LAW NO. 19,966 ESTABLISHES A SYSTEM OF GUARANTEES IN HEALTH Having present that the H. National Congress has given its approval to the following Bill: " TITLE I of the General Regime of Guarantees in Health Paragraph 1 General Provisions Article 1.-The General Regime of Guarantees in Health, hereinafter the General Regime of Guarantees, is an instrument of sanitary regulation that forms an integral part of the Regime of Health Benefits referred to in Article 4 of Law No. 18.469, prepared according to the National Health Plan and the resources available to the country. It will establish the promotional, preventive, curative, rehabilitation and palliative benefits, and the programs that the National Health Fund will have to cover to their respective beneficiaries, in their institutional care modality, according to The provisions of Law No. 18.469. Article 2.-The General Regime of Guarantees will also contain explicit guarantees in health regarding access, quality, financial protection and opportunity with which the benefits associated with a prioritized set of programs should be granted, diseases or health conditions that the corresponding decree indicates. The National Health Fund and the Health Care Institutions must guarantee these guarantees to their respective beneficiaries. The Explicit Guarantees in Health will be constitutive of rights for the beneficiaries and their compliance may be demanded by them before the National Health Fund or the Institutions of Health Care, the Superintendence of Health and the other instances that correspond. Likewise, the guarantees mentioned in the preceding paragraphs shall be the same for the beneficiaries of the laws Nº18.469 and Nº18.933, but may be different for the same benefit, according to general criteria, such as disease, sex, age group or other objective variables that are relevant. The institutions of health care will also be obliged to ensure the granting of the benefits and the financial coverage that the National Health Fund confers at least in its mode of free choice, in the terms of the article 31 of this law. Article 3.-The Ministry of Health will dictate the general rules and instructions on access, quality and opportunity for the benefits granted to the beneficiaries of the National Health Fund not referred to in the previous article, such as as standard of care and management of waiting times, taking into account the available physical, human and budgetary resources. These general rules and instructions shall be of public knowledge. The rules referred to in the preceding paragraph may not be affected by the establishment and subsequent amendments to the explicit guarantees in health, without prejudice to any changes based on health, technical and Administrative procedures. Article 4.-For the purposes provided for in Article 2, the following definitions shall be understood as: (a) explicit guarantee of access: obligation of the National Health Fund and of the Health Institutions to ensure the granting of health benefits guaranteed to the beneficiaries of laws Nº18.469 and Nº18.933, respectively, in the form and conditions determined by the decree referred to in Article 11. (b) explicit quality assurance: granting of the health benefits guaranteed by a registered or accredited provider, in accordance with Law No 19,937, in the form and conditions determined by the decree referred to in Article 11. (c) explicit guarantee of opportunity: maximum period for the granting of guaranteed health benefits, in the form and conditions determined by the decree referred to in Article 11. That period shall at least consider the time at which the benefit must be granted by the health provider concerned in the first place; the time to be served by a different provider, designated by the National Health Fund or the Pension Health institution, when it has not been attended by the first; and, in the absence of the above, the time when the provider defined by the Superintendence of Health must grant the benefit to the institutions before points. It is not understood that there is a breach of the guarantee in cases of force majeure, fortuitous case or that they are derived from an imputable cause to the benefi-ciary. (d) explicit financial protection guarantee: the contribution to be made by the benefit or group of benefits, which shall be 20% of the value determined in a reference tariff of the scheme. Notwithstanding the foregoing, the National Health Fund shall cover the total value of the benefits in respect of Groups A and B referred to in Article 29 of Law No 18.469, and may provide greater financial coverage than that provided by the Fund. Previous paragraph to persons belonging to the groups C and D mentioned in the same article, in accordance with the rules laid down in Title IV of Law No 18.469. The tariff referred to in the first paragraph of this point shall be approved in the supreme decree referred to in Article 11 and shall be subject to the procedures set out in paragraph 3 of this Title. Paragraph 2 of the Additional Financial Coverage Article 5.-Without prejudice to the provisions of Article 4 of this Law, members of the Health Care Institutions or the National Health Fund shall be entitled to financial coverage. additional charge of such bodies, as appropriate, in the terms and conditions it establishes |! |this Paragraph and its regulations. Article 6.-Additional financial coverage shall mean the financing of 100% of the copays caused only by diseases or health conditions contained in the Explicit Guarantees in Health that this law deals with, deductible referred to in the second subparagraph. The sum of the copayments that shall be accumulated for each event shall be understood as deductible to be entitled to the additional financial coverage. Article 7.-For members of the Health Care Institutions and for those belonging to Group D, as referred to in Article 29 of Law No 18.469, the deductible shall be equal to 29 monthly, legal or agreed contributions, according to corresponds, for each event associated with the Explicit Guarantees in Health that occurs to him or to the beneficiaries who are dependent; in these cases, the deductible will not exceed 122 units of promotion. In the case of affiliates belonging to Group C of the aforementioned law, the deductible will be equal to 21 monthly contributions per event. In case of more than one event in a period of twelve months, counted since the first co-payment of the first event, the deductible for the set of events, for the members of the Institutions of Health Retirement and for those belonging to Group D of Law No 18.469, shall be 43 monthly contributions, legal or agreed, as appropriate; in such cases, such deductible shall not exceed 181 units of promotion. In the case of members belonging to Group C of the said law, the deductible shall be 31 monthly contributions. For the purposes of this Article, where the basic contribution is legal, the contribution shall be determined on the basis of the average of the contributions declared or paid in the last six months or the equivalents in the case (a) payment of incapacity for work; the average must be calculated retroactively from the contribution declared or paid in the month immediately preceding the beginning of the event, or the first event, as appropriate. If less than six contributions declared or paid are recorded in the said period, the contribution shall be determined on the basis of the average number of months recording information. If the price corresponds to a fixed amount, the deductible shall be calculated on the basis of the quotation of the month preceding the month in which the first payment is due. Article 8.