LEY NÚM. 21.674

MODIFICE OF THE DECRETO WITH FORCE OF LEY No. 1, 2005, OF THE MINISTERY OF HEALTH, IN THE MATERIAS THAT INDICA, CREASE A NEW MODEL OF ATTENTION IN THE NATIONAL FUND OF HEALTH, OTORGA FACULTIES TO THE SUPERINTENDENCE OF HEALTH, AND MODIFICATIONS RELATING TO INST

Bearing in mind that the H. National Congress has approved the following

Bill:

"Article 1 Introducing the decree by force of law No. 1, promulgated in 2005 and published in 2006, of the Ministry of Health, which establishes a consolidated, coordinated and systematized text of Decree Law No. 2.763 of 1979, and of Acts No. 18.933 and No. 18.469, the following modifications:

(1) Enter, in article 50, paragraph 1 (g), the following subparagraph (g), new paragraph (g) and (h) to be verbatim (h) and (i), respectively:

"g) Ensure the proper operation of the tendering, hiring and implementation of the Modality of Supplementary Coverage in the terms referred to in Articles 144 bis and following of this Law. For these purposes, it will be up to you, among other functions, to develop the insurance policies or policies to be observed by the insurance companies that grant the aforementioned coverage and deposit them in the Financial Market Commission, in accordance with the provisions of article 3 (e) of the Decree with the force of law No. 251, of 1931, of the Ministry of Finance, on insurance companies, anonymous companies and trading bags.

In addition, the National Health Fund will be able to carry out all the necessary actions to ensure the hiring of insurance by the beneficiary persons referred to in Article 144 bis.

(2) Please, in the second paragraph of Article 107, interchange between the phrases "of free choice," and "what the law establishes," the following: "and of supplementary coverage, without prejudice to the powers of the Financial Market Commission in respect of insurance companies."

(3) Incorporate, following article 130, the following Chapter VIII, and articles 130 bis, 130 ter, 130 quater, 130 quinquies, 130 sexies, 130 septies and 130 new octies, which comprise it:

"Chapter VIII

Advisory Council on Health Insurance

Article 130 bis.- Check out a Technical Health Insurance Advisory Council, henceforth and indistinctly the "Council", which will have the function of advising the Superintendency of Health in the process of presenting, evaluating and approving the payment plans and adjustments of the Previsional Health Institutions, for restitution of collections made in excess by applying tables of factors elaborated by those institutions other than the Table of Health Factors.

The views, pronouncements, studies and proposals of the Council shall not be binding and shall be referred to the Superintendency of Health. They must be made available to the public through the institutional website of the Superintendence, within thirty days of such referral.

The Superintendency of Health should clearly and accurately justify in its pronunciation the circumstance of not integrating or rejecting the views, pronouncements, studies and proposals of the Council, which should be made available to the public through its institutional website within thirty days of the adoption of the resolution.

Article 130 ter.- The Council shall consist of five persons, with extensive professional and/or academic experience, in matters of public health, health economy or health law.

Counselors shall be in charge of the time required for their assignment under article 130 bis.

The members of the Council shall be entitled to a diet equivalent to fifteen promotion units for each session to which they attend, with a maximum of sixty promotion units per calendar month. This diet will be compatible with other income that each counselor perceives.

It will be up to the counselors to appoint one of them as chairperson of the Council, who will chair the meetings. They should also elect one of them as a deputy to the President of the Council.

Article 130 quater.- The quality of adviser will be incompatible with the exercise of the posts of State Minister, Undersecretary, Deputy, Senator, Regional or Provincial Presidential Delegate, Mayor, Councillor, Regional Governor, Regional Advisor, Member of the Primary Scale of the Judiciary, Public Prosecutor of the Public Prosecutor ' s Office, official of the Central Bank of Chile, member of the Armed Forces and of Order and Public Security and member of the governing bodies of the political parties.

Article 130 quinquies.- The members of the Council shall be disqualified to provide advice to the Previsional Health Institutions, while exercising the post.

Those who have conflicts of interest cannot be integrated into the Council. In particular, there is a conflict of interest in the following circumstances:

(1) If in the past five years they have held the posts of directors, managers, administrators, principal executives of a Previsional Health Institution or an Institutional Health Benefit related to the provisions of Article 100 of the Securities Market Act No. 18.045, of the Securities Market.

(2) If in the last two years, as a natural person or through societies of persons of which the members of the Council are part; or in comanditas societies for actions, anonymous closed in that they or these are shareholders, or in anonymous companies open in that those or these are owners of shares that represent 10% or more of the capital, they have provided services of advice in the field of insurance of health benefits, whatever the nature.

(3) Having personal economic interest in one or more of the aspects or matters that it is incumbent upon it to know in the exercise of its function, or having it its spouse or civil convivor, children or relatives up to the fourth degree of consanguinity and second degree of affinity, including, or a legal person, in which it has, directly or indirectly, 10% or more of the participation, actions or rights, irrespective of its type, or exercises in its administration and/or functions.

(4) Participate, directly or indirectly, in an institutional private health provider related to one or more Previsional Health Institutions, in accordance with article 100 of Act No. 18.045. This inability includes any kind of participation that generates economic benefits to the member of the Council or to the natural or legal persons indicated in the preceding paragraph.

For the purposes of paragraph (3) above, it shall not be considered to have a personal economic interest if the person or any of the relatives mentioned in that numeral is or has been affiliated or beneficiary of the private health system.

Once they have ceased in their positions, and within six months, the ex-consejeros may not provide any service, either free or paid, or acquire participation in the ownership of entities for which reference is made in the previous numerals. The prohibition of this article extends to those companies that form part of the same business group in the terms of Article 96 of Law No. 18.045.

Article 130 sexies.- The following will be the cause of cessation in the post of counselor:

(a) Expiration of the period for which he was appointed.

