By Which The General Social Security System Reform In Health And Other Provisions

Original Language Title: Por medio de la cual se reforma el Sistema General de Seguridad Social en Salud y se dictan otras disposiciones

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ACT OF 2011
1438 (January 19)
Official Gazette No. 47957 of January 19, 2011 CONGRESS OF THE REPUBLIC

Through which the General Social Security System Reform in Health and other provisions. Summary

Term Notes Effective Jurisprudence


ARTICLE 1o. PURPOSE OF THE LAW. This law is aimed at strengthening the General System of Social Security in Health, through a model of public service delivery in health under the care strategy Primary Health allow coordinated action of the state institutions and society to improve health and creating a safe and healthy environment, to provide higher quality services, inclusive and equitable, where the center and goal of all efforts are residents in the country.
Provisions are included to establish the unification Benefit Plan for all residents, the universality of insurance and guarantee portability or provide benefits anywhere in the country, in a framework of financial sustainability.
Article 2.
. ORIENTATION GENERAL SOCIAL SECURITY SYSTEM IN HEALTH. The General System of Social Security in Health will be aimed at creating conditions that protect the health of Colombians, with the user being the central axis and articulator core health policies. For this they concur public health actions, health promotion, disease prevention and other benefits as part of a strategy of Primary Health Care, necessary to constantly promote the health of the population. To achieve this purpose, the Benefit Plan unify all residents, the universality of assurance, portability or provide benefits anywhere in the country and ensure financial sustainability of the system is preserved, among others.
To comply with this, the Government will define goals and indicators of health outcomes involving all levels of government, pubic and private institutions and other actors involved in the system. These indicators will be based on technical criteria, which will include at least:
2.1 Prevalence and incidence in perinatal mortality and maternal morbidity and infant.
2.2 Incidence of diseases of public health interest.
2.3 Incidence of chronic noncommunicable and generally the forerunners of events high cost diseases.
2.4 Incidence of communicable diseases including immuno prevalent.
2.5 Effective access to health services.
Every four (4) years the Government will make a comprehensive evaluation of the General System of Social Security in Health based on these indicators. When this assessment shows that results in poor health, the Ministry of Social Protection and the National Health evaluate and determine the measures to follow.

ARTICLE 3. GENERAL PRINCIPLES OF SOCIAL SECURITY SYSTEM IN HEALTH. Amend section 153 of Act 100 of 1993, with the following: "These are principles of the General System of Social Security in Health:
3.1 Universality. The General System on Social Security in Health covers all residents in the country, at all stages of life.
3.2 Solidarity. It is the practice of mutual support to ensure access to services and sustainability of Social Security in Health, between people.
3.3 Equality. Access to Health and Social Security is guaranteed without discrimination to persons resident in Colombian territory, for reasons of culture, gender, race, national origin, sexual orientation, religion, age or economic capacity, without prejudice to the constitutional prevalence of The rights of children.
Mandatory 3.4. Membership in the General System of Health Social Security is mandatory for all residents in Colombia.
3.5 Prevalence of rights. It is the duty of the family, the state and society in health, care for, protect and assist women who are pregnant and childbearing age, children, and adolescents, to ensure life, health, their physical and moral integrity and harmonious and integral development. The provision of these services correspond to those made life cycles in this law, within the Benefit Plan.

