for |! |decide on the provenance of such benefit. The |! | Health Care Institution should adopt the |! |measures necessary to maintain the confidentiality of |! |these certifications. If the Health Institution considers |! |that the information provided by the provider is |! |incomplete, imprecise or fear founded that it is not |! |fit to the truth, you may designate a surgeon doctor |! |independent of the parties for to review |! personally |the clinical tab. If the review |! |it is not appropriate to grant the coverage |! |financial requested, the Health Institution |! | Pension will inform the affiliate, |! |the one that will be able to turn to the Superintendence, in order to |! |that this resolve the controversy. The surgeon doctor |! |that is designated must be registered in a register that |! |the Superintendence will carry for these effects. The health care provider must give |! |compliance with the requirement stated in the article |! |preceding, and must allow the review of the |! |medical record, within five working days. |! | The Health Care Institution must maintain the |! |information received in reservation, according to the |! |provided in law Nº19,628. It will be up to the Superintendence to monitor the |! |proper exercise of this power and to resolve the |! |conflicts that may occur between the providers and |! |the ISAPRES. " 11) Replace the second to sixth of the |! |article 33a, by the following: " No exclusion of |! |benefits may be agreed, except the following: 1.-Plastic surgery for purposes of beautification or |! |other benefits for the same purpose. For the purposes of the provisions in this numeral no |! |will be considered to have purposes of beautification the |! |plastic surgery intended to correct malformations or |! |deformations suffered by the creature during the |! |pregnancy or birth, nor the intended to be repaired |! |deformations suffered in an accident, or the one with |! |a strictly curative or restorative purpose; 2.-Particular attention to nursing, except that it is |! |! |free-of-choice-mode capabilities to be |! |refers to law Nº18.469; 3.- Hospitalization for rest purposes; 4.-Prstations covered by other laws up to the |! |amount of the covered. At the request of the affiliate, the |! | Health Care Institution must collect insurance |! |traffic accidents as referred to in law | !|Nº18,490 directly in the Insurance Company |! |correspondingly; 5.-Those required by a beneficiary as |! |consequence of their participation in acts of war; 6.-Disease or health conditions |! |non-declared pre-existing, unless fair is credited |! |cause of error. For the purposes of this law, it will be understood that they are |! |pre-existing those diseases, pathologies or |! |health conditions that have been known by the |! |affiliated and medically diagnosed prior to |! |the subscription of the contract or the incorporation of the |! |beneficiary, if any. Such health history |! |must be registered reliably by the affiliate |! |in a document called Health Declaration, together |! |with the other health records required by the |! | Health Care Institution. The Declaration of |! | Health must be subscribed by the parties in advance |! |the conclusion of the contract or the incorporation of the |! |beneficiary, if any. The Health Declaration forms |! |essential part of the contract; however, the lack of |! |such a statement will not invalidate it, but will make you boast of |! |right that the Institution of Health Retirement resigned |! |to the possibility of res tringir coverage or put |! |term to convention by default of some |! |disease or pre-existing health condition. Without prejudice to the above, the Institution of |! | Health Care will be obliged to pay for the payment of |! |sickness benefits or health conditions |! |non-declared pre-existing, in the same terms |! |stipulated in the contract for performance |! |for non-pre-existing health conditions or conditions |! |covered by the plan, if it is credited that the default is |! |due to error due to error or when |! |a five-year term, counted from the subscription of the |! |contract or since the incorporation of the beneficiary, in |! |its case, without the beneficiary has required attention |! |medical for pathology or health condition |! |preexisting. In these cases, neither will the |! |termination of the health contract. Bad faith will be presumed if the Institution will test |! |that the pathology or pre-existing health condition |! |required medical attention during the above five |! |years and the knowingly affiliated the hidden in order to |! |favor of this legal provision. In these cases, |! |the Health Care Institution may terminate |! |the contract, in the terms set out in the article |! | 40; 7.-Prstations awarded outside the territory |! |national; 8.