(b) Voluntary resignation.

(c) Condemns to grief.

(d) The death of the person.

(e) Excessive psychic or physical inability to perform the post.

(f) Involve in any case of inability or incompatibility to those referred to in the preceding two articles.

(g) Serious and manifest breach of administrative probity standards. It shall be understood as such the non-compliance with the standards set out in article 130 septies, and in particular the non-compliance with the duty to abstain.

(h) Serious failure to comply with obligations as a counselor. It will be understood as a serious fault, among others, the unwarranted insistence on two consecutive meetings or four meetings of the Council, during the same calendar year, as well as the failure to comply with the duty of reservation and secret set out in article 130 octies.

The counselor for whom any causal evidence of those contained in subparagraphs (c) to (e) shall automatically cease in his or her position, and must immediately communicate that circumstance to the Council.

Verification of the cases referred to in subparagraphs (g) and (h) shall be carried out by the rest of the Council, at a meeting specifically convened for that purpose, in accordance with the provisions of the rules of procedure. For this case, the Council may sessitize without having to be convened by the Superintendent.

Article 130 septies.- Members of the Council shall be subject to the rules on administrative probity set out in Decree No. 1/19.653, promulgated in 2000 and published in 2001, of the Ministry General Secretariat of the Presidency, which sets out the consolidated, coordinated and systematized text of Law No. 18.575, a constitutional organ of the General Bases of the State Administration, and in particular the duty of abstention established in article 12 of Law No. 19,880, which governs of administrative procedures.

Counselors shall also be subject to the rules contained in Act No. 20,880 on probity in the public service and prevention of conflicts of interest, and in particular, they shall be obliged to make the declaration of interests and property set out in Title II of the Act. Also, counselors shall apply the rules contained in Act No. 20,730 regulating the lobby and the actions that represent particular interests to the authorities and officials.

Article 130 octies.- The Superintendent shall convene ordinary meetings of the Council, at least once every two months, as long as the powers provided for in this Act remain. It may also convene special meetings of the Council where circumstances so require.

To sessitize, the Council will require a minimum quorum of three members, including the presence of the chairperson or the deputy. At sessions counselors shall have the right to voice and vote. The Council will adopt its agreements by the simple majority of its members present. In the event that the majority is not reached, the president or the deputy will have the power to settle among the alternatives presented. The agreements adopted by the Council should be recorded in the record of the respective meeting, where minority votes should also be recorded.

The Superintendent of Health shall have the right to be heard by the Council whenever he deems it appropriate, and may attend his meetings.

For its proper functioning, the Council will have an executive secretariat to be headed by a staff member or staff member designated by the Superintendency, who will not receive any additional remuneration for this function, and who will have as functions act as a minister of faith in the Council, carry out the lifting of the agreements and recommendations and the proposal for a record of each session, and all those functions necessary for the proper functioning of the Council. The Superintendent of Health will also provide administrative and service support for the development of its functions.

The matters dealt with at each meeting of the Council shall be recorded in records prepared by the executive secretariat and approved in due course by persons members of the Council, who shall be subject to publicity, in accordance with the provisions of Act No. 20,285, on access to public information.

The members of the Council and the executive secretariat shall keep absolute reservation and secret of the information and documents to which they are informed in the performance of their work, without prejudice to the information to be provided in accordance with the law. ".

(4) Replace article 142 with the following:

"Article 142. Notwithstanding the provisions of article 141, members and beneficiaries who depend on them may choose to be treated under the Free Choice, Supplementary Coverage, or both, which are set out in the following articles. In these cases, they may choose the health provider who, according to the respective modality, gives the required benefit. ".

(5) Add, after article 144, the following articles 144 bis, 144 ter, 144 quáter, 144 quinquies, 144 sexies, 144 septies and 144 octies, new:

"Article 144 bis.- Affiliates in groups B, C and D may register for the Supplementary Coverage modality set out in articles 144 ter and following, while making health contributions over the past six months.

Without prejudice to the above mentioned in the preceding paragraph, those who have paid for the first time health contributions and do so in the National Health Fund may choose to register in this modality without meeting the minimum requirement for contributions.

Exceptionally, independent workers who pay their contributions in the form set out in article 92 F of Decree-Law No. 3,500 of 1980 of the Ministry of Labour and Social Security, which establishes a New Pension System, will require that the amount paid for health contributions be at least the equivalent of twelve legal health contributions for the minimum monthly income. If the funds retained by the General Treasury of the Republic for these purposes are not sufficient, they may quote in the form set out in article 90, paragraph 4, of that regulatory body.

Article 144 ter.- The Modality of Supplementary Coverage is that whereby persons affiliated with the National Health Fund, who meet the requirements set out in the previous article, are voluntarily registered in this modality for the purpose of obtaining access and financial protection for tariff-rate health benefits in a network of fixed lenders, forcing payment of a supplementary premium. The modality also contains catastrophic insurance in the terms of article 144 quater.

This modality allows registered persons to receive outpatient and hospital benefits in a borrower network and under an associated tariff. Inscribed persons shall pay an additional premium to the legal contribution for health, for which they shall receive supplementary financial coverage to that granted by the National Health Fund for the financing of such benefits.

The benefits covered in the Supplementary Coverage modality shall be financed by the National Health Fund in accordance with the tariff fixed to the effect, and in the corresponding part; by the supplementary financial coverage provided by the insurance company in the terms established by the policy, and by the co-payment to which the beneficiary attends. The supplementary financial coverage granted by insurance companies will have an annual cap in the terms set out in the policy.