Focus 3.6. The principle of differential approach recognizes that there are populations with particular characteristics because of their age, gender, race, ethnicity, disability status and victims of violence for which the General System of Social Security in Health will offer special guarantees and efforts to the elimination of situations of discrimination and marginalization.
3.7 Equity. The General System of Social Security in Health must guarantee access to Plan Benefits to members regardless of their ability to pay and conditions, preventing not relevant individual benefits according to technical and scientific criteria jeopardize the resources to attention from the rest of the population. 3.8
Quality. Health services must meet the conditions of the patient according to the scientific evidence, provided comprehensive, reliable and timely manner, through humanized care.
3.9 Efficiency. It is the optimum ratio between available resources to achieve the best health outcomes and quality of life of the population. 3.10
social participation. It is the community involvement in the organization, control, management and supervision of institutions and the system as a whole.
3.11 Escalation. It is gradualism in updating the services included in the Schedule of Benefits. Free choice
3.12. The General Social Security System in Health ensure users freedom in choosing between the Health Promotion Entities and providers of health services within their network at any point in time.
3.13 Sustainability. The system recognizes the benefits be financed with resources allocated by law for this purpose, which should have an efficient and expeditious flow. The decisions taken under the General System of Social Security in Health should consult fiscal sustainability criteria. The fund management system will not affect the flow of resources from it.
3.14 Transparency. The conditions of provision of services, the relationship between the different actors of the General System of Social Security in Health and the definition of policies on health must be public, clear and visible.
3.15 Administrative decentralization. In the organization of the General Social Security System in Health management will be decentralized and it will be part of the territorial health.
3.16 Complementarity and competition. Will be encouraged to system actors in different territorial levels are complemented by actions and resources in achieving the aims of the General System of Social Security in Health.
3.17-responsibility. Everyone must advocate for self-care, the health care of your family and community, a healthy environment, the rational and appropriate use of resources the General System of Social Security in Health and fulfill the duties of solidarity, participation and collaboration. Public and private institutions promote ownership and compliance with this principle. 318
No Waiver. The right to Social Security Health is inalienable, it can not be waived in whole or in part.
3.19 Intersectoriality. It is the joint and coordinated action by the different sectors and organizations directly or indirectly, in an integrated and continuously affect determinants and health status of the population. 3.20
Prevention. It is the precautionary approach applied to risk management, evaluation procedures and the provision of health services.
3.21 Continuity. Any person having entered the General System of Social Security in Health has a durable and should not, in principle, be separated from it when their quality of life and integrity is in danger.

ARTICLE 4. STEWARDSHIP OF HEALTH SECTOR. Direction, guidance and leadership of the Health Sector will be headed by the Ministry of Social Protection, as the governing body of the sector.

The 5th ITEM. POWERS OF THE DIFFERENT LEVELS OF PUBLIC ADMINISTRATION. Add to Article 42 of Law 715 of 2001 the following numbers:
42.22. Approve the biennial Public Investment Plans for the provision of health services, departments and districts, in the terms determined by the Ministry of Social Protection, according to the policy of providing health services.

42.23. Design indicators to measure achievements in health, determine the methodology for application and distribution of resources in accordance with these, when the law so authorizes. The indicators should measure the achievements of the General System on Social Security in Health, in front of all players in the system.
Modify the following paragraphs of Article 43 and 44 of Law 715 of 2001, as follows:
43.2.7. Upholding Biennials Public Investment in Health, the municipalities within its jurisdiction, in the terms defined by the Ministry of Social Protection, in accordance with the policy of provision of health facilities plans, which consolidated constitutes the Biennial Public Investment Plan department.
43.3.4. Formulate and implement the Plan of departmental collective interventions.
43.3.9. Provide technical assistance and supervise municipalities in providing collective interventions Plan and the actions of individual public health that are made in their jurisdiction. The Ministry of Social Protection regulate the process of technical assistance, financial resources, technological, human, process management and expected results.
43.4.3. Co-finance Subsidized affiliation to the poor and vulnerable. Editor's Notes

44.3.1. Adopt, implement and adapt policies and public health plans in accordance with the provisions of national and departmental order and formulate, implement and evaluate plans for collective interventions. Adding
Article 43 and 44 of Law 715 of 2001 the following numbers:
43.3.10. Coordinate and control the organization and operation of health services under the strategy of Primary Health Care at the departmental and district levels.
44.3.7. Coordinate and control the organization and operation of health services under the strategy of Primary Health Care at the municipal level.


ARTICLE 6o. Year plan for public health. The Ministry of Social Welfare will prepare a Ten-Year Public Health through an extensive process of social participation and as part of the strategy of primary health care, which must converge sectoral policies to improve the health status the population, including mental health, ensuring that the process of social participation to be effective, by promoting the training of citizens and social organizations.
The Plan will define the objectives, goals, actions, resources, sector managers, monitoring indicators and evaluation mechanisms of the Plan.
The Ministry of Social Welfare may make modifications to the Ten-Year Plan according to health priorities according to analysis of events of interest in public health that arise.
PARÁGRAFO TRANSIENT. The first Ten-Year Plan will be in effect in 2012.

