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21 Dic 23 Significant Changes in the Regulatory Framework for Prepaid Medicine and Social Works in Argentina

Posted at 22:17h in Publications by

Agustín Cerolini, Matías Ferrari, Natalia Artmann and Julieta Sica

Through Decree No. 70/2023, (the «DNU» for its acronym in Spanish), dated December 21, 2023, the National Executive Power (the «PEN» for its acronym in Spanish) implemented significant changes in the regulations related to prepaid medicine and social works.

Below, the detail with the most relevant measures:

Prepaid Medicine:

The DNU repeals certain articles of the Prepaid Medicine Law (Law No. 26,682) to eliminate the intervention of the Ministry of Health of the Nation (the «Enforcement Authority») in contracts between individuals, specifically section 5 subsection g and m (elimination of two functions of the Enforcement Authority in relation to the control of tariffs), section 6 (elimination of Permanent Commission), section 18 (the Enforcement Authority may no longer fix the mandatory minimum tariffs), section 19 (elimination of contracts templates), section 25 subsection a (the Enforcement Authority will not receive as a source of financing the annual fees paid by the entities) and section 27 (elimination of the Permanent Council).

Social Works:

The Social Works Law (No. 23,660) has undergone numerous modifications. Social works will:

  • Act as non-state public entities
  • They shall, on the one hand, allocate their resources mainly to health services, which shall be part of the Life Insurance National System. On the other hand, they must provide other social benefits.
  • Register with the Superintendence of Health Services (the «SSS«)
  • As insurance agents, annually submit relevant documentation to the SSS to support their proper functioning.
  • Include workers, whether in the private or public sector, national retirees and pensioners, and beneficiaries of non-contributory benefits as beneficiaries.
  • Develop their own by laws and maintain their own administration and governance regime.

The SSS will act as the enforcement authority, aiming to promote, coordinate, and integrate activities in areas not governed by law. Its powers include: approving annual reports and balances of social works, providing information for the control of those entities to the National Directorate of Pension Collection, proposing interventions to the National Executive Power in cases of serious irregularities, maintaining a mandatory registry of all entities, requesting necessary information for compliance verification, and resolving conflicts related to beneficiary classification, determining the allocation of contributions. Additionally, it can intervene in cases of non-compliance with obligations as an insurance agent, based on complaints arising from the entity.

As a consequence of these changes, the right to choose a different option has also undergone variations. Workers starting a new employment relationship can exercise the right to choose an insurance agent under Law No. 23,661. Affiliates who have changed insurance agents must remain therewith for a minimum period determined by the enforcement authority, which shall not exceed one (1) year. After this period, they may exercise the option again.