-In the case of independent workers affiliated to the National Health Fund and classified in group D of law Nº18.469, the deductible for each event shall be equal to twice the average of their income monthly calculated in accordance with the provisions of Article 33 of that law, averaging only the months in which it received revenue in the twelve months preceding the event; in such cases, the deductible shall not exceed 122 units of promotion. In the event that such workers are classified in Group C of that law, the deductible amount shall be equal to 1.47 times the monthly average of the said income. If there is more than one event in a period of twelve months, counted since the first co-payment of the first event, the deductible for the set of events, for the members belonging to Group D of Law No 18.469, shall be equivalent to 3 times the monthly average of the income of such members, calculated in accordance with the provisions of the preceding paragraph; in such cases, the deductible shall not exceed 181 units of promotion. In the case of affiliates belonging to Group C of the aforementioned law, such deductible shall be equal to 2.16 times the average monthly of the said income. Article 9.-The deductible shall be accumulated over a maximum period of twelve months and shall be computed from the date on which the beneficiary records the first due co-payment. If at the end of the twelve months the deductible will not be completed, the copays will not accumulate for the next period, restarting the calculation of the deductible for another twelve months, and so on. For the purposes of calculating the deductible, no payments shall be taken into account of the co-pays for benefits n or covered by the Explicit Guarantees in Health or that, being covered, have been granted outside the Internet Assistance Network or by providers other than those designated by the Health Care Institutions or the National Health Fund to grant such guarantees, without prejudice to the providers designated by the Superintendence, in accordance with Article 4 (c). Notwithstanding the provisions of the foregoing paragraph, and only for the purposes of the accumulation of the deductible, health condition explicitly guaranteed to involve vital urgency or serious functional sequel and that, consequently, requires immediate and undelayed hospitalization in a different establishment from those referred to in the Assistance Network or from the one designated by the Health Care Institution, the co-payments due shall be taken into account the establishment, according to the plan contracted or the law Nº18.469, until the patient is in a position to be transferred. Without prejudice to the provisions of the seventh indent, the treating physician in the establishment shall determine the time from which, for the purposes of this article, the patient is in a position to be transferred, in which case The following rules shall apply: (a) If the patient or his or her family members, notwithstanding the determination of the physician, opt for maintenance in the establishment, the co-pays which are payable from that time shall not be counted for the calculation of the deductible. b) If the patient or his or her family members, in the same case, opt for the transfer to an establishment that is not part of the Assistant Network or is not of those designated by the Health Care Institution or the National Health Fund, according to The provisions of the preceding subparagraph shall apply. c) If the patient or his or her family members opt for the transfer to an establishment of the Assistant Network or one of those designated by the Health Care Institution or the National Health Fund, as appropriate, it will be restarted from that moment on. the computation of the copays for the calculation of the deductible. If, after the situations described in (a) and (b) of the preceding paragraph, the patient decides to enter the Assistant Network or be attended by the provider designated by the Health Care Institution, the patient will start or restart the calculation of the co-pays for the calculation of the deductible. Establishments which receive persons in the situation described in the third subparagraph shall inform the Intrend of Prejudice Funds and Insurance within the following 24 hours, indicating the identity of the establishments. This information must be registered through the electronic page enabled by the aforementioned Intrend for these effects and will be immediately available for consultation by the National Health Fund and the Health Care Institutions. In case of a discrepancy about the qualification of a situation as a vital emergency or with a serious functional sequel, the National Health Fund and the Health Care Institutions may require that the Superintendence of Health be resolved, through the Intrend of Foresight Funds and Insurance. They must bring the order, signed by a registered physician in the Superintendence, within 24 hours after they consider that the patient is in a position to be transferred, accompanying the clinical history in which it appears to be based. If the antecedents are insufficient or are not subscribed by the aforementioned professional, the Intendence may reject the application outright. The Intendence will resolve within two days, and the cost of his intervention will be the responsibility of the applicant. In the event of repeated and unjustified challenges of the qualification made by the treating physician of emergency situations vital or with a serious functional sequel, the Intrend will sanction the applicant. Article 10.-A regulation of the Ministry of Health, which is also signed by the Minister of Finance, will lay down the rules for the proper application of the provisions of this paragraph, and must establish, among other things, the supposed facts that make up an event, the time of commencement and termination of the event, the circumstances in which an attention or a set of attention shall be considered as a vital or generating urgency for a serious functional sequel, the information to be recorded at least and the procedures to be followed by the beneficiaries, the providers and the National Fund Health and Health Care Institutions. Paragraph 3 Of the Determination of the Explicit Guarantees of the General Regime of Guarantees in Health Article 11.-The explicit guarantees in health will be elaborated by the Ministry of Health, in accordance with the procedure laid down in this law and in the regulations, and must be approved by supreme decree of the Ministry of Finance, in addition, by the Minister of Finance. Article 12.