ARTICLE 7. Intersectoral coordination. For the development of the Ten-Year Health Plan in the context of primary health care strategy, will be attended by all instances that are part of the Social Protection System and other actors, who perform tasks for intervention on health determinants in a coordinated manner, under the guidelines, criteria and mechanisms National Social Policy Council (CONPES) and the Ministry of Social Protection. PARAGRAPH 1.
. For the purposes of coordination Create Yourself an Intersectoral Public Health Commission which will meet every six (6) months to follow up actions for managing health determinants, which shall inform the CONPES. PARAGRAPH 2.
. At the level of local authorities such coordination will be done through the Regional Councils of Social Security health with the participation of institutions and organizations committed to health determinants.

Article 8. NATIONAL OBSERVATORY OF HEALTH. The Ministry of Social Protection will create the National Health Observatory, as an agency of the National Institutes of Health. The National Government shall establish by regulation the conditions of organization and operation of the National Health Observatory, technical and human resources to operate and will allocate the resources for implementation.

Article 9. FUNCTIONS OF NATIONAL HEALTH OBSERVATORY. The National Observatory of Health will be responsible for the following functions:

9.1 The National Observatory of Health will be responsible for monitoring the public health indicators for each municipality and department, and will allow for information disaggregated results by Insurer, Lender and Territorial Entity. The results and impact achieved trends will be released twice a year and basis for the impact assessment results management of all stakeholders in the system.
9.2 To monitor the health of the Colombian population, by analyzing the variables and indicators recommended by the health practice and public policy on health conditions and priorities in research and development in the field. These variables and indicators can be disaggregated by sex, age, region, race and ethnicity. Serve 9.3
support to the country's authorities, in analysis of the health situation, for decision-making. 9.4 Perform
directly or indirectly, periodic assessments of the health situation of the regions of special population groups, and make the results public.
9.5 Strengthen the Epidemiological Information System, with emphasis on border areas. 9.6
create opportunities for discussion of results and construction proposals.
9.7 Make recommendations, proposals and warnings follow the Ministry of Social Protection and Health Regulation Commission, or the entity that replaces it. 9.8
Submit reports to the Seventh Joint Committees of the House and Senate before the end of each legislature on all periodic evaluations that perform them.


ARTICLE 10. USE OF RESOURCES promotion and disease prevention. The National Government will be responsible for public health policy and to ensure the implementation and results of the actions of health promotion and disease prevention as pillars of the strategy of Primary Health Care, for which determine the priority in the use of resources for this purpose administer local authorities and the Health Promotion entities.
The Ministry of Social Protection and local authorities establish goals, targets, monitoring indicators on results and impacts on public health of health promotion activities and disease prevention.
PARÁGRAFO. This does not exclude the responsibility of the Health Promotion Entities, supported by the epidemiological profile and offset the cost.

ARTICLE 11. RECRUITMENT OF SHARES OF PUBLIC HEALTH AND PROMOTION AND PREVENTION. Shares of public health and health promotion and prevention, will be implemented within the framework of the strategy of primary health care, according to the Territorial Health Plan and will be contracted and implemented in an articulated manner. The resources of territorial entities to which this article refers will continue turning and manejándose in the Master Accounts mentioned in letter B, of Article 13 of Law 1122 of 2007. Governors and mayors
hired collective actions public health of its competition with the networks formed in population space determined by the municipality based on the regulations established by the Ministry of Social Welfare, for the provision of health services, according to the strategy of Primary health Care.
The Health Promotion Entities ensure the provision of interventions of health promotion, early detection, specific protection, surveillance and treatment of diseases of public health interest, Benefit Plan with a population defined networks and space.
Networks articulated by municipalities and the Health Promotion Entities in population areas for the provision of health services will be enabled by the competent department or district entities, under the Mandatory System for Quality Assurance, in accordance with the regulations established for this purpose the Ministry of Social Protection.
The contract will include coverage by age group, goals, results, impact and monitoring indicators to be verified with the Individual Records Service Delivery (RIPS).
The Government shall regulate the inclusion of health education programs and promote healthy practices since the early school years, which will be oriented to create a culture of self-care health throughout the population.

PARÁGRAFO TRANSIENT. Until the conditions enabling networks are verified, the hiring of collective action and public health promotion and prevention, will continue to run in accordance with the rules of the enactment of this law.