A decision by the Ministry of Health, on the proposal of the National Health Fund, shall establish the tariff set out in this article. This resolution must also be signed by the Ministry of Finance. This tariff should at least provide for the benefits contained in the tariff of the free choice modality. In the case of hospital care, payment mechanisms will be envisaged to finance the solution of the health problem. The tariff of the supplementary coverage modality may consider health-related benefits not contained in the tariff of the free choice modality. For the incorporation of new benefits in the tariff of the modality, other tariffs may be considered for non-recipients of Book II of this decree by force of law, referred to in article 24 of Act No. 18,681, which establishes complementary rules of financial administration, budgetary and personal incidence.

Those benefits financed under this article shall be excluded for the granting of loans under article 162 of this Act.

Benefits derived from emergency or emergency detentions duly certified by a surgeon ' s doctor shall be governed by the rules of article 141, paragraph 2, and article 143, paragraph 3 (a), as appropriate.

Article 144 quater.- Persons who register in the Supplementary Coverage modality shall also have access to a catastrophic insurance under which they shall have the right to special financial protection that shall cover all co-payments arising from a particular health and care problem of the beneficiary who exceed, within one year of the respective policy, the corresponding deductible.

The catastrophic insurance shall operate with lenders within the same network to which the beneficiary is granted under the Complementary Coverage modality, and with respect to those benefits financed in accordance with the tariff referred to in Article 144 ter fourth.

Catastrophic insurance coverage will be provided by the insurance company that provides supplementary financial coverage. This must be activated by the insurance company automatically, once the co-payments financed by the registered persons exceed the deductible.

This catastrophic insurance will not apply to those benefits covered by Acts No. 19,966, which establishes a health guarantee regime, and No. 20,850, which creates a financial protection system for diagnosis and high-cost treatments and pays homage to don Luis Ricarte Soto Gallegos.

The resolution referred to in paragraph 4 of the previous article may exclude other benefits from the coverage of catastrophic insurance.

Article 144 quinquies.- The participant who registers in the form referred to in article 144 ter shall enroll the persons referred to in article 136 (b) and (c) of this Act, and the civil survivor, in accordance with article 29 of Act No. 20,830, which creates the Civil Union Agreement, if applicable.

Upon registration, the participant shall pay a premium for himself and for each registered person, which shall constitute an income for the insurance company that grants the supplementary financial coverage and shall not, in any case, constitute tax income or form part of the public budget; which may be heard through entities that collect social security contributions.

Employers may conclude collective agreements or contracts with their workers for the purpose of contributing to the payment of the supplementary premium for those who are affiliated with the National Health Fund and their family groups.

The supplementary premium will be the same for each of the registered persons, without distinction or discrimination. Without prejudice to the above, there may be special conditions of premium price for family groups, which will be determined in the policy. However, the price of the premium for family groups can never be greater than the sum of the premiums of all its members.

The value of the supplementary premium will be set in promotional units and will be determined in the manner established in the Licitation Bases. The Director of the National Health Fund shall, by a resolution, adjust the value of the supplementary premium, in accordance with the modifications to the tariff referred to in article 144 ter fourth and the changes in the sinisterness experienced by the population registered in the Supplementary Coverage modality, when the budgets established in the Litigation Bases are met and in accordance with the formula established therein. The adequations shall apply to persons registered in the modality at the time of the renewal of registration in the form set out in the following paragraph, after notification by the insurance company, by electronic means or certified letter, which shall be carried out thirty days in advance of such renewal.

The registration of the person affiliated in the modality shall be for a period of twelve months, automatically renewable for equal periods, and may relinquish it by informing the National Health Fund through its care channels at least ten days in advance of the original period or its renewals. Exceptionally, the participant may, at any time, waive the modality by basing his or her application in dissent, in permanent variation of his or her legal contribution and/or the composition of his or her family group. The resignation of the member must include all of his family group.

The beneficiaries who fail to pay the supplementary premium will not be protected by the coverage in the respective month. In addition, in the event that for two continuous months or three discontinuous months, within a period of twelve months, they cease to comply with the payment of the premium, they will cease to have access to the Modality of Complementary Coverage, which must be notified by the insurance company, by electronic means or certified letter, with at least five working days of anticipation to the date of cessation of the modality, and will inform the National Health Fund. The exclusion of the person from this modality must include all of his family group and does not inhibit the insurance company from pursuing the collection of insolute balances until the end of the coverage. However, in the event that the participant is a dependent or pensioned worker or worker, he or she must be reinstated or reinstated with retroactive effect if the supplementary premiums for the unpaid months are credited to them by his or her employer or by the entity responsible for the payment of the pension.

In the event that the person has ceased to have access to the Modality of Supplementary Coverage for waiver or non-payment of the supplementary premium, he or she may only re-register in that period six months after the end of the coverage. In order to register again, it must also have solved the possible debts that had been generated during its subscription to this modality in previous periods.

That the participant has ceased to have access to the Complementary Coverage modality will not involve the involvement of his or her affiliation or access to coverage through the National Health Fund.

Article 144 sexies.- The National Health Fund shall award by public tender the granting of supplementary financial coverage to which persons registered in the Supplementary Coverage modality shall be granted.

The tendering process shall be governed by the rules and conditions laid down in the respective Bases, which shall be public, contain objective criteria and requirements, and respect the principles of equality and free participation among the offenders.

The Litigation Bases for each process will be established by the National Health Fund, by resolution, which must also be signed by the Budget Directorate.

These Bases shall contain the necessary conditions for the award of tendering and continuity in the supplementary financial coverage of the persons registered in this modality, and must at least establish the following elements:

(a) The stages and deadlines of tendering, timelines and modalities of clarification of the Bases, delivery and opening of tenders, evaluation of tenders, awarding and signature of the respective contract.

(b) The conditions and requirements to be met by offers.

(c) The objective criteria that will be considered for awarding the tender, including a premium value, a sum of annual supplementary financial coverage and special premium conditions for family groups.

(d) The designation of the assessment commissions.

(e) The duration of the contract, which may not exceed four years.

(f) The conditions for granting supplementary financial coverage and catastrophic insurance, including the deductible under Article 144 quater, to be established in proportion to the supplementary premium.