-When initiating the process aimed at establishing the explicit guarantees in health, the Ministry of Finance will set the framework of the resources available for its financing in the National Health Fund and the value of the Universal Prima, expressed in units of promotion, to which these guarantees must be adjusted. The Explicit Guarantees in Health that will be determined will not be able to generate an expected average individual cost, from all the beneficiaries of the National Health Fund and the Health Care Institutions, estimated for a period of twelve months, significantly different from the Universal Prima that has been established in accordance with the previous paragraph. Such an individual expected cost must be estimated on the basis of the referential protocols defined by the Ministry of Health and the other rules established by a regulation signed by the Health and Finance Ministers. Article 13.-The elaboration of the Proposal for Explicit Guarantees in Health will consider the development of studies with the objective of determining a list of priorities in health and interventions that consider the health situation of the population, the effectiveness of the interventions, their contribution to the extension or the quality of life and, where possible, their cost effectiveness. To this end, epidemiological studies should be developed, among others of disease burden, systematic reviews on the effectiveness, economic evaluations, potential demand and supply capacity of the Chilean health system. Article 14.-Considering the studies mentioned in the preceding article, and the national and foreign scientific experience and evidence, a list of diseases and their associated benefits will be produced, and should be discarded those for which there are no grounds that they mean a benefit to the survival or quality of life of those affected. In addition, the cost of incorporating them into the Regime should be estimated, according to the capacity of the public and private sectors and the potential demand for such interventions. A regulation will establish the variables and mechanism to be used for prioritization. Article 15.-The proposal will be submitted to a process of verification of the expected cost per beneficiary of the set prioritized with explicit guarantees, by a study called for such effects, that will be directed and coordinated by the Ministry Health. The National Health Fund and the Health Care Institutions will intervene in the process, in the form and conditions provided for in this law and the regulation, and must provide all the necessary information, in the form and conditions that the Ministry of Health request. Article 16.-For the purpose of carrying out the study referred to in the previous article, the Ministry of Health, by means of a resolution published in the Official Journal and in other printed or electronic means of broad national and international access, call for a tender for national and international bidders, which shall be governed by the rules laid down in this law and, in an additional manner, by the provisions of Law No 19.886. The administrative and technical bases shall include, inter alia, the time limit for the delivery of the study, the technical criteria on which it is to be based, the performance of an audience with the aim of making the results known to the The National Health Fund and the Health Care Institutions and a period for these and those to make observations. Article 17.-Considering the results of the study, the Ministries of Health and Finance will submit the proposal to the Advisory Council. In accordance with the procedures laid down in this paragraph and in the following paragraph, the Ministers of Health and Finance shall decide on the decree referred to in Article 11. Article 18.-Changes in the value of the Universal Prima may not exceed the variation experienced by the General Index of Remuneration Per Hour, calculated by the National Institute of Statistics, or the one that replaces it, between the ninetieth day before the promulgation of the decree containing the explicit guarantees in health that is being modified and the ninetieth day before the promulgation of the decree containing the respective modification. Article 19.-The National Health Fund and the Health Care Institutions shall periodically inform the Health Superintendence of the unit prices, frequencies and benefits granted that are part of the explicit guarantees of the Regimen and that have been required in this character; all in accordance with the instructions that, by means of circulars of general application, gives the Superintendence of Health. This information should be considered in the studies to be developed according to the Friction described in the above articles. Paragraph 4 of the Advisory Council Article 20.-A Council shall advise the Minister of Health in all matters related to the analysis, evaluation and review of the Explicit Guarantees in Health. The Council shall be convened by the Minister whenever he considers it necessary and when, in accordance with this law, he must be heard. Article 21. The Council shall be composed of nine members of recognized suitability in the field of medicine, public health, economics, bioethics, health law and related disciplines. These members will be appointed as follows: 1.-A representative of the Chilean Academy of Medicine, chosen by the latter. 2.-Two representatives of the medical faculties of the universities officially recognized in Chile, chosen by them according to the regulations. 3.-Two representatives of economic faculties or administration of the universities officially recognized in Chile, chosen by them according to the regulations. 4.-A representative of the faculties of chemistry and pharmacy of the universities officially recognized in Chile, chosen by them according to the regulations. 5.-Three members appointed by the President of the Republic, and must ensure due regional representation in their designation. The directors will perform their duties from the publication of the decree that sets the Explicit Guarantees in Health, will last for three years and their choice or designation can be renewed for one time. They shall not receive any remuneration for their performance. The Council shall be chaired by one of its members, elected by them in accordance with the Rules of Procedure. They will be able to attend their sessions, with the right to speak, the Ministers and the Undersecretaries of Health and Finance. It will also have an Executive Secretariat, in charge of a professional appointed and paid by the Ministry of Health's Deputy Public Health Secretariat, on a proposal from the Council. The Executive Secretary shall coordinate the operation of the Council, carrying out the tasks to which the regulation defines. Article 22. The Council shall, within the time limit set by the Regulation, give an opinion to the Minister for Health on the proposal referred to in Article 17. He will also give his opinion on all matters in which the Minister asks for his opinion. The amendments proposed by the Council should indicate the adjustments needed to maintain the cost of the proposal within the defined budgetary framework. In order to comply with the provisions of the preceding paragraphs, the members shall have the technical background and studies provided by the Ministry. Without prejudice to the foregoing, the Council may, through the Secretariat of Public Health, order other background and technical studies to be complementary to those provided, according to the budget, For these purposes, the Sub-Secretariat shall be used annually. The Commission may not refuse to grant such applications, if they are in accordance with the available resources. A regulation issued by the Ministry of Health, upon the suggestion of the Council itself, shall establish the provisions relating to its operation, the quorum for sessioning and the taking of agreements, the causes of inability or cessation in the office of an adviser, and the period of time. to receive the technical background to be provided by the Ministry of Health and to decide. The regulation will also indicate how the Council should collect the opinions of the National Health Fund, the Health Care Institutions and public and private health providers, which should be included in the report. Paragraph 5 Of the validity and modification of the Explicit Guarantees of the General Regime of Guarantees in Health Article 23.