-All those benefits and medicines, in |! |this last case of an outpatient nature, no |! |referred to in the tariff referred to in point (d) |! |of article 33. Without the consent of the Institution of |! | Health Care will not proceed the approval of |! |benefits, unless the Superintendence orders it in |! |exceptional cases and provided that it is |! |benefits in which there is scientific evidence of your |! |effectiveness. In such cases, the cost of the provision |! |for the Institution may not be higher than the one that would have been |! |corresponding to the benefit to which it is approved. No waiting periods may exist during the |! |which benefits and benefits are not payable |! |agreed, except for pregnancy and |! |pre-existing diseases, in the terms stated in |! |article 33, letter (f). ". 12) Incorporate the following Articles 33 ter and |! | 33 quater, new:" Article 33 ter.-For payment or grant of a |! |benefit under the health contract, the |! | Pension institution, by the sole ministry |! |of the law and for all intents and purposes, it is subrogated to the |! |affiliate or beneficiary in the rights and actions that |! |this has against third parties, because of the facts that |! |required the respective benefit, and up to the |! |amount corresponding to what the ISAPRE paid u |! |granted. Article 33 c.-All the different benefits |! |those referred to in the Explicit Guarantees in Health |! |that the Institution of Health Care will have to |! |be included in the Plan of Health Complementary. " 13) Replace, in the Article |! | 34, the conjunction "and" preceding the "38" guitarianism, by |! |a comma (,); and add, following the referred |! |guarism, the expression "38a and 38b", preceded by |! |a comma (,). 14. Amend Article 38 as follows: a) Assume, the final sentence of the second indent, |! |whose text is as follows: " With everything, the parties may |! |agree to the maintenance of the health contract for a time |! |determined, during which the affiliate will not be able to |! |exercise its right to (b) Substitute the third and fourth subparagraphs of the third and fourth subparagraphs, new: " Annually, in the month of subscription of the contract, |! |the institutions may review the health contracts, |! |being able to modify the price only basis of the plan, with the |! |limitations referred to in Article 38a, in |! |conditions general that does not matter discrimination |! |among the affiliates of the same plan. Reviews will not |! |may take into consideration the health status of the |! |affiliate and beneficiary. These general conditions |! |must be the same as they are being offered to that |! |date to the new contractors in the respective plan. |! | The breach of this provision will result in the |! |contract being understood to be in force under the same conditions |! |generals, without prejudice to the other penalties that are |! |applicable. The proposed adequacy must be |! |communicated to the affected by registered letter |! |issued with, at least, three months in advance to the |! |expiration of the period. In such circumstances, the |! |affiliate will be able to accept the contract with the adequacy of |! |price proposed by the Health Institution |! | Foresight; in the event that nothing says, will be understood |! |that accepts the proposal of the Institution. In the same |! |opportunity and way in which the adequacy is communicated, |! |the Health Care Institution must offer one or |! |more alternative plans whose base price is equivalent |! |to the current, unless it is the price of the plan |! |minimum that she offers; identical |! will be offered to all members of the plan whose price |! |is suitable, which, in case of rejecting the adequacy, |! |they will be able to accept any of the alternative plans that are |! |they offer them or Challenge the Institution of |! | Health Care. Only plans can be offered that |! |are available to all affiliates and the price |! |must correspond to the base price modified by the |! |risk tables according to age and gender. Without prejudice to the above, the modifications of the |! |the contractual benefits may be effected by mutual |! |agreement of the parties and will give origin to the subscription of |! |a new health plan from among those found |! |marketing the Pension Health Institution. "c) Replace in the fourth indent, which has passed to |! |be fifth, the word" above "for" third ". (d) The fifth indent is assumed. e) Add, in the final paragraph, before the point |! |final (.), the following sentence: "within three months |! |following counted from the one in which the payment was not paid |! |the quote". f) Add to the end the following new points: " The same period will have the Health Institution |! | Pension to inform the non-payment of the quote and |! |of its possible consequences, regarding its affiliates |! |independent workers and Volunteer contributors. The breach of the obligation stated in the |! |two preceding incisents, will be sanctioned by the |! | Superintendence with fine, in the terms of the article |! | 45 of this law. In the case of workers |! |independent, voluntary or workers trading |! |that, having been dependent, are in |! |situation of unemployment, lack of notification |! |timely, in addition, will prevent the Institution of Health |! | Prejudice to terminate the contract for non-payment of the |! |quotation or charge interest, readjustments and fines. "15) Add, following Article 38, the following Articles 38a and 38b, new:" Article 38a.