(g) The conditions and requirements to be met by insurance companies both at the time of participating in the bidding processes and during the execution of the contract. Among the conditions and requirements to be established, shall be those relating to the minimum risk classifications with which each offerer must be counted at the time of the tender, the minimum assets and the risk assets that may be required especially for the supply of this coverage, the technical reserves, the instruments, assets and investment limits to be determined by the Commission for the Financial Market in accordance with the regulations of the decree with the force of the Treasury No. 251, of 1931, Ministry of the Ministry of Finance. Without prejudice to the above, insurance companies may not participate in the tender at the time of the commencement of the tendering process or have been found within the last twelve months, in any of the situations described in Title IV of the same legal text.

(h) The determination of the measures to be applied in cases of breach of contract and of the specific grounds in which such measures should be established and the procedure for their implementation.

(i) Modifications and grounds for termination of contracts.

(j) The overall characteristics and conditions of the policy, including the percentage of supplementary financial coverage, the reference value of the premium and the matching formulas of the policy, a reference minimum amount of annual supplementary financial coverage cap and special premium price conditions for family groups.

(k) Any other condition that the National Health Fund deems relevant or necessary for the proper development of the Modality of Supplementary Coverage.

Article 144 septies.- In the event that the tender was dismissed, or all tenders were declared inadmissible in the bidding process, the National Health Fund should convene a new public tendering process within three months of that declaration. In order to convene this process, the Fund shall issue a new resolution establishing the bases for this new process in accordance with article 144 sexies.

If the new bidding process is not awarded to one or more of the applicants, the National Health Fund will be able to conduct a direct procurement process in accordance with the terms of reference set by the National Health Fund through a well-established resolution to be signed by the Budget Directorate and published on its institutional website.

In the case of contracts already awarded, and it is appropriate to make a new tendering process, if it is declared a desert, that declaration will enable the National Health Fund to extend the contracts awarded in force for one time. If the extension is not possible, the National Health Fund may conduct a direct recruitment process in accordance with this article.

In any case, participants and beneficiaries will continue to affect the Regime referred to in Book II of this Law.

Article 144 octies.- With the expiration of the contract awarded to the insurance company for the tender, or in the event of termination for any other reason, and if the new tender is awarded to a different insurance company, the beneficiaries with existing contracts will continue to be affiliated to them, until the expiration of their respective policies, after which they may choose to continue to be affiliated to this modality of supplementary coverage, in the terms offered by the new insurance company, less than ten days prior to

In all that is not expressly regulated and compatible with the provisions of articles 144 bis, 144 ter, 144 quáter, 144 quinquies, 144 sexies and 144 septies, the rules of the Free Choice Modality shall apply to the Modality of Complementary Coverage. ".

6) Add, in the final paragraph of Article 164, following the phrase "and reclassify it", the following text: "without prejudice to the ability of the Fund to reclassify it by means of a well-founded resolution, which shall be notified by electronic means or by a certified letter. The Fund should always reclassify the participants and beneficiaries who depend on them belonging to groups B, C and D, in group A at the event that such affiliates cease to know their contributions during the twelve consecutive months. The person who is a dependent or pensioned worker shall be reinstated with retroactive effect if he certifies that the contribution for the unpaid months was discounted by his employer or employer, or the entity responsible for the payment of the pension."

7) Replace the eighth subparagraph of article 188 with the following new eighth, ninth and tenth subparagraphs, moving from the ninth to the eleventh subparagraph, and so on:

"At the time of a health contract, the Previsional Health Institutions will not be able to offer plans whose prices are lower than the value of the legal contribution for the health of the participant, calculated on the average amount of the last six months of the remuneration, rent or pension, as the case may be.

In the event that, in successive annual adjustments, the amount of surpluses to be allocated to the individual current account exceeds 5 per cent of the legal contribution for health, the Previsional Health Institution will be obliged to offer the participant the incorporation of new benefits or alternative health plans, whose prices are closer to the value of their new legal contribution for health and have been marketed within six months prior to the offer. The general conditions of each health plan offered should be the same as the new contractors of the respective plan are being offered at that date and may not import any discrimination between such affiliates. In no case will the affiliate be obliged to subscribe to one of the alternative health plans offered by the Provident Health Institution. While you do not subscribe to a new plan whose best price is approximate to the value of your legal quote, any difference greater than 5% of the legal quote will not generate surpluses.

However, the revisions to the annual adequacies referred to in the preceding subparagraph may not take into account the health status of the participant and its beneficiaries. ".

8) Article 189:

(a) Interclude, at the chapeau of the second subparagraph, between the word "free" and the term "performances", the following phrase: "the health plan, which may consider benefit bonus or benefit packages, should be detailed."

(b) Add, following the seventh subparagraph, the following eighth, new, paragraph, to the present eighth paragraph, to be ninth, and so on:

"With the sole objective that the Isapres may review the correct issuance of the accounts collected by the health providers with whom they have payment agreements through benefit packages, the lenders must make available to the Previsional Health Institution the details of the benefits granted to the beneficiaries who have required health care through this modality."

9) Add the following paragraph 1 of article 190, the next subparagraph, the second, the second subparagraph, to the second subparagraph, to the third subparagraph, and so on:

"What is stated in the preceding paragraph shall not apply to supplementary plans whose bonus is defined in fixed copayment or through payment mechanisms to the benefit package provider, such as diagnostic payment or diagnostic-related groups. In no case, the coverage provided by the Previsional Health Institutions may be lower than those provided by the National Health Fund for the same benefit contained in the above-mentioned payment mechanisms. ".

10) In article 206 (2):

(a) Replace the phrase "within the ninety days following the publication of the said decree" with the following: "within the period provided for in the following article".