-The explicit guarantees in health and their subsequent modifications shall enter into force on the first day of the sixth month following the of its publication in the Official Journal. However, the changes may take effect before the deadline, when there are qualified and substantiated circumstances in the respective decree. The Explicit Guarantees in Health will be valid for three years. If they have not been modified at the end of the period referred to above, they shall be extended for a further three years and so on. However, in special circumstances, the President of the Republic may, by supreme decree, be able to arrange for the modification before the deadline indicated in the previous paragraph is met. The modifications referred to in this article shall comply with all the procedures and requirements laid down by this law, especially those referred to in paragraphs 3 and 4 of this Title. Paragraph 6 Of the obligation to grant the explicit guarantees of the General Regime of Guarantees in Health Article 24.-The National Health Fund and the Health Care Institutions must comply with the requirements of the Explicit Guarantees in Health that contemplate the Regime that regulates this law for their respective beneficiaries. The supreme decree referred to in Article 11 shall indicate, for each pathology, the time from which the beneficiaries shall be entitled to the Explicit Guarantees. Health providers must inform both the beneficiaries of law Nº18.469 and those of law Nº18,933 that they have the right to the explicit guarantees in health granted by the Regime, in the form, opportunity and conditions that it establishes. for these purposes the regulation. In the event of non-compliance, the person concerned or the representative may claim to the Superintendence of Health, which may sanction the providers with warning or, in the event of repeated failure, with suspension of up to one hundred and eighty days for The Explicit Guarantees in Health, either through the National Health Fund or a Health Care Institution, as well as to provide benefits in the Free Election Mode of the National Health Fund. In order to provide explicitly guaranteed benefits, providers must be registered or accredited to the Health Superintendence, as referred to in Article 4 (b). Also, such benefits shall be granted exclusively through establishments located in the national territory, without prejudice to what is stipulated in the respective contract for the granting of these benefits, in the case of the members of the Health Care Institutions. Article 25.-To be entitled to the explicit guarantees in health, the beneficiaries of law Nº18.469 must be treated in the appropriate assistance network. They must also access it through primary health care, except in cases of emergency or emergency, duly certified by the health care professional of the respective emergency service, and other situations that It will be decided by the Finance Minister to determine the regulation, which will also be signed by the Finance Minister. The aforementioned regulation will also determine the form and conditions in which independent health providers, who have signed an agreement for these effects with the National Health Fund, may refer to the Network in attendance at the level of care. to those beneficiaries of Law No 18,469 who have been confirmed to be diagnosed with any of the guaranteed health conditions or diseases. These beneficiaries, in order to benefit from the rules of the General Regime of Health Guarantees, must be included in the respective Assistant Network, enjoying the explicit guarantees. Article 26.-The beneficiaries of Law No 18.469 may choose, within the establishment in which they are to be cared for, the professional of their preference, provided that this allows them to comply with the explicit guarantee of opportunity. It shall be for the Director of the establishment to determine whether such availability exists. Otherwise they must be treated with the professional who is determined, within the same establishment or in the place where they are derived. Article 27.-The beneficiaries of Law No 18.469 may choose to attend to the free-choice mode, in accordance with the provisions of Articles 12 and 13 of that same legal body, in which case the Explicit Guarantees of which deals with this law. Article 28.-To be entitled to the Explicit Guarantees in Health, the beneficiaries of Law No 18,933 who have been diagnosed with any of the diseases or health conditions covered by such Explicit Guarantees, must be treated with any of the health care providers who, for such purposes, determine the Health Care Institution to which they are affiliated, according to the plan contracted for these purposes. However, the beneficiaries may choose to comply with their supplementary plan in force with the institution, in which case they shall not be subject to the explicit guarantees that this law is being dealt with. Article 29.-The Health Superintendence shall establish the mechanisms or instruments to be implemented by the National Health Fund and the Health Institutions to ensure that these or the providers, where appropriate, are aware of report, at least, the following matters as regards the explicit guarantees in health referred to in article 2 of this law: illness or health condition consulted and associated benefit; amount of the payment to be made to the beneficiary; period within which the relevant provision must be granted; the effective grant of the benefit or the causal by which it was not granted, with the express mention of the reason for the refusal. It will also have to regulate the mechanisms to be implemented by the National Health Fund and the Health Institutions to comply with the explicit guarantee of the United States. d provided for in this law if the benefit had not been granted in time to the beneficiary. Article 30.-The obligation to comply with the explicit guarantee of opportunity may be suspended in accordance with the provisions of Article 36 of the Health Code, for the maximum period of one month, which may be extended if the causes are maintained. indicated in that precept. Paragraph 7 Other obligations Article 31.