-Freedom of the Institutions |! |Health Care to change the base prices of |! |health plans in the terms of the third indent |! |of article 38 of this law, will be subject to the |! |following rules: 1.-Before 31 March each year, the ISAPRES |! |must inform the Superintendence of the base price, |! |expressed in units of promotion, of each one of the |! |health plans that are in place for the month of |! |January of the current year and their respective portfolios to that |! |date. To express in promotion units prices |! |base of health plans found |! |established in legal tender currency, Institutions |! |Health Care will use the value that said |! |unit monetary has at 31 of December of the year |! |previous. 2.-In this opportunity, they must also report |! |the variation that will experience the base price of all and |! |each of the contracts whose annuity is met between |! |the months of July of the year in progress and June of the year |! |next. These variations may not be higher than |! | 1.3 times the weighted average of the variations |! |percentage of base prices reported by the |! |respective Health Care Institution, nor |! |lower than 0.7 times the average. The weighted average of the variations |! |percentage of base price will be calculated by adding the |! |price variations of each of the plans whose |! |annuity is met in the months indicated in the paragraph |! |above, weighted by the percentage participation |! |of your respective portfolio in the total sum of |! |beneficiaries of these contracts. In both cases, it will be |! |will consider the current portfolio for January of the year |! |in progress. 3.-Also, the annual variation of prices |! |base of plans created between February and June of the year |! |in progress, both months inclusive, must conform to the |! |rule indicated in the first paragraph of the numeral 2 |! |precedent, when the respective annuity. 4.-The Health Care Institution will be able to opt |! |for not adjusting the base prices of those plans of |! |health where the lower limit of the variation, to which |! |alludes the numeral 2, is equal to or less than 2%. Said |! |option should be communicated to the Superintendence in the |! |same opportunity to allude the numeral 1 of this |! |article. 5.-In no case will the ISAPRES be able to offer |! |discounts or decreases with respect to the base price of the |! |plan that is treated informed to the Superintendence, to |! |the members in force or to the new contractors of |! |that plan. 6.-It is prohibited to offer or to agree alternative plans |! |with less than one year of marketing or that, |! |complying with the stated validity, do not have persons |! |attached, to the affiliates or beneficiaries whose |! |annuity is fulfilled in the period indicated in the number |! | 2. The same ban was applied When it is put |! |term to the contract and the person becomes afilie again in |! |the same Institution of Health Pension. It will be up to the Superintendence to audit the |! |compliance of this rule, being able to leave without effect |! |price hikes that do not conform to the above |! |precently, without prejudice to apply the sanctions |! |that you consider pertinent, everything which will be informed to the |! |general public, by means of publications in daily |! |national circulation, electronic means or other that is |! |determine. The above mentioned incisos will not be |! |applicable to the health care contracts whose |! |price is expressed in a percentage |! |equivalent to the legal contribution. Article 38b.-To determine the price that the |! |affiliate will have to pay to the Health Institution |! | Pension for the health plan, the Institution must |! |apply to the base prices that result from the willing |! |in the preceding article, the or factors that |! |correspond to each beneficiary, according to the |! |respective factor table. The Superintendence will set, by means of instructions |! |of general application, the structure of the tables of |! |factors, establishing the types of beneficiaries, |! |according to sex and condition of listing or loading, and the |! |age ranges use. Each age range setting the Superintendence in |! |the instructions outlined in the preceding paragraph is |! |subject to the following rules: 1.-The first tranche will start from birth and |! |will extend to less than two years of age; 2. The following sections, from the two years of the age of two years old and up to less than eighty years old, will comprise |! |a minimum of three years and a maximum of five years; 3.-The Superintendence will fix, from the eighties |! |years of age, the corresponding sections. 4.-The Superintendence should fix, every ten |! |years, the maximum ratio between the lowest factor and the |! |highest of each table, differentiated by sex. 5.