(b) Interclude, between the expression "each Previsional Health Institution" and the point and then the phrase ", together with the amounts resulting from the verification carried out in accordance with Article 206 bis".

11) Add, following article 206, the following article 206 bis, new:

"Article 206 bis.- The Superintendency of Health, through the Intendence of Previsional Health Funds and Insurance, will verify the price that the Isapres will charge for the Explicit Health Guarantees, in accordance with the following procedure:

(a) Within fifteen days from the publication of the decree establishing or amending the Explicit Health Guarantees, the Isapres shall inform the Superintendent of Health of the prices that will be charged for such guarantees to its affiliates. In such a communication, the Isapres must point out and justify the price they will charge for the Explicit Health Guarantees and accompany all the technical backgrounds that serve as the basis for calculation.

The Superintendency of Health, by means of a circular issued for this purpose, will determine the information, as well as how to present each of the above technical backgrounds.

(b) With such a background, the Superintendency of Health will verify the price of each Isapre.

Verification of prices reported by Isapres should consider the variation in the costs of health benefits, and the variation in the frequency of use experienced by them. It should also observe the cost of the benefits included in the Explicit Health Guarantees baskets, the effective use rate of such guarantees by the beneficiaries, and the cost verification study regulated by Act No. 19.996, which establishes a Health Guarantees Scheme.

(c) The Superintendent of Health shall issue a resolution that shall contain the verification of the prices reported by the Isapres and the price to which each of them shall be charged by the Explicit Health Guarantees to its affiliates, within thirty days from the publication of the decree referred to in letter (a). This resolution should be published in the Official Journal and on the website of the Superintendency of Health.

The prices that will charge the Isapres for the Explicit Health Guarantees thus fixed will be justified for all legal effects. These prices will enter into force together with the decree that refers to verbatim (a). ".

(12) Amend article 226 as follows:

(a) Add, in paragraph 1 (3), the following second, new paragraph, to the second paragraph to the third paragraph:

"Unrelated lenders shall be preferred, for whose determination shall be to the definition of a related person established in Article 100 of Law No. 18.045."

(b) Replace, in the penultimate paragraph, the expression "the concursal procedure" by "the concursal procedure".

Article 2°- The Superintendency of Health will determine, by means of a circular issued especially for these purposes, how to make effective the adequacy of the final price of all forecast health contracts to which the Previsional Health Institutions applied a table of factors elaborated by themselves and different from the Single Table of Factors established by the Superintendency of Health.

This circular shall contain at least the following instructions for the Previsional Health Institutions:

(1) The obligation to adjust the final price of all the health forecast contracts that were in effect as at 1 December 2022 and which did not employ the Single Table of Factors contained in the IF/N° 343 Circular of 11 December 2019 of the Superintendency of Health.

This adequacy may not import an increase in the final price of the existing contracts.

The obligation to adjust will also not be able to import a reduction in the agreed price of the contracts under the value of the mandatory legal quote at the time the adequacy of the final price was calculated. The value of the compulsory legal contribution shall be calculated on the average amount of the last six months of the remuneration, rent or pension as the case may be, counted from the calculation of the adequacy. If, at the time of applying the adequacy indicated in this numeral, the participant had a foreseeable contract of health at a price lower than his legal contribution, the adequacy procedure may not import a modification of that price.

This adequacy shall be carried out simultaneously with the adjustment referred to in article 9 of this Act.

(2) The obligation to inform the Superintendency of Health of all contracts that, on the occasion of the application of the preceding numeral, result at a final price lower than the one charged and perceived by the respective Institution, should indicate those differences in promotional units, for each of them.

(3) The obligation to replace, in the terms set out in articles 3 and below, the amounts received in excess by the Previsional Health Institutions, since 1 April 2020, as a result of the process of adequacy of factor table. Restitution shall not consider the amounts of surpluses in accordance with article 188 of the Decree by force of law No. 1, promulgated in 2005 and published in 2006, of the Ministry of Health, which, in the period concerned, were already returned, waived or required by persons affiliated for the purposes set out in the said article. The unreturned, waived or required by the affiliates must be restored in full.

(4) The obligation to replace, in the terms set out in articles 3 and below, the amounts received by the Previsional Health Institutions for the collection of non-nates and under two years of age, from 1 December 2022. These collections may not be required or made retroactively, once the beneficiary is two years old.

Calculated the final price of the contracts in accordance with paragraph (1) above, the Previsional Health Institutions may only raise the final price of such contracts when it is based on the incorporation of new charges or beneficiaries and the sum of the risk factors of the family group there provided for, the charge of which will be suspended until the new beneficiary is two years old.

This article is without prejudice to the adequacy of prices that legally correspond in accordance with this law and the decree by force of law No. 1, promulgated in 2005 and published in 2006, of the Ministry of Health, as well as the obligation to know the quote set out in article 84 of Decree Law No. 3,500 of 1980.

The circular referred to in this article shall also indicate the manner and time limit in which the Health Insurance Institutions shall notify the persons affiliated with the changes made in the health contracts resulting from the adequacy noted in numeral 1), as well as any other measure that the Health Superintendency considers relevant.

Article 3.- Within one month of the publication of the circular mentioned in the previous article, which is extended for one time for one month, the Previsional Health Institutions shall submit to the Superintendency of Health a payment plan and adjustments, which shall include at least the following:

(a) A proposal for the return of debt resulting from the application of the rules contained in the previous article, for each month in which a table was occupied other than the Single Table of Factors contained in the IF/N° 343 Circular of 11 December 2019, of the Superintendence of Health. This proposal should contain, at least, the number of contracts affected to return; the amounts to be returned to each person who is affiliated with a health contract, expressed in promotional units; the maximum period of return; the modalities of return; compensation proposals, if appropriate, and all backgrounds that take into account the value of the debt.

(b) A proposal to reduce the costs of the Institution. This proposal should include, at least, an efficient payment system for lenders and a cost transparency policy for affiliates.