-At the same time as the explicit guarantees on health will be determined, the financial coverage for the free-choice modality will be fixed, by decree of the Ministries of Health and Finance The National Health Fund must grant, at least, to the members of Law No 18.469 and to the beneficiaries who are dependent on them, a decree that will have the same period of validity as the aforementioned explicit guarantees. Article 32.-The modifications to the financial coverage that are made in accordance with the previous article, will not be able to mean a growth in the expected cost per beneficiary of the free choice modality of the National Health Fund the variation experienced by the General Nominal Index of Remuneration per Hour, calculated by the National Institute of Statistics or the body that replaces it, between the ninetieth day before the promulgation of the decree containing the Explicit Guarantees in Health that are being modified and the ninetieth day before enactment of the decree containing the respective modification. Article 33.-The decree establishing the explicit guarantees in health will determine the goals of the preventive medicine examination referred to in article 8 (a) of Law No. 18.469, which will be mandatory for the National Health Fund and The Institutions of Health Care. It will be up to the Superintendency of Health to monitor compliance with the goals mentioned in the previous paragraph. TITLE II Provisions several Articles 34.-Introduces the following amendments in law No 18.469: 1.-Add the following point (g), to Article 6: " g) Persons who enjoy the provision of an unemployment benefit in accordance with Law No 19,728 and their 2.-Substitute the heading of Article 8, and point (a), as follows: " Article 8.-The beneficiaries shall be entitled to receive the following benefits from the General Conditions of Health Insurance Scheme: a) The examination of preventive medicine, constituted by a periodic plan of monitoring and evaluation of health throughout the life cycle with the purpose of reducing morbidity and mortality due to diseases or preventable conditions or controllable to be part of the health priorities. Only those diseases or conditions for which there is evidence of the benefit of early detection in an asymptomatic individual should be considered for inclusion in the examination of preventive medicine. The Ministry of Health shall define, inter alia, the procedures, contents, time and frequency of the examination, setting equivalent conditions for the public and private sectors. The results must be handled as sensitive data and the persons examined may not be discriminated against as a result of them. " 3.-Amend Article 11 as follows: (a) Replace your first indent with the following: " Article 11.-The benefits included in the General Regime of Health Guarantees will be granted by the National Health Fund, through the Health Facilities corresponding to the Health Care Network of each Health Service and the Health establishments of an experimental nature. ' (b) The third and fourth points shall be assumed. 4.-In Article 27, the following new points are added: " The General Treasury of the Republic may withhold from the refund of income taxes, and from any other tax refund or credit in favor of the taxpayer, the sums that are adeude to the National Health Fund or to the public entities that are part of the National Health Services System, by way of care received by that or its beneficiaries in the establishments of the corresponding Assistant Network, provided that there is no dispute pending the existence of the debt, its amount or its Enforceability. For this purpose, the National Health Fund will communicate to the General Treasury of the Republic, before March 31 of each year, the individualization of the debtors and the amount to retain each of them. The money that the General Treasury of the Republic has for this concept must be rotated by it in favor of the National Health Fund, which must transfer them to the corresponding agency, all in accordance with the procedures and deadlines that The regulation is fixed. If the amount of the tax refund is less than the amount due, the taxpayer's obligation shall remain for the insolute balance. The debts generated by non-compliance in the payment of the fees mentioned in the first indent will be adjusted according to the variation experienced by the Consumer Price Index, fixed by the National Statistics Institute, between the ninetieth day prior to the date on which the payment was made and on the ninetieth day preceding that in which the payment was actually made, and shall bear the criminal interest laid down in Article 31 (4) (4). '; 5.-Amend the final paragraph of Article 30 as follows: i. Replace the expression "Health Service", by "National Health Fund". ii. Replace the phrase "according to previously defined criteria by means of a resolution founded by the Director of the National Health Fund", preceded by a comma (,): " being able to entrust that task to the Directors of the Health and the Directors of Self-Management Facilities in Network ". 6.-Amend Article 33 as follows: i. In the sixth indent, replace the words "affiliated" and "affiliated" with "beneficiary" and "beneficiaries", respectively, and the phrase "public service" by "agency of the State administration". 'affiliated' with 'beneficiary'. Article 35.-Enter the following amendments in Law No 18.933: 1.-In Article 2: (a) Replace, at the end of point (i), the expression ", and" by a semicolon (;). (b) Substitute, in point (j), the final point (.) by the letter "y", preceded by a comma (,). (c) Add, following point (j), the following point (k), new: "k) The expression" agreed health plan "," health plan "," supplementary plan "or" plan ", for any benefit or set of additional benefits to the Explicit Guarantees concerning access, quality, financial protection and opportunity referred to in the General Conditions of Health Guarantee Scheme. " 2.-In the second indent of Article 33: (a) Replace the heading, as follows: " In this contract, the parties shall freely agree to the benefits and benefits included, as well as the form, modality and conditions of their grant. However, those contracts shall comprise at least the following: ". (b) Reposition point (a), as follows:" (a) The explicit guarantees relating to access, quality, financial protection and opportunity referred to in the scheme General of Guarantees in Health, in accordance with the provisions of the law established by the said Regime. Also, a supplementary plan must be agreed to the Explicit Guarantees outlined above, which will include the benefits of Article 18 of Law No 18.469, and those referred to in Article 35 of this Law, as long as they are not part of the said guarantees. Explicit guarantees, including maximum co-payments, coverage percentages and values on which they will apply, as appropriate. This plan must include at least the benefits and the financial coverage that is set at least for the free choice to be granted by the National Health Fund, in accordance with the provisions of the General Regime of Guarantees in (c) Substitute (c) the following: "(c) Mechanisms for the granting of all the benefits and benefits to be provided by this law and those provided for in the contract." (d) Intercalase, in the first subparagraph of point (d), continuation of the word "replace", the expression: "in the mode of free choice"; and replace the the second subparagraph of that point: 'The price of the Explicit Guarantees shall be regulated in accordance with the provisions of paragraph 5 of this Title.' 