-In each section, the factor corresponding to a |! |load may not be greater than the factor corresponding to |! |a same sex listed. In the framework of the above mentioned paragraph, |! |the Health Care Institutions will be free to |! |determine the factors of each table that they employ. In |! |all case, the table of a certain health plan does not |! |may vary for the beneficiaries while they are |! |find attached to it, nor can it be altered for |! |those who join it, unless the modification |! permanently the factors, |! |fully or partially, which will require authorization |! |previous of the Superintendence; such decrease will be made |! |applicable to all health plans that use that |! |table. Each health plan may have only one |! |factor table. The Health Institutions |! | Pension will not be able to set more than two tables of |! |factors for all the health plans that are |! |find in marketing. Without prejudice to the provisions of the foregoing paragraph |! |precedent, the Health Institutions Pension |! |may establish new tables every five years, |! |counted from the last informed to the |! | Superintendence, remaining in force the previous ones |! |in the health plans that have incorporated them. The Health Care Institutions will be |! |required to apply, from the month in which the |! |annuity is fulfilled and in accordance with the respective table, the |! |increase or the reduction of factor corresponding to a |! |beneficiary due to its age, and to inform the respective |! |listed by registered letter issued |! |at the same opportunity as referred to in the article 38 (3). 16) Replace Article 40, by the following: " Article 40.-The Institution may only put |! |term to the health contract when the listing incurs |! |in any of the following non-compliances |! |contractual: 1.-Distort or not deliver from reliable way all |! |the information in the Health Declaration, in the |! |terms of article 33a, except that the affiliate or |! |beneficiary demonstrate just cause of error. The simple omission of a pre-existing disease does not |! |give right to terminate the contract, except that the |! | Institution of Health Care demonstrates that the |! |omission causes you damages and that, if you have known |! |said disease, there would be no contracted. The faculty of the Health Care Institution |! |to terminate the health contract, is understood without |! |prejudice to their right to apply the exclusion of |! |coverage of the benefits originated by the |! |pre-existing diseases declared. 2.-Non-payment of quotes by the |! |willing and independent contributors, both those |! |that they review such quality by affiliation as the ones that the |! |subsequently acquire for a change in their situation |! |work. To exercise this power, it will be indispensable |! |have communicated the non-payment of the quote in the |! |terms of the final article 38. 3.-To formally impose or obtain unduly, |! |for the or any of its beneficiaries, benefits |! |that they do not correspond to them or that they are greater than the ones that |! |proceed. Equal penalty will apply when you benefit |! |a third party foreign to the contract. 4.-To omit from the contract to some family member |! |beneficiary of the indicated in the letters b) and c) of the |! |article 6th of the law Nº18.469, in order to harm |! |to the Institution of Health Pension. To exercise the faculty established in the paragraph |! |precedent, the Institution of Health Care must |! |communicate in writing such a decision to the listing, case in |! |which the benefits, with the exception of the |! |benefits derived from Preexisting diseases no |! |declared, will continue to be in charge of the Institution, |! |until the end of the month following the date of your |! |communication or until the term of incapacity |! |work, in case the listed person is in |! |this situation and provided this deadline is greater than the |! |above. The foregoing, without prejudice to the provisions of Article 33 (g) of this Law. The quoted person can claim to the Superintendence |! |of this decision, within the term of validity of the |! |benefits indicated in the previous paragraph. Done the |! |claim, the contract will remain in force until the |! |resolution of this, with the exception of the benefits |! |derived from non-declared pre-existing diseases. The Health Institution's right to |! |terminate the contract will expire after ninety |! |days counted since taking cognizance of the fact |! |constitutive of the causal of termination. For these |! |effects, in the case of pre-existing diseases, |! |the term will be counted from the moment that the Institution |! |Health Care has received the antecedents |! |clinicians who demonstrate the pre-existing character of the |! |pathologia; in the case of the non-payment of the quote, |! |from the thirty days following the date on which |! |communicated the debt in the terms of the eleventh paragraph |! |of article 38; regarding the improper obtaining of |! |benefits, since the institution of Health |! | Retirement is the act of the act, and the omission of a |! |family beneficiary, since the Institution takes |! |knowledge of it. ". 