(c) A proposal to incorporate into all contracts administered by the Institution, an extraordinary premium per beneficiary, corresponding to the amount necessary to cover the cost of obligations with its affiliates, corresponding to benefits, medical licenses, excesses and surpluses of contributions, among others. It should also consider the operational and non-operational costs that permit compliance with health contracts, including, in addition, the cost-containing measures proposed in the same plan.

With regard to the proposal noted in subparagraph (a) above, the period of return of the debt may be up to thirteen years. However, the proposal should consider mechanisms to ensure that the debt of persons over eighty years of age is paid in full within the first twenty-four months of implementation of the payment plan and adjustments; and that the debt of persons aged sixty-five years or older is paid within the first sixty months.

In respect of the amounts owed, the Previsional Health Institutions may offer to return such amounts to persons affiliated in the form of surpluses, and may require them for the purposes set out in article 188, paragraph 4, of the Decree with force of law No. 1, promulgated in 2005 and published in 2006, of the Ministry of Health. For this purpose, the debt shall be accrued in monthly contributions to be recognized in the current account referred to in Article 5.

Alternatively, the Previsional Health Institutions can always offer accelerating the payment of the debt and partially paying or all of the cash debt directly to the listed individuals. The person or the applicant may request, at his or her will, the advance payment of the debt or a portion of the debt and, for this purpose, he or she may transfer to the Previsional Health Institution by a single payment agreed between the parties, whose amount will correspond to the insolute balance, total or partial, of the debt less a discount rate for the temporary payment preference. The discount rate may not exceed the equivalent of the conventional maximum interest rate at the time of the agreement. In the event that the Previsional Health Institutions intend to use this mechanism, they must report it to the payment plan and adjustments. If the applicant and the respective Institution entered into such an agreement, the Previsional Health Institution shall inform the Superintendency within five working days of the date of the agreement.

With regard to the premium established in subparagraph (c) above, the latter may not consider the deficit that the Provident Health Institution might have presented prior to 30 November 2022. In addition, the above-mentioned premium may not imply an increase of more than 10 per cent per contract in respect of the discounted health contribution of the remuneration, pensions and rents affected to those, corresponding to the month of July 2023 or at the time of the application of the extraordinary premium if the contract was subsequent to that date. In the case of independent and voluntary contributors, the premium may not involve an increase of more than 10 per cent by contract with respect to the quote agreed in the month of July 2023 or at the time of the application of the extraordinary premium if the contract was later.

The Superintendency of Health, following a review of compliance with the minimum contents of the respective plan, will forward it within five days to the Advisory Council on Previsional Insurance, which will have thirty days to issue a recommendation based on plan submitted by each Previsional Health Institution.

Pursuant to the time limit set out in the preceding paragraph and in the light of the recommendation of the Council, the Superintendence shall be pronounced on the respective plan, adopting it or instructing changes necessary for its approval, within 10 days of the receipt of the respective recommendation of the Council. No appeal shall be made against this resolution.

In the event that the Superintendent of Health instructs changes to the plan, the Previsional Health Institution must present a new plan with the corresponding modifications, within thirty days from the notification of the administrative act that instructs the modifications. Upon receipt of the new payment and adjustments plan, the Superintendence shall transmit it within the second working day to the Advisory Council on Previsional Insurance, which shall have a ten-day deadline to deliver its recommendation. The Superintendence will rule over this new plan, approving or rejecting it. Contrary to the resolution rejecting it, the replenishment and hierarchical remedies will be made in accordance with article 113 of the decree by force of law No. 1, promulgated in 2005 and published in 2006, of the Ministry of Health.

If the Superintendency rejects the modified plan, it must set a payment plan and adjustments, after consultation with the Advisory Council on Previsional Insurance, within thirty days. In this case, the Superintendency may subject the Previsional Health Institution to the special supervigilance and control regime established by article 221 of the decree with force of law No. 1, promulgated in 2005 and published in 2006, of the Ministry of Health, with the same powers indicated therein.

The approval of the payment plan and adjustments by the Superintendency shall consist of a resolution which shall at least make explicit the maximum period of return, the return fees, the conditions under which the respective Provisional Health Institution shall restitution of the amounts owed, and the manner in which each person shall be notified.

Failure, late or partial compliance in the delivery of the payment and adjustment plan, or in the implementation of the payment plan, shall be punished in accordance with Chapter VII of Book I of the Decree by force of law No. 1, promulgated in 2005 and published in 2006, of the Ministry of Health. The above, without prejudice to the fact that, in the event of non-compliance with the implementation of the respective plan, the Superintendence may directly establish a payment plan and adjustments, in accordance with the rules set out in paragraph 9 above.

In the event of a delay in the payment plan approved by the Superintendency of Health, the average interest paid by banks in readjustable operations of no more than one year will be earned, as reported by the Central Bank of Chile in the respective period.

Article 4°- In the opportunity and manner in which the application of the extraordinary premium is reported, the Previsional Health Institution should offer one or more alternative plans whose agreed price is equivalent to the current one, unless the minimum plan price is offered. For this purpose, the provisions of article 197 of the Decree with force of law No. 1 of 2005 and published in 2006 of the Ministry of Health shall operate.

Within six months of the application of the extraordinary premium, the persons concerned may apply to it for their Previsional Health Institution to change to any of the plans offered to them, for which they may not be required to subscribe to a new health statement and will operate the delivery at the time of signing the contract applied to the extraordinary premium.

Article 5.- The debts contained in the payment and adjustments schemes, referred to in Article 3 and which are approved by the Superintendency, shall be recognized in an individual current account that the Previsional Health Institutions shall open in favour of each person affiliated especially for this purpose, and that shall be clearly differentiated for all the accounting effects of those surpluses that are generated in accordance with Article 188 of the Decree, as provided for in Article 1 of the Law,

This account may not be closed until the full payment of the debt and the Previsional Health Institutions may not, in any case, charge for the maintenance of that account to the affiliates.