3.-Substitute the first paragraph of Article 33a, as follows: ' Article 33a.- A supplementary plan shall not be provided for in which benefits are agreed for a specific benefit of less than 25% of the coverage provided by the same plan to the corresponding generic benefit. Also, the benefits may not be less than the financial coverage provided by the National Health Fund, in the form of free choice, to all the benefits provided for in the tariff referred to in Article 31 of the law that establishes the General Regime of Guarantees in Health. The clauses that contravene this rule will be held in writing. "4.-Intercalase, following Article 42, the following paragraph 5, new, passing the current paragraphs 5 and 6 to be 6th and 7th, respectively:" Paragraph 5 of the Guarantees Explicit of the General Regime of Guarantees in Health Article 42 A.-In addition to the provisions of Articles 33 and 35, the institutions of health care will be obliged to assure the listed and their beneficiaries the Explicit guarantees in Health related to access, quality, financial protection and opportunity referred to in the Scheme General of Guarantees in Health, according to the dispute (a) the law establishing the scheme. The procedures and mechanisms for granting the guarantees should be subject to the regulation and will be submitted by the Health Institutions to the knowledge and approval of the Superintendence. The provisions of Article 33 (e), (f) and (g) shall not apply to the benefits referred to in this Article, except as soon as the exclusion of benefits covered by other laws is appropriate, up to the amount paid by the latter. The price of the benefits referred to in this paragraph, and the unit in which it is agreed, shall be the same for all the beneficiaries of the Health Care Institution, without it being possible to apply the price ratio for sex and age provided for in the contract for the supplementary plan and, except as provided for in Article 42 C, shall be agreed in clear and independent terms of the price of the plan. Article 42 B.-Without prejudice to the date of affiliation, the Institutions of Health Care shall be required to ensure the explicit guarantees in health referred to in this paragraph, to count on the first day of the sixth month following the date of publication of the decree which provides for them or their subsequent amendments. Such Explicit Guarantees may only vary when the aforementioned decree is revised and modified. The Health Care Institution must inform the Superintendence, within ninety days of the publication of the aforementioned decree, the price that will be charged by the Explicit Guarantees in Health. This price shall be expressed in promotion units or in the currency of legal tender in the country. It will be up to the Superintendence to publish in the Official Journal, with thirty days of anticipation for the validity of the above decree, at the very least, the price set by each Health Institution. It shall be presumed that the members have been notified of the price, since the publication. The Health Care Institution may charge the price from the month in which the decree enters into force or when the respective annuity is fulfilled; in the latter case, the collection will not proceed with retroactive effect. The option chosen by the Health Care Institution should be applied to all members of the institution. The price can only vary every three years, counted from the validity of the respective decree, or in a lower period, if the decree is revised before the period indicated. In the subsequent modifications of the decree containing the explicit guarantees in health, the institution of health care will be able to alter the price, which must communicate to the Superintendence in the terms mentioned in the second indent of this article. If nothing says, you will understand that you have chosen to keep the price. Article 42 C.-The institutions of health insurance referred to in the final paragraph of Article 39 may ensure the explicit guarantees in the health of this paragraph and the other benefits agreed in the supplementary plan, with charge the percentage of the legal contribution for health. Article 42 D.-The rules of Paragraph 3 of Title II of this Law shall apply to the contributions corresponding to the granting of the explicit guarantees in health by the institutions of health care. Article 42 E.-Without prejudice to the second paragraph of Article 38, the affiliate may terminate the health contract within 60 days of the entry into force of the Explicit Guarantees in Health or its subsequent days. modifications. If nothing says within the said period, the affiliate may only be able to remove the contract subject to the rules contained in the aforementioned legal precept. " Article 36.-Suprimense, in the second subparagraph of Article 27 (b) of Decree Law No 2,763, 1979, the sentences beginning with the sentence "at the express request of the Minister of Health" and end with the sentence " if the circumstances so ameritan, as well as the comma (,) that antecedates. Article 37.-Without prejudice to the provisions of the General Regime of Guarantees in Health, the health benefits related to curative medical care established in the following legal norms shall remain in force: Law No. 6.174, of Medicine Preventive; law Nº18,948; law Nº19.086; law Nº19.123; law Nº19,779; decree law Nº1,757, 1977; decree law Nº1,772, 1977, and decree law Nº2,859, 1979. TITLE III Of the health liability Paragraph I General provisions Article 38.-The organs of the State Administration in the field of health shall be liable for damages caused to individuals for lack of service. The individual must prove that the damage was caused by the action or omission of the organ, mediating this lack of service. The organs of the State Administration which, in the field of health, are condemned in judgment, shall be entitled to repeat against the official who has acted with reckless recklessness or in the exercise of his duties, and by virtue of the The service was condemned. The official must always be accredited in the judgment in which the action of repetition is exercised, which shall be prescribed within two years, from the date on which the judgment in which the body is sentenced is established. or executed. Article 39.-In the case referred to in the final paragraph of the previous article, the organs of the State Administration shall instruct the corresponding summary or administrative summary investigation not later than ten days after the notification of the Term sentence. Article 40.-The action to pursue this responsibility shall be prescribed within four years from the action or omission. Article 41.-The compensation for the moral damage shall be fixed by the judge considering the seriousness of the damage and the modification of the conditions of existence of the affected with the damage produced, having regard to his age and physical conditions. Damages arising from facts or circumstances which could not have been foreseen or avoided according to the state of the knowledge of the existing science or technique at the time of the occurrence of such damage shall not be compensated. Article 42.