17) Add, in article 41, the following |! |final, new:" With everything, in the event that a beneficiary |! |acquires the legal quality of listing, you will be able to choose |! |to remain in the Institution celebrating a contract |! |according to what is established in this law. The institution |! |will be obliged to subscribe the respective contract of |! |health care and to offer the health plans in |! |current marketing, especially those whose |! |price will be adjusted to the amount of their legal contribution, without |! impose other restrictions on them which |! |are already in force or require a new one |! |health declaration. "18) Intercalase, following Article 41, the |! |following article 41a, new:" Article 41a.-In the event that the quote |! |die after one year of validity |! |uninterruptible Contractual benefits, the |! | Health Care Institution will be required to |! |maintain, for a period not less than one year counted |! |since death, all benefits of the |! |health contract in effect to the date it was verified |! |such circumstance, to all the declared beneficiaries |! |by that, understanding incorporated into these to the son |! |that it is to be born and that it would have been its beneficiary |! |legal to live the causative to the time of its birth. The benefit set out in this article will be |! |subject to the following rules: 1.-When applicable, the Health Institutions |! | Pension will be entitled to receive the contributions |! |for health arising from pensions or |! |remuneration payable by the beneficiaries |! |mentioned in the first indent, during the period in |! |that rija the benefit provided in this article. 2.-Finished the validity of the benefit, the |! | Institution will be obliged to offer to the beneficiary the |! |same health plan, owing this one to pay the value that |! |results from multiplying the base price of the plan by the |! |factor corresponding to its sex and age. If the beneficiary does not want to maintain the same plan, |! |the Health Care Institution will have to offer you |! |another health plan in current marketing whose |! |price will be adjusted to the amount that you would find in the |! | Institution, according to the factor table |! |in the health plan of the deceased listed, or one |! |minor, if so expressly requested by the beneficiary. 3.-In the health contracts that are signed in |! |virtue of this provision other |! |restrictions or exclusions may not be agreed that those that were found |! the contract that maintained the listing |! |deceased with the Institution, nor demand a new |! |health declaration. The persons indicated in the first paragraph of this |! |article may waive the benefit there established, |! |without prejudice to exercise, in such event, the faculty that |! |grants the second paragraph of the numeral 2 of the paragraph |! |precedent. ". 19) Add, following Article 42 E, the |! |next Paragraph 6th, new, passing paragraphs 6th and |! | 7th to be Paragraphs 7th and 8th, respectively: " Paragraph 6th Of The Creation and Administration of the Solidarity Compensation Fund Article 42 F.-Believe a Compensation Fund |! | Solidarity between Health Institutions Pension, whose |! |purpose will be in solidarity with the health risks between |! |the beneficiaries of these institutions, with relation |! |to the benefits contained in the Guarantees |! | Explicit in Health, in accordance with the established in |! |this Paragraph. The above mentioned Fund will not be applicable to the |! | Institutions referred to in the final paragraph of the |! |article 39 or whose portfolio is mostly |! |formed by workers and former workers of the |! |company or institution that constituted the Institution of |! | Health Pension, and will be overwatched and regulated by |! |the Superintendence. Article 42 G.-The Solidarity Compensation Fund |! |will compensate the Health Institutions |! | Pension, for the difference between the premium |! |community that is determined for the Warranties |! | Explicit in Health and the premium adjusted by The risks that |! |correspond, which will be determined according to the |! | Regulation. For calculation of the risk-adjusted premium, |! |only the gender and age variables will be considered. |! | The premiums referred to in this article, will be placed |! |in the knowledge of the Health Institutions |! | Prejudice so that, within the next fifth day, |! |manifest their observations. If nothing they say, they are |! |understand accepted. If any of them make observations, the |! | Superintendence must evacuate its mind. From |! |keep the discrepancy, a commission of three |! |members will resolve the dispute, without further recourse. The |! |commission will be composed of a representative of the |! | Superintendence of Health, a representative of the |! | Health Institutions Pension, designated in the |! |way that I point out the Regulation, and a designated expert |! |by drawing a payroll of four that will be made |! |with two persons designated by the referred |! | Superintendence and two by the Health Institutions |! | Pension. The commission must resolve within the |! |15 days following its constitution. The fees of the expert will be in charge of the |! | Institutions of Health Care, in equal parts. Article 42 H.