The debt shall be accrued on a monthly basis, and the Previsional Health Institution shall make available to the member ' s account the corresponding debt assessment according to the period of return provided for in the payment plan and adjustments.

The funds accumulated in the account will be adjusted according to the variation experienced in the Consumer Price Index, without interest. For this purpose, the Previsional Health Institution shall, every six months, make such readjustment available to the member ' s account.

The debts that each Previsional Health Institution report in its payment plan and adjustments shall not be considered in the guarantee that they must maintain in an authorized entity equivalent to the amount of the obligations assumed, in accordance with article 181 of the decree with force of law No. 1, promulgated in 2005 and published in 2006, of the Ministry of Health. In addition, they shall not be considered for the calculation of the indicators of articles 178 and 180 of the aforementioned decree with the force of law No. 1, nor for the determination of the minimum assets established in article 178 of the same legal body.

In the event that the health contract between the affiliate and the Previsional Health Institution is terminated with which it maintains a credit of those informed in the payment plan and adjustments to Article 3, the Institution shall continue to make available to the member account the corresponding debt assessment according to the payment plan and adjustments. This rule will be applied every time the person migrates to another Previsional Health Institution or the National Health Fund, until the total payment of the debt.

If the cancellation of the registration of a Previsional Health Institution occurs, the eventual default of the debts generated by the adequacy of the final price of the plans will be paid in the sixth priority order as a first-class credit, in accordance with the provisions of article 2472, paragraph 6, of the Fourth Book of the Civil Code.

Article 6.- The Previsional Health Institutions may make a division of dividend or distribution of profits only if they have paid the entire debt of the excess amounts referred to in the previous article and have been certified by the Superintendency of Health previously.

To this end, the Previsional Health Institution must inform the Superintendence of Health of the total payment of the amounts received in excess, accompanying all the backgrounds that give account of it, the Superintendence must certify compliance within ten working days, counted from the date of receipt of the Institution communication with the respective background.

If the Superintendency becomes aware that a Previsional Health Institution, in session or board, is this ordinary or extraordinary, approved to make a division of dividends or distribution of profits, without the proper certification of the total payment of the amounts perceived in excess, it may impose one of the following penalties:

(a) A tax benefit of 10 to 20 per cent of the value of the dividends or the profits that were agreed to be distributed, in the event that those have not reached distribution.

(b) A fine of 25 to 35 per cent of the value of the dividends or distributed profits, if the operation has been improved.

For the specific determination of the appropriate fine to apply, the number of persons affiliated whose debt has not yet been paid in its entirety; the risk caused to the security of the forecast system; the economic benefit obtained on the basis of the infringement; the intentionality in the commission of the infringement; the economic capacity of the offender; the collaboration of the offender; to have been previously sanctioned for the infractions specified in this article, and any other criterion that is relevant.

Prior to the application of the penalty, the Superintendency shall notify the charges to the affected Previsional Health Institution, which shall have a ten-day period to formulate its discards. After such a period of time, with or without discards, the Health Insurance and Previsional Intendent will issue a well-founded resolution of the matter.

During the administrative procedure referred to in the preceding paragraph, the Superintendence may dictate the provisional measures it deems appropriate to ensure the effectiveness of the decision, if there are sufficient evidence to do so. In this regard, it may order the banking institutions or financial entities that correspond to the retention of the funds or deposits of the institutions and the prohibition of transaction of shares, bonds or musttures. It may also decree any measures necessary to avoid the use, use, benefit or destination of any kind of property, values or money of the Institution.

In cases of urgency, in order to avoid the consolidation of legal situations arising from the offence, the provisional measures referred to in the preceding paragraph may be issued prior to the initiation of the administrative procedure referred to in paragraph 6 of this article. These measures must be confirmed, modified or lifted by the Superintendency in the initiation of the procedure, which must be carried out within ten working days of its adoption. The measures shall be void if the procedure is not initiated within that period.

Provisional measures may be lifted or amended in the course of the proceedings, under circumstances that may arise or may not be taken into account at the time of their adoption. In any event, they shall be extinguished with the effectiveness of the administrative resolution that puts an end to the procedure concerned. In the event of an order of detention, the resolution ordering the fine will also order the restitution of the money to the Institution of Institution of Institution of Institution of Institution of Institution of Institution of Institution of Institution of Institution of Institution of Institution of Institution of Institution of Institution of Institution of Institution of Institution of Institution of Institution of Institution of Institution of Institution of Institution of Previsional Institution of Institution.

In contravention of the resolutions referred to in this article that impose a sanction or that render an interim measure, the remedies and claims set out in article 113 of the decree by force of law No. 1, promulgated in 2005 and published in 2006, of the Ministry of Health may be filed.

The distribution of dividends or the withdrawal of profits that are made without the corresponding certification shall be null and void and shall result in the personal responsibility of the managers and managers of the Previsional Health Institution, as well as those who have perceived dividends or profits, in solidarity with the Institution.

Article 7°- The malicious delivery of false or incomplete information on the implementation of payment plans and adjustments shall be punished with minor presiding at their midpoint. If the delivery of false or incomplete information is made for obtaining the authorization referred to in the previous article, the penalty shall be less presiding to the maximum extent. Coercion to obtain such authorization shall be punished equally.

The one who, within the year prior to the failure to comply with a payment plan and adjustments, knowing the bad state of his business or with inexcusable ignorance about the bad state of his business, will perform some act in a Previsional Health Institution manifestly contrary to the requirements of a rational heritage administration, will be punished with the penalty of lesser imprisonment to its maximum degree. If the act contributes to the improvement of the property or financial situation of the Institution and is carried out within two years prior to the resolution of reorganization or liquidation, or during the time between the notification of the demand for forced liquidation and the issuance of the respective resolution, the penalty shall increase to one degree.