-The National Health Fund shall be responsible for the lack of service and the Health Institutions for negligent non-compliance, their obligation to ensure the granting of the explicit health guarantees provided for in this law, provided that such non-compliance is a direct consequence of its action. The providers registered with the Health Superintendence, and not the institutions mentioned in the previous paragraph, will respond to the non-compliance with the explicit guarantees in health, in case the non-compliance is a consequence of the the action or omission of such providers. Article 43 (II)-The exercise of judicial proceedings against public institutional providers which form the care networks defined by Article 16a of Decree Law No 2,763 of 1979, or their officials, in order to obtain compensation for the damage caused in the performance of their functions for the provision of benefits, requires that the person concerned, in advance, has submitted his claim to a procedure of mediation before the State Defense Council, which may appoint as mediator one of its officials, another on secondment or a professional meeting the requirements of Article 54. In the case of private providers, the interested parties must submit to a mediation procedure before mediators accredited by the Superintendency of Health, in accordance with this law and the regulation, a procedure that will be the responsibility of the parties. The parties shall designate by common agreement the mediator and, in the absence of agreement, the mediation shall be deemed to be unsuccessful. Mediation is a non-adversarial procedure and aims to provide that, through direct communication between the parties and with the intervention of a mediator, they will reach an out-of-court settlement of the dispute. Article 44.-In the case of the first indent of the previous article, the person concerned shall submit his claim to the State Defense Council, with the indication of the full name, identity card, age, profession, office, address and other a background to be identified and the legal representative, in the event that, according to the general rules, it is necessary to act, the reason for the claim and, as far as possible, specific requests against the claimed provider, accompanying all the background you consider appropriate. In the case of the second indent of the previous article, the person concerned must submit his claim directly to the Superintendence of Health. If the mediator warns that other people might have an interest in the agreement, or that the agreement should involve people who have not appeared, they should be cited. The claim will be entered, the parties will be summoned to a first hearing, with the date, time and place in which they will appear. Article 45.-The total time limit for the mediation procedure shall be 60 days from the third day of the first summons to the claimed; upon agreement of the parties, this period may be extended until 20 days, maximum. If, within the original or extended period, no agreement is reached, the procedure shall be deemed to have failed and a record shall be drawn up, to be signed by both parties. If you do not want or cannot sign, you will be aware of the mediator, who will act as minister of faith. During the period of the mediation, the term of limitation shall be suspended, both for the civil actions and for the criminal actions to be taken. Article 46.-In the course of the proceedings, the mediator may quote all the (a) the necessary conditions for the fulfilment of the purposes of the mediation. If the first mediation hearing fails for the appearance of either party, it will be cited again. If this second citation fails to appear on the same grounds, it is understood that the mediation has failed if, within the third day, there are no credible records to justify the appearance. In the event that the appearance is declared justified, the parties shall be summoned for the third and final time for a first hearing. For subsequent hearings, if any, they shall be carried out in the same manner. Article 47.-In the first hearing, the mediator shall inform the parties about the nature and objectives of the mediation, its duration and stages and the voluntary nature of the agreements resulting from it, and shall illustrate them about the the legal value of such agreements. The parties may, at any time of the mediation, express their willingness not to persevere in the procedure, which shall be terminated by means of an act to be signed by the parties and the mediator. If any of the parties refuses to sign up, they will be put on record. Article 48. The appearance of the hearings must be personal, without prejudice to the possibility that the parties may designate a proxy expressly authorized to compromise. Institutional providers shall appear through their legal representative or a duly empowered proxy. Without prejudice to the above, the parties may be assisted or accompanied by third parties. Article 49.-The mediator shall be free to engage with the parties, either jointly or separately, from which he shall keep the other party informed. It must also be impartial and ensure that the principles of equality, speed, voluntariness, confidentiality and impartiality are respected. The mediator must help the parties to resolve their dispute by themselves, without prejudice to the proposed basis for an agreement, if necessary. In order to do so, you will be able to make personal contact with the parties, you will be able to make visits to the place where the facts occurred, require the parties or third parties the background you deem necessary and, unless any of the parties object, request technical reports from experts on the subject of mediation, the cost of which will be the responsibility of the parties. Article 50.-In the case of the first paragraph of Article 43, the mediator shall, in particular, comply with the principle of administrative probity to ensure his impartiality. The parties may request the inability of the mediator and the appointment of another to the State Defense Council, which shall resolve in a single hearing, no later than the third working day. If either party does not comply with the decision, the procedure shall be deemed to have failed and a record shall be drawn up. Without prejudice to the foregoing, if the mediator considers that there are facts or circumstances that disable him to intervene in the matter, he must declare it of his own motion and transfer it to another, as established by the regulation. If the mediator does not consider the case to be serious, it shall expose the situation to the parties and, if they do not oppose it, shall continue the proceedings before him. Otherwise, the matter will be transferred to another mediator. Article 51.