-The Superintendence will determine the |! |or the effective amounts of compensation for each |! | Health Care Institution. The Health Institutions will perform |! |among them the transfers that correspond to the |! |compensations that determine the Superintendence of |! | Health, in the period and through the procedure that is |! |determine. Article 42 I.-The Superintendence will control the |! |compliance by the Health Institutions |! | Prejudice of the obligations that it establishes this |! | Paragraph. If any of the Health Care Institution |! |do not perform the compensation of this Title in |! |the appropriate opportunity or this is less than the |! |determined by the Superintendence, said organism, |! |without prejudice to the Administrative sanctions that |! |proceed, will do so with the guarantee that it deals |! |article 26 of this law. In this case, the Institution |! |Health Care will be obliged to replenish the amount |! |of the guarantee within the period of twenty days and if not |! |it will, the regime of oversurveillance will be applied to |! |that refer to the articles 45 bis and 45 ter of this |! |same legal text. The administrative or judicial resources that |! |deinduce the Institutions of Health Care regarding |! |of the origin or the amount of the compensation, no |! |will suspend the effects of the ordered. Article 42 J.-For the purposes of the provisions in |! |this Paragraph, the Health Care Institutions |! |must send to the Superintendence the information |! |necessary to calculate the payments and compensations |! |indicated, according to the general instructions |! |application you are issuing. Article 42 K.-The Regulation referred to in this |! | Paragraph shall be issued through the Ministry of Health |! |and shall bear the signature, in addition, of the Minister of |! | Hacienda. "20) Substitute Article 43, by the following:" Article 43. Institutions shall maintain a |! |disposition of the general public and their |! |beneficiaries, the following antecedents: 1.-Name or social reason and individualization of |! |their legal representatives; 2.-domicile, agencies and branches; 3.-Date 4.-Duration of the society; 5.-General balance of the last exercise and the |! |situation states that determine the Superintendence; 6.-Standard of equity, liquidity index and |! |amount of the guarantee; 7.-Ratio of the fines applied by the |! | Superintendence in the last three-year period, with |! |indication of the amount and motive; 8.-Listing of health plans in current |! |marketing, with indication of their base prices, |! |table of factors, benefits and benefits. |! | In the case of the beneficiaries, the Institutions |! |must always be in a position to deliver the said |! |information regarding their plans, and 9.-Nomina of the sales agents of the |! | Corresponding Health Institution, by |! |cities. The information referred to may be in media |! |electronic or printed, or in both, total or |! |partially, and shall be regularly updated of |!.................................................... |! |by the following: " The fines referred to in the previous paragraph, no |! |may exceed a thousand units of encouragement. In the case of |! |be repeated infringements of the same |! |nature, within a period of twelve months, may |! be applied a fine of up to four times the amount |! |maximum before expressed. " 22) Replace the first and second incisations of the |! |article 46a, by the following: " Article 46a.-The institution requesting the |! |cancellation of your registration shall submit to the |! | Superintendence an affidavit, reduced to |! |public deed, in which the |! |obligations currently payable with the listed, |! |their payloads and beneficiaries, with Health providers, |! |with other Health Institutions Pension for |! |concept of transfers from the Compensation Fund |! | Solidarity and with the Superintendence. Jointly with |! |filing the application, the Institution will |! |communicate to its listed and beneficiaries, according to |! |the deadlines and procedures that set the |! | Superintendence, your intention to close the registration. |! | For the approval of the application, the Institution |! |must prove that another Institution has accepted the |! all of its health contracts, including all |! |its affiliates and beneficiaries, in accordance with the |! |provided in Article 44 b. No submission of a |! |affidavit will be required when the Institution accredits that the |! |registration closure request has originated by a |! |merger of two or more Health Care Institutions, |! |according to Article 99 of the Law No 18.046. Once |! |given the resolution that cancels the registration, the |! | merged institutions shall notify of this fact |! |the affiliates, by registered letter issued |! |within ten working days, counted from the |! |date of cancellation of the registration. The affiliates of the |! | merged institutions will be entitled to deahuciar |! |their contracts without cause expression, within the six |! |months following the merger and, if nothing says within the |! |term stated, will govern in their respect the provisions in Article 38, second paragraph, of this law. In the same |! |term they will be able to disallow their contracts the affiliates of |! | Institutions that divide or transform or in that, |! |dealing with anonymous societies, change the shareholder |! |or controlling group. The Superintendence will determine the |! |mechanisms to inform the affiliates of such |! |modifications. "23) Amend article 48, as follows: 1.