ARTICLE 12. PRIMARY HEALTH CARE. Adopt Strategy Primary Health Care which will consist of three integrated and interdependent components: health services, intersectoral / sectoral action for health and social, community and citizen participation.
The Primary Health Care is the strategy of intersectoral coordination that enables comprehensive and integrated care, from public health, health promotion, disease prevention, diagnosis, treatment, rehabilitation patient all levels of complexity to ensure a higher level of welfare users, without prejudice to the legal powers of each of the actors of the General System of Social Security in Health.
Primary care makes use of methods, technologies and scientifically sound and socially acceptable practices that contribute to equity, solidarity and cost effectiveness of health services.
For the development of primary health care in the Ministry of Social Protection should define and implement tools for routine use as electronic health records throughout the national territory and other technical instruments.

ARTICLE 13. IMPLEMENTATION OF PRIMARY HEALTH CARE. To implement primary care in the General Social Security System health The following items are taken into account: 13.1
The system of primary health care is governed by the following principles: universality, multiculturalism, equality and differential focus, attention comprehensive and integrated, intersectoral action for health, community social participation and decision-making and equal citizenship, quality, sustainability, efficiency, transparency, progressive and irreversibility.
13.2 Emphasis on health promotion and disease prevention.
13.3 Intersectoral Action to impact health determinants.
13.4 Culture of self-care. 13.5
individual, family and community orientation. 13.6
comprehensive, integrated and continuous care.
13.7 Interculturalism, which includes among other elements of traditional practices, alternative and complementary health care. 13.8 Human talent
organized in multidisciplinary teams, motivated, and qualified enough.
13.9 Strengthening low complexity to improve the resoluteness.
13.10 Active participation of the community.
13.11 territorial approach.

ARTICLE 14. STRENGTHENING SERVICES OF LOW COMPLEXITY. The national government will formulate the policy of strengthening low complexity services to enhance their operational capacity, so they can solve the most frequent demands on the health care of the population.

ARTICLE 15. BASIC HEALTH EQUIPMENT. The local authority, in accordance with the regulations of the Ministry of Social Protection, define the optimal requirements to enable the creation of Basic Health Teams, as a functional and organizational concept that allows easy access to health services under the strategy of Primary Health Care. For funding and establishment of these teams will attend human talent and agency health sector resources for public health and other sectors involved in addressing health determinants.
The constitution of basic equipment involves functional reorganization, training and progressive adaptation of human talent. The basic equipment must be adapted to the needs and requirements of the population.

ARTICLE 16. FUNCTIONS BASIC HEALTH EQUIPMENT. Basic health teams will have among its functions as follows:
16.1 Perform family diagnosis, according to the unified tab that is defined at the national level.
16.2 Identification of individual, family and community risk users by age, sex, race and ethnicity.
16.3 Report on the portfolio of services of social protection in health to families according to their needs and policies and regulations of such services.

16.4 Promote membership system, full identification of families, so that identifying a person not affiliated with the processing system starts membership so they can access the services of social protection.
16.5 Inducing demand for events related public health priorities and those that cause a high impact on public health.
16.6 Facilitate the provision of basic health services, education, prevention, treatment and rehabilitation.

16.7 Effective Notes
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priority attention. Plan Benefits include a special and differentiated part to ensure the effective prevention, early detection and appropriate treatment of diseases of children and adolescents. It should be structured according to the life cycles of birth: prenatal to under six (6) years and six (6) under fourteen (14) years and fourteen (14) under eighteen (18) years.
The Health Regulation Commission or his substitute define and update this particular part and differentiated every two years, by providing health care services for children and adolescents, ensure the promotion, effective prevention, detection early and appropriate treatment of diseases, emergency care, physical and psychological restoration of violated rights and rehabilitation of physical and mental abilities of children and adolescents with disabilities, taking into account their life cycles, the epidemiological profile and disease burden.

ARTICLE 18. SERVICES AND MEDICATION FOR CHILDREN AND TEENS WITH DISABILITY AND CERTIFIED catastrophic diseases. Services and medicines of special and differentiated part of Plan Benefits for children and adolescents with physical, sensory and cognitive disabilities, catastrophic and ruinous diseases that are certified by the treating physician, will be free for children and adolescents of Sisbén 1 and 2.