The offences referred to in the preceding subparagraphs shall be considered as offences of first category, in accordance with article 1 of Act No. 21.595 of economic offences.

Article 8.- As long as the payment and adjustment plan is in force, and to the extent that the Superintendence of the plan has been informed, the Previsional Health Institutions may offer the affiliates long-term debt representative titles for the total amount of the debt owed or for the balance still not recognized in the surplus account referred to in Article 3rd. However, the term of these titles may not exceed the period of return provided for in that plan and should always be issued captive. In no case shall affiliates be obliged to accept debt representative titles. These titles shall be governed by the provisions of the Securities Market Act No. 18,045.

Article 9°- Without prejudice to the provisions of article 188, paragraph 8, of the Decree with the force of law No. 1, promulgated in 2005 and published in 2006, of the Ministry of Health, exceptionally and for a single time, all health contracts that have a agreed price that is less than the compulsory legal contribution, shall be in accordance with the value of such quotation.

This adjustment shall be made after the instruction of the Superintendency of Health, which may be included in the circular dealing with Article 2 of this Law or another different.

With regard to the health contracts that their final prices have been or should be appropriate in accordance with Article 2 of this Law, this adjustment shall operate on the value of the plan obtained when applying the provisions of paragraph (1) of this Article.

In order to make the adjustment effective, the Previsional Health Institution should provide the affiliate with new benefits. It will also offer alternative plans whose agreed price is closer to the value of its legal contribution for health and have been marketed within six months prior to the offer. The general conditions of each health plan offered should be the same as the new contractors of the respective plan are being offered at that date and may not import any discrimination between such affiliates.

For the above, the Previsional Health Institutions shall notify the adjustment to all affected affiliates, within the time limit and in the manner provided by the Superintendency in circular respect. At the same time and form, they shall report on the benefits and alternative plans mentioned in the preceding subparagraph.

The participant may choose to maintain his plan adjusted to the new value with the benefits offered, accept any of the alternative plans, or disaffiliate himself from the Previsional Health Institution. At the event that nothing says, it will be understood that the person agrees to maintain his plan with the new benefits proposed by the Institution.

However, within six months of the notification, participants may apply for a change to any of the plans offered to them by their Previsional Health Institution, for which they may not be required a new health statement, keeping the delivery at the time of the contract that was adjusted.

Article 10.- For contracts under Article 2(1) of this Law, the modifications to the basic prices of the health plans carried out in accordance with Articles 197 and 198 of the decree by force of law No. 1, promulgated in 2005 and published in 2006, of the Ministry of Health, shall be applied in the future on the final price.

For this purpose, the final price of the contracts indicated in the preceding paragraph shall be the price paid less by the Explicit Guarantees and the value of the Previsional Health Institutions for any additional benefits agreed upon.

Article 11. The Superintendency of Health will monitor any aspect that protects the correct application of articles 2 and 2 of this Law. For the performance of this function, it may require all financial, accounting and operational information to the Previsional Health Institutions and may treat personal data, for which it may require the National Health Fund, Ministry of Health and other public agencies, private health institutions and health providers, any aggregated or disaggregated information, registration or data necessary. The personal data obtained in this process shall be protected by law No. 19,628 on the protection of private life.

In the event that the private institutions mentioned in the preceding paragraph do not refer the information within the time limits established by the Superintendency of Health or unjustly delay its delivery, they may be punished with the fines set out in articles 121, number 11, and 220 of the decree by force of law No. 1, promulgated in 2005 and published in 2006, of the Ministry of Health.

Article 12.- The Superintendency of Health shall issue a circular with rules that guarantee access to the information contained in this Act. Such standards should be consistent with the criteria of accessibility, effectiveness, inclusiveness and anti-discrimination, which would govern the health-care institutions.

Transitional arrangements

Having complied with the provisions of Article 93, paragraph 1, of the Constitution of the Republic, and since I have had the right to adopt and punish it, therefore, to promute and take effect as the Law of the Republic.

Santiago, May 20, 2024.- GABRIEL BORIC FONT, President of the Republic.- Ximena Aguilera Sanhueza, Minister of Health.- Mario Marcel Cullell, Minister of Finance.

Transcribing for your knowledge Law No. 21.674 - May 2024.- By order of the Undersecretary of Public Health.- He presents his compliments to you, Yasmina Viera Bernal, Chief of the Legal Division, Ministry of Health.

Constitutional Court

Bill amending Decree No. 1, of 2005, of the Ministry of Health, which sets out the consolidated, coordinated and systematized text of Decree-Law No. 2,763 of 1979, and of Acts No. 18,933 and No. 18,469, in the matters indicated, creates a new model of care in the Fonasa, grants powers and powers to the Superintendence of Health and amends regulations relating to the health institutions.

The Registrar (S) of the Constitutional Court, who subscribes, certifies that the Honorable Senate of the Republic sent the draft set forth in the heading, approved by the National Congress, in order that this Court exercise the preventive control of constitutionality in respect of article 130 septies contained in article 1 (3) and article 6°, and that this Magistracy, by judgement of 17 May 2024, in the Rol 15.455-24-C process.

It states:

I. That the phrase "Subsequently, the Councillors shall apply to them the rules contained in Law No. 20.880, on Probity in the Public Function and Prevention of Conflicts of Interest, and in particular, they shall be obliged to carry out the declaration of interests and heritage established in Title II of that Law", contained in the second paragraph of the new article 130 septies, as well as the new article 130 quáter, both incorporated in article

II. No provision is made, in a preventive review of constitutionality, of the remaining provisions of the draft law, for not regulating matters reserved for the Constitutional Organic Law.

Santiago, 17 May 2024.- Sebastián López Magnasco, Undersecretary.