-In the first subparagraph: (a) Replace your header with the following:" Article 48.- Cancelled the registration of a |! | Health Care Institution in the register and a |! Once the guarantee of article 26 has been made effective, the |! | Superintendence will have to pay the obligations that |! |the one is cautious, within a period not exceeding |! |ninety days. This warranty will be used for |! |solution: ". b) Replace the number 2), as follows:" 2) Once the credits to which you allude |! |the number 1) of this paragraph are fixed, and in the event of existence |! |a remnant, the payment of the bonuses |! |and refunds owed to the listed, loads and |! |third beneficiaries, the surplus and excess of |! |quotes, the paid contributions in form |! |advance, the quotations corresponding to the |! | Health institution Preretirement to have been |! |affiliate the contributors of that whose record is |! |cancels, or to the National Health Fund, according to |! |correspond, all of the above in full or in proportion, |! |as the case may be; " c) Assume the numbers 4) and 5), passing the |! |current 6) and 7) to be numbers 4) and 5), respectively. 2.-Add in the end the following incissos, |! |new: " The debts mentioned in the first indent are |! |accredit as follows: a) The Superintendence will communicate, through |! |electr media , the credits that to the date of |! |cancellation of the record of the Health Institution |! | Pension. For these purposes, the Institutions must |! |refer to the Superintendence, with the periodicity that |! |this determines, the updated information and |! |detail of the debts covered with the guarantee. (b) The communication referred to in the |! |literal precedent, the interested parties will have a deadline of |! |sixty days to assert their credits no |! |considered in it or to claim of the amount |! |informed. c) Within the fifteen days following the |! |expiration of the previous deadline, the Superintendence |! |will calculate the payment corresponding to each of the |! |credits, according to the rules of the first indent, and |! |will bring to the attention of the interested the result |! |of this calculation, by registered letter. The interested parties may contest the calculations within |! |of the ten days following the notification, the one that is |! |will understand practiced the third working day following the |! |receipt of the letter by the post office. d) Timed or resolved the challenges, |! |the Superintendence will pay the debts, in a term no |! |superior to ninety days. When the guarantee is insufficient to pay |! |the debts to the affiliates of a Health Institution |! | Pension whose registration has been cancelled and is |! |found declared bankrupt, the Intrend of Funds |! |and Previsional Insurance of Health must issue a |! |resolution containing the identification of the affiliate or |! |the provider and the amount due. Such resolution |! |will have executive merit and will be referred to the |! |bankruptcy, for the purposes of being considered in the payment |! |with charge to the mass of the failed. The above is understood |! |without prejudice to the right of affiliates and providers |! |to directly assert their accreances in the |! |bankruptcy. In that part which could not be solved |! |with the guarantee, the credits contained in the numeral 2 |! |the first paragraph of this article will enjoy the |! |privilege granted to the credits of the number 6 of the |! |article 2,472 of the Civil Code, which, in any case, |! |will be paid with preference to those, riying in all |! |the other the provisions of article 2,473 of the same |! | Code. ". Article 2. This law shall enter into force on the same date as the first decree containing the explicit guarantees in health of the General Regime of Health Guarantees. Any pre-retirement health contracts concluded after the entry into force of this law shall be in accordance with the law. Contracts concluded in advance shall be in accordance with their provisions in their respective annuities. Without prejudice to the foregoing, the following matters shall be governed by these rules: 1.-The retirement health contracts, the price of which, at the date of validity of this law, are expressed as a percentage equal to the legal contribution and are not those referred to in the final paragraph of Article 39 of Law No 18,933, nor those concluded by two or more workers in which benefits other than those which they could obtain with their individual contribution have been agreed; remain in force and may only be converted to promotion units or to the currency of legal tender in force in the country if the parties so agree expressly or when a change of health plan occurs for any cause. 