ARTICLE 19. RESTORATION OF HEALTH OF CHILDREN AND ADOLESCENTS WHOSE RIGHTS HAVE BEEN VIOLATED. Services for physical and mental rehabilitation of children and adolescents who are victims of physical or sexual violence and all forms of abuse, which are certified by the competent authority, will be completely free for victims, regardless of the type of affiliation. They will be designed and implemented to ensure comprehensive care for each case, until the recovery of victims are medically certified.

ARTICLE 20. STEWARDSHIP. The State, parents or legal guardians of children and adolescents are responsible for their care and manage the timely and comprehensive health care of their children or represented minors and require the System on Social Security Health established services in the special and differentiated part Benefit Plan.
The State and the institutions of the General Social Security System in Health will establish the legal, administrative and budgetary mechanisms for effective and timely compliance with the special and differentiated part Benefit Plan and provide timely, effectively and with the quality services.

ARTICLE 21. OBLIGATION TO REPORT POSSIBLE INFRINGEMENT, abuse or neglect. Health Coaches and health institutions Entities must notify the Colombian Institute of Family Welfare (ICBF), to police stations family or, failing that, to police inspectors or municipal or district personerías, where you can be negligent parents or adults responsible for the care of children and adolescents, and also report to the Attorney General's Office when they detect signs of physical, psychological or sexual violence abuse.


PORTABILITY. All Health Promotion Entities must ensure access to health services in the country through agreements with health service providers and Health Promotion Agencies. The Health Promotion Entities may offer benefit plans in the two schemes, preserving the attributes of continuity, longitudinality, integrity, and individual and family secondment to basic health teams and integrated service networks.

Access to health care is through the identity card or other identity document.
PARÁGRAFO TRANSIENT. This provision will take effect no later than the first (1st) June 2013.

ARTICLE 23. ADMINISTRATIVE EXPENSES OF HEALTH PROMOTING ORGANISATIONS. The National Government shall fix the percentage of administrative expenses of the Health Promotion Entities, based on criteria of efficiency, actuarial and financial studies and technical criteria. The Health Promotion Entities that do not meet this percentage enter into causal intervention. This factor may not exceed 10% of the Capitation Payment Unit.
Resources for health care may not be used to acquire fixed assets or in currencies other than the provision of health services activities. Nor can it make Subsidized.
PARÁGRAFO TRANSIENT. The provisions of this article shall be regulated so that the maximum percentage of management between into force no later than the first of January 2013. The National Government will have six (6) months to make the necessary revisions based on technical studies on the percentage maximum indicated in this article and could make appropriate modifications. Until the Subsidized not define continue to manage 8%. Effective Jurisprudence

REQUIREMENTS ARTICLE 24. OPERATION OF ENTITIES PROMOTING HEALTH. The National Government shall regulate the conditions for Health Promotion Entities have a minimum number of members to ensure the scales necessary for risk management and have the solvency margins, financial capacity, technical and quality to operate properly .

ARTICLE 25. BENEFITS PLAN UPDATE. The Benefits Plan must be updated fully once every two (2) years in response to changes in the epidemiological profile and disease burden of the population, resource availability, balance and extraordinary medications are not explicit in the Benefit Plan.
The methodologies used for defining and updating Benefit Plan must be published and explicit and consult the opinion, among others, of the entities that make up the General System on Social Security in Health, organizations of health professionals, the affiliates and scientific, or organizations and entities that are considered relevant companies.
Benefits Plan can only be updated by the competent administrative authority to do so.
PARÁGRAFO. The Benefits Plan must be updated holistically before the first (1st) December 2011.