-To permit the success of the procedure, all statements by the parties and the actions of the mediation shall be of a secret nature. In accordance with the provisions of the previous paragraph, both the mediator and the parties involved must reserve all that they have known during or on the occasion of the mediation process. This duty of confidentiality reaches third parties who take knowledge of the case through reports or interventions that have contributed to the development or success of the procedure. The violation of that reservation will be sanctioned with the penalty provided for in Article 247 of the Penal Code. Without prejudice to the foregoing, documents and instruments, public or private, which are accompanied by the procedure, shall not be affected by the secrecy and their use and probative value in subsequent judgment shall be governed by the general rules. The parties may require the return of the documents and instruments accompanied after the termination of the mediation procedure. Article 52.-The citations that this Paragraph establishes shall be governed by the provisions of Paragraph 1 of Chapter III of Law No 19,880. Article 53. In the event of agreement, a signed minutes shall be drawn up by the parties and the mediator. It will describe the terms of the agreement, the obligations that each of the parties assume, and the express renunciation of the claimant to all the corresponding judicial actions. The minutes shall have the effect of a transaction contract. In the case of public institutional providers, the transaction contracts must be approved by the State Defense Council, as provided in the first paragraph of article 7 of the decree with force of law Nº1, of the Ministry of Hacienda, 1993, in the case of sums exceeding a thousand units of promotion. In addition, the transaction contracts must be approved by resolution of the Ministry of Finance, in the case of sums exceeding three thousand promotion units. The amounts that are agreed to be paid as a result of the mediation will bind only and exclusively the resources of the public institutional provider involved. A joint resolution of the Ministries of Health and Finance will establish the maximum amounts that, under the procedure governed by this paragraph, will be able to pay the public institutional providers. Public institutional providers shall instruct the relevant summary or administrative summary inquiry not later than ten days after the total processing of the transaction contract, without prejudice to the right to sue him or her. the officials who have incurred the fault or the fault, in order to obtain compensation for what has been paid under the transaction contract. Article 54.-To be registered in the Register of Mediators, it is required to hold a professional title of a career of at least ten semesters of duration, awarded by an institution of higher education of the State or recognized for this, five years of work experience and not having been convicted nor having been the subject of a formalization of criminal investigation, if any, for a crime that deserves a penalty. The Health Superintendence shall establish the duties to be paid by the mediation, in the case of the second paragraph of Article 43. Article 55.-By means of a regulation issued jointly by the Ministries of Health and the Ministry of Finance, the form of designation of the mediators, the procedures for the control of the mediators, the causes of the elimination of the Registry and the other rules for the operation of the system set out in this paragraph. TRANSITIONAL PROVISIONS Article 1.-The explicit guarantees in Health of the General Regime of Health Guarantees will enter into force according to the following timetable: 1.-To count from April 1, 2005, the Explicit Guarantees will apply to a maximum of 25 pathologies or health conditions and the annual Universal Prima may not exceed 1,02 units of promotion. 2.-On 1 April 2006, the Explicit Guarantees shall apply to a maximum of forty pathologies or health conditions and the annual Universal Prima shall not exceed 2,04 units of promotion. 3.-On 1 April 2007, the Explicit Guarantees shall apply to a maximum of fifty-six pathologies or health conditions and the annual Universal Prima shall not exceed 3,06 units of promotion. If the respective decree has not been published in the Official Journal, or if, having been published, no more than five months have elapsed, the explicit guarantees shall enter into force on the first day of the sixth month. next to the appropriate publication. Article 2.-The change in the value of the Universal Prima, which is fixed in the decree after which it is issued in application of the preceding article, may not exceed the variation experienced by the General Index of the Remuneration per Hour, calculated by the National Institute of Statistics, or the one that replaces it, between the ninetieth day before the promulgation of the decree establishing the explicit guarantees in health indicated in the first article of the previous article and the ninetieth day before the promulgation of the decree containing the respective modification and, in all case, must be sufficient to cover the expected cost of the explicit guarantees included in the respective decree. Article 3.-The rules of this law shall govern the entry into force of the decree establishing the explicit guarantees in health referred to in numeral 1 of the first transitional article, in accordance with the rules of that article, except for the following exceptions: 1. The joint decree of the Ministries of Health and Finance establishing the Explicit Guarantees in Health, referred to in the first paragraph of Article 1 of the transitional Article, may be given on the date of publication of this law and the procedure for determining the guarantees shall not apply to it Explicit. For the elaboration of the remaining decrees it will be necessary to fulfill all the procedures provided for in this law. 2.-The explicit guarantee of quality will be required when the systems of certification, accreditation and registration of the Superintendence of Health come into force, in accordance with the provisions of Law Nº19,937. 3.-The rules on mediation laid down in Paragraph II of Title III of this Law shall enter into force six months after the publication of this law. 4.-The requirement that the physician be registered in the Superintendence of Health, contained in the final article 9 of this law, will be effective according to the number 2 precedent. Article 4.-The President of the Republic shall be empowered to, within a period of six months, counted from the publication of this law, by means of a decree with force of law issued by the Ministry of Health, set the texts The law of the State of the State of the State of the State of the State of the State of the State of the State of the State of the State of the State of the State of the State of the State of the State of the State of the State of the State of the State of the State of the State of the State of the State of the State of the State In the exercise of this right, the phrase "Health Guarantees Regime" must be replaced, in all the rules in which it appears and where appropriate, by the phrase "General Regime of Guarantees in Health." And by how much I have had to approve it and sanctioning it; therefore, promulgate it and take effect as the Law of the Republic. Santiago, 25 August 2004.-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 you, Antonio Infante Barros, Undersecretary of Health.