2. Within the time limit set out in the first indent of this Article, the Intrend of Health Pre-Visionary Funds and Insurance shall establish, by means of general instructions, the design of the table of factors to be attached to the Pension Health Institutions and the rules that are necessary for the due fulfillment of this obligation. To count on the date this law will take effect, the Social Health Institutions will have to use the new factor tables in all new health contracts that they will conclude. All health plans offered as an alternative by the institutions in the adjustments that take place from the date indicated must use the new factor tables. In the case of contracts in progress at the date of entry into force of this law, the tables of factors that they contain will remain in force until the affiliate chooses to accept an alternative plan offered in some adaptation or even to hire a different health plan. In any event, the process of matching base prices that takes place between the date this law enters into force and June 30, 2006, inclusive, will be developed in accordance with the provisions in force before the entry into force of this law. and shall be governed exclusively by them. Article 3.-Declare, interpreting Articles 26, 46 and 48 of Law No 18.933, that: 1.-In the event of cancellation of the registration of a Health Care Institution, the guarantee to be maintained by the institutions shall be settled and paid exclusively by the Superintendence, even in the event of bankruptcy of the institution, thus leaving the guarantee out of the mass of the bankruptcy until it loses its inembargability. 2.-The care orders, care bonds or similar that the Health Care Institutions have issued for the financing of the benefits granted to their beneficiaries and which the health providers have, can only be in the third order of precedence for the purposes of payment under the guarantee. Article Transitory Articles first.-Those institutions of health care that, at the date of publication of this law, are also providers of health care, shall constitute, within the period of one year counted from the said publication, a new Institution of Health Care, through the creation of a different legal person, which will be understood, for all legal effects, as legal continuator of that in what it says relationship with the spin of financing health benefits and benefits regulated by law Nº18,933, especially for the provision of Article 2 of Law Nº19895. Article 2.-The maximum relation to which the numeral 4 of the third indent of Article 38b is added to the law Nº18,933 shall be, for the first decade counted from the validity of this law, up to 9 times, in the case of women, and up to 14 times, in the case of men. Article 3.-The waiver of the waiver of health contracts for a given time that, at the date of validity of this law, have agreed on the members and the Institutions of Health Care, will be maintained until the expiration of the deadline respective. In such cases, the adjustments of the basic prices that the Health Institutions provide in the terms of Article 38a of Law No 18.933 shall not consider the health contracts referred to in the preceding paragraph, for the purposes of the effects of determining the weighted average of the variations to the annuity in which the waiver ceases. Also, once the time limit has elapsed, the base price used for determining the final price of the respective contract shall be that in force for the plan concerned at that time, without any possibility for the same plan, different base prices. Article 4-Facultate the President of the Republic so that, within six months from the date of publication of this law, and by means of a decree with force of law, fix the recast, coordinated and systematized text of the decree Law Nº2,763, 1979, and laws Nºs 18.469 and 18.933. For such purposes, the President of the Republic may incorporate the amendments and derogations which have been the subject of them; include the legal provisions which have been interpreted by them; bring provisions directly and substantially together in the same text. (i) to introduce formal changes, whether in terms of wording, to maintain the logical and grammatical correlation of phrases, to qualifications, to the location of precepts and others of a similar nature, but only in the extent to which they are indispensable for coordination and systematization, and must replace, in all the rules in which it appears and as appropriate, the phrase "Health Guarantees Regime" by the phrase "General Regime of Guarantees in Health" or "Explicit Guarantees in Health". The exercise of these powers shall not, in any event, be subject to the alteration of the true meaning and scope of the legal provisions adopted. ' And because I have had to approve and sanction it; therefore, promulgate and take effect as the Law of the Republic. Santiago, 3 May 2005.-RICARDO LAGOS ESCOBAR, President of the Republic.-Pedro García Aspillaga, Minister of Health.-Nicolas Eyzaguirre Guzmán, Minister of Finance. What I transcribe to you for your knowledge.-Salute to Ud., Cecilia Villavicencio Rosas, Deputy Secretary of Public Health.