TECHNICAL COMMITTEE ARTICLE 26. SCIENTIFIC HEALTH PROMOTING ENTITY. To access the provision of services by individuals, extraordinary and required in need conditions, prescription professional treating health must be submitted to the Technical-Scientific Committee of the Healthcare Promotion Entity autonomy of its members, acting on the lack of explicit benefits, the need for the provision of special services, within a period not exceeding two (2) calendar days from the application of the concept.
The Technical-Scientific Committees should be integrated or formed by scientists and physicians. Under no circumstances the administrative staff of Health Promotion Entities integrate these committees and are doctors.
PARÁGRAFO. The formation of the Technical and Scientific Committees should ensure interdisciplinarity among specialized pairs of treating health professional and full professional autonomy in their decisions. Effective Notes

ARTICLE 27. REQUEST FOR SERVICES PROVIDED NO PLAN BENEFITS AND CREATION OF THE BOARD TECHNICAL - SCIENTIFIC PEER. The provision of services not covered by the Benefit Plan, as required in need and be relevant in the particular case in accordance with the requirement of professional treating health, shall be submitted by the sponsor of Health the Scientific Technical Committee or the Technical Board - Scientific peer of the National Health Authority, in accordance with the regulations determined.

Both the Technical Committees Scientific as the Technical Meetings - Scientific peer of the National Health, independently of its members, shall decide on the lack of explicit benefits, the need and relevance of providing extraordinary services in a no later than seven (7) calendar days from the full application of the concept, to be established by regulation and in accordance with the medical condition of the patient. Editor's Notes

The National Health Authority will have a list of specialists and other medical professionals to form the Scientific Technical Board.
The formation of the Scientific Technical Board should ensure interdisciplinarity among specialized pairs of treating health professional and full professional autonomy in their decisions.
In cases where the Government determines that the provision of services not covered by the benefit plan is decided by the Scientific Technical Board, the Health Promotion Entity must send the request to the Scientific Technical Board more than the day of receipt of the prescription health care professional.
Scientific Technical Committees should be integrated or formed by medical specialists and other professionals. Under no circumstances the administrative staff of Health Promotion Entities integrate these committees and are doctors.
The establishment of the technical and scientific committees should ensure interdisciplinarity among specialized pairs of treating health professional and full professional autonomy in their decisions.
PARAGRAFO TRANSIENT. The National Government will issue regulations within six (6) months following the effective date of this decree law.
Article 26 of Law 1438 of 2011 remain in force until the effective date of the regulations ordered by this article. Effective Notes

Editor's Notes

Effective Jurisprudence

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PRESCRIPTION ARTICLE 28. RIGHT TO REQUEST REIMBURSEMENT OF ECONOMIC BENEFITS. The right of employers to ask the Health Promotion Entities reimbursement of the value of the economic benefits prescribed in the term of three (3) years from the date on which the employer made the payment for the worker.

ARTICLE 29. ADMINISTRATION OF SUBSIDIZED. Local authorities administer the subsidized system through monitoring and control assurance affiliates within its jurisdiction, ensuring timely and quality access Benefits Plan.
The Ministry of Social Protection will rotate directly on behalf of the local authorities, the Capitation Payment Unit for Health Promotion Entities, or may make direct payments to health institutions on the basis of the defined legal instrument by the national government. In any case, the Ministry of Social Welfare may make direct rotation based on the information available, without prejudice to the responsibility of local authorities in fulfilling their legal powers. The Ministry of Social Welfare define a plan for the gradual implementation of direct rotation.
The Nation will collaborate with municipalities, districts and departments, where applicable, with the identification and registration of beneficiaries of the subsidized regime.
PARÁGRAFO TRANSIENT. Districts and municipalities of more than one hundred thousand (100,000) will continue to manage resources Subsidized Regime to thirty-one (31) of December 2012, using the legal instrument defined in this article.

ARTICLE 30. INSURANCE IN TERRITORIES WITH POPULATION geographically dispersed. The national government will define territories sparsely populated and mechanisms to improve access to health services in these communities and strengthen underwriting.

ARTICLE 31. REVENUES AND ROTATION MECHANISM OF THE RESOURCES OF SUBSIDIZED. The National Government will design a system resource management and may hire a financial mechanism to raise and directly spinning the resources that finance and co-finance the Subsidized Health, including the General System of Units and the resources mentioned in Article 217 of Law 100 of 1993. in the case of territorial self-effort the financial mechanism may be contracted with the financial system and / or the Institutes of Development and Regional Development (Infis).

