CNSS increases Family Health Insurance outpatient drug coverage by 50%

The National Social Security Council (CNSS), approved this Thursday the increase in the coverage of outpatient medications from DR 8,000.00 to DR 12,000.00 per year, in favor of members of the Family Health Insurance (SFS) of the Contributive Regime, which contributes to reduce the out-of-pocket expenses of the population.

In an ordinary session of the governing body of the Dominican Social Security System (SDSS), Resolution No. 581-03 was approved, which also includes 70 new procedures, taking into account that these health services represent the greatest demand for the care requested by members.

The CNSS instructs the General Directorate of Information and Defense of Affiliates (DIDA) and the Superintendence of Health and Labor Risks (Sisalril) to inform the population of the new benefits and requests Pro-consumer to remain vigilant in order to avoid increases in the prices of medicines, which would result in an expense that would impact the population affiliated to the Family Health Insurance (SFS).

With the consensus of the sectors that make up the CNSS, the resolution includes biopsies and new approaches, which will reduce surgical complications and prolonged hospital stays, and will guarantee greater accuracy in reaching a diagnosis.

This resolution includes the readjustment and organization of the list of coverage described in the Basic Health Plan, making accessibility to health services more efficient, in order to avoid denial of coverage, slow response times and undue charges to the affiliated population.

The resolution establishes the reorganization of the coverage of vaccines corresponding to the Expanded Program of Immunizations, which must be granted and guaranteed with 100% coverage, without co-payments. The Administrators of Health Risks (ARS) must reimburse the affiliates of the Contributory Regime for the expenses incurred for the new benefits included.

The CNSS approved an increase to the monthly per capita of the Family Health Insurance (SFS) of the Contributory Regime (RC) of DR 128.08 charged to the People’s Health Care Account, going from DR 1,555.14 to DR 1,683.22, effective as of November 2023. It does not affect the affiliates’ pocket.

In the case of additional dependents, the increase will be reflected in the payment notices of the Social Security Treasury for the month of January 2024, for coverages as of February 2024.

The resolution was approved after receiving the proposals submitted by the Superintendence of Health and Labor Risks (Sisalril) before the National Social Security Council (CNSS), with the new benefits to be incorporated in the PBS/PDSS Benefits Catalog.

The present resolution instructs Sisalril to carry out the corresponding study to include these coverages in the subsidized regime, for the Pensioners and Retirees Plans, and submit a Report to the CNSS.

It is recalled that since 2020 to date, the CNSS has issued a series of resolutions that have improved and expanded the catalog of health services. Medical coverage has been included in cases of renal transplant, breast reconstruction for cancer, preventive prophylactic mastectomy and the development of actions to reduce maternal and neonatal mortality.

It was also approved to reduce by 50% the co-payment of the Family Health Insurance (SFS) of the Contributive Regime for hospitalization services, cesarean sections, surgeries, renal transplants and other high cost diseases.

Coverage for high cost medicines related to cancer treatment was increased from DR 1,000,000.00 to DR 2,090,000.00. Coverage was increased for hospitalization, medical fees and consultations for hospitalization, diagnostic tests, hospitalization, as well as the use of rooms and equipment, among other health services.

There was a 40% increase in medical fees for procedures and a 50% increase in inpatient consultations and a 7% increase in fees for examinations and diagnostic tests. There was also a 15% increase for the use of rooms, equipment and the use of rooms in clinics and hospitals.

Source: Presidencia.gob.do

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