There will be an individual account for each district, municipality and department, in which the securities from the funds referred to in the preceding paragraph shall be recorded, whose owners are local authorities, which should run without situation to budget and funds . For these purposes, it means that local authorities undertake the expense in determining the beneficiaries of subsidies and implement the appropriation by the twists that make the Nation in accordance with this law.
Individual account these resources to the Health Promotion Entities and / or health service providers will be rotated directly. The turn to the Health Promotion Entities will be made by paying a capitation payment unit, for each of the members who have registered and validated by the instrument defined for this purpose. In the case of service providers direct transfer of resources, it will be based on the instrument defined for this purpose. PARAGRAPH 1.
. Departments, districts and municipalities may turn your account in the payment system established by the Nation or Health Promotion Entities, resources to co-finance the subsidized health system resources for the territorial own efforts and ceded income, which they will be drawn to the health Promotion Entities to recruit people who have not been covered with resources administered by the payment system contracted by the Nation and / or providers of health services payment services that have been capitated. PARAGRAPH 2.
. Costs and expenses of administration, technical support, audit and the necessary compensation to finance the mechanism provided in this Article, shall be paid to the financial return of these or resources of the Solidarity Fund and Guarantee, if the first no they are sufficient. PARAGRAPH 3.
. The national government will unify the management system and payment of resources contributive and subsidized through the financial mechanism to be determined for this purpose.
The twists of national resources and those determined by the regulations may be made directly by the General Treasury of the Nation or Fosyga as appropriate.
The shape and operating conditions Subsidized will be determined by the national government similar to the Contributory Scheme.
TRANSITORY PARAGRAPH 1o. TERM FOR SETTLEMENT OF CONTRACTS. Governors or Mayors and the Health Promotion Entities shall within a period of three (3) calendar months from the date of enactment of this Act, to settle by mutual agreement contracts signed prior to April 1 2010. if no settlement within the terms established, territorial entity in its supports and the Healthcare Promotion entity days calendars made, if any, will proceed to the unilateral settlement within thirty (30) the expiration of the term described in this article.
The breach of these terms will result in a report to the control bodies and the respective disciplinary sanctions, and the contract amount shall be the amount of reference with which the tax liability of State agent be determined. The failure will be reported to the control bodies and corresponding monitoring.

TRANSITORY PARAGRAPH 2o. DEBTS CLEARED through contracts. The amount for the Healthcare Promotion Entity contained in the minutes of settlement by mutual agreement of contracts administration Subsidized or in the event of liquidation unilateral force on the date of entry into force of this law and those arising compliance with it, must be turned to the Sponsor of Health, Territorial Entity, within thirty (30) days of the issuance of this law, money that will be made directly to the institutions providing services health in the case where the health Promotion Entities owe their resources, the remaining amount, if any of this, will turn to the health Promoting Company within the same period.
Remaining balances in favor of the local authority, shall be drawn by the Health Promotion Entity master accounts, within the same term.

In the event that local authorities do not pay debts settled contracts, the national government in order to safeguard the sustainability of the system and ensuring access to affiliates, deducted from the resources allocated to the municipality royalties, Savings Fund for Oil Stabilization (FAEP) or other municipal sources that are available at the national level, amounts owed and will be drawn to the respective Health Promotion Entities under the terms established in this article. The National Government shall regulate the procedure for that purpose for this demanding liquidation proceedings showing all funds collected.


ASSURANCE ARTICLE 32. UNIVERSALIZATION. All residents in the country must be members of the General System of Social Security in Health. The National Government will develop mechanisms to ensure membership.
When a person requires health care and is not affiliated, proceed as follows: 32.1
If you have ability to pay cancel the service and will liaise with the Health Promotion Entity tax regime of their preference.
32.2 If the person indicates not have repayment ability, this will be answered compulsorily. The initial membership will be made to the Health Promotion Entity Subsidized by the simplified mechanism developed for this purpose. Made affiliation, Health Promotion Entity, verify within no more than eight (8) working days if the person is eligible for the subsidy in health. If not, affiliation and Health Promotion Entity shall carry out the collection of services will be canceled. It can be reactivated membership in the Subsidized when the conditions for entitlement to the subsidy is credited. In any case the payment of health services provided will be paid by the Health Promotion Entity if indeed he joined it; if it did not join they will be paid with resources to offer institution providing health services in accordance with the applicable general regulations for payment of health services.
If you do not have identification, the fingerprint registration and identification data will be taken following the procedure established by the Ministry of Social Protection in coordination with the National Civil Registry for the registration procedure.

32.3 cases not provided for in this article to achieve universal insurance will be regulated by the Ministry of Social Protection in a term not exceeding one (1) year. PARAGRAPH 1.
. Those who enter the country, are not residents and uninsured, they are encourage to purchase health insurance or Voluntary Health Plan for care in the country if necessary. PARAGRAPH 2.
. Those who enjoy the special schemes and exceptional stay in them; managers of these regimes entities must provide periodic information requested by the Ministry of Social Protection.
PARÁGRAFO TRANSIENT. From the first of January 2012 there will be no grace period in the General System of Social Security in Health.

ARTICLE 33. PRESUMPTION Affordability and income. It is presumed to ability to pay and therefore are required to join the contributory scheme or may be affiliated unofficially:
33.1 Natural persons reporting income tax and complementary sales tax and tax on industry and trade. 33.2
Those with income and withholding certificates that reflect the income established to belong to the Contributory Scheme. About 33.3
meet other indicators established by the National Government.
This is without prejudice to be classified as eligible for the subsidy through Sisbén, in accordance with the relevant rules.
The National Government will regulate a system of presumed income based on the information on economic activities. In case there are differences between the declared to the Directorate of National Taxes and Customs (DIAN) values ​​and contributions to the latter system should be adjusted.

ARTICLE 34. PARTIAL SUBSIDY TO TRADING. Eligible partial subsidy contribution not affiliated with the General System of Social Security in Health, people will pay on income contribution base of a legal minimum wage and contribution rate of 10.5%, or provide equivalent under the regulations issued by the National Government. These people are entitled to a partial grant price at or Subsidized Contributory Scheme in which case not include economic benefits. This subsidy will be 67% of the contribution or the equivalent contribution charged to subaccount resources Fosyga Compensation in the case of members of the Contributory Scheme and Solidarity subaccount in the case of the Subsidized. 33% of the contribution or contribution equivalent must be previously paid by the affiliate.

ARTICLE 35. STAYING IN SUBSIDIZED. The subsidized regime may remain in this when they obtain a work contract and move to be linked through their work. In these cases, employers or members will be paying the contributions to be paid by the contributory scheme to the same Health Promotion Entity will be compensated monthly to the subaccount of solidarity Solidarity and Guarantee Fund (Fosyga). In this event, the member shall be entitled to cash benefits.
When a temporary or day laborer whose monthly allowance does not reach a current monthly legal minimum wage, do not want to be unrelated to the Subsidized Regime because of their employment relationship, the employer must provide the subsidized system the equivalent value in proportion to the payment that the worker should contribute to the contributive regime. In this case you not entitled to cash benefits.
If the employer does not comply with the obligation to pay the price, at the end of the employment relationship the employer must pay the contributions due from the General System of Social Security in Health.
BENEFIT PLANS PARTIAL. By unifying benefit plans may be no partial benefits plans.

ARTICLE 37. HEALTH PLANS VOLUNTEERS. Replace Article 169 of Law 100 of 1993, with the following:
"Article 169. Voluntary Health Plans. Volunteers Health care plans may include coverage related to health services, will be recruited voluntarily and fully funded by the affiliate companies or establish what resources other than the mandatory contributions or subsidy to listing.
The acquisition and retention of a Voluntary Health Plan implies prior affiliation and continuity by paying the contribution to the tax regime of General System of Social Security in Health. Such plans may be
169.1 complementary care plans Compulsory Health Plan issued by the Health Promotion Entities.
169.2 Prepaid Plans Medicine, prehospital care or ambulance services prepaid, issued by entities Prepaid Medicine. 169.3
insurance policies issued by insurance companies supervised by the Financial Superintendency.
169.4 Other plans authorized by the Financial and the National Health ".

ARTICLE 38. APPROVAL OF PLANS HEALTH VOLUNTEERS. The approval of the Voluntary Health Plans and tariffs, in relation to the Health Promotion Entities and entities prepaid medicine, will be in charge of the National Health Authority, which will record the plans, within a period not exceeding thirty (30) calendar days and perform further verification. The deposit of the plans shall take before the National Health.

ARTICLE 39. CREATION OF VOLUNTEERS AND PLANS HEALTH INSURANCE. The national government will stimulate the creation, design, licensing and operation of voluntary insurance plans and individual and collective health.

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