NewsWhore
11-23-2009, 03:10 PM
New regulations make it easier to change health service provider known here as ARS. The Superintendent of Health and Labor Risks (Sisalril) has established a new procedure that provides better guarantees to Payroll Contribution for Family Health Insurance affiliates who request transfer from one health provider to another when their access to health care has been affected by slow payments, suspension or denial of service.
The disposition is contained in Resolution176-09 on the process for transferring from an ARS due to delays, suspension or denial of service to affiliates of the Family Health Insurance program.
Superintendent of Health and Labor Risks Fernando Caamano pointed out that while Law 87-01 establishes that affiliates can change from one ARS to another once a year, he says they can also change at any other time when they feel that the service of their health service provider does not satisfy their needs. For instance, if the ARS denied coverage to one or several services covered in the Dominican Program of Social Services, or that due to negligence it did not authorize or administer a procedure, with the exception of cases mentioned in Law 87-01.
Caamano said that the new resolution establishes a mechanism that allows faster processing between the entities involved in the transfer request and the company that is processing the Dominican Social Security System database, Unipago.
The resolution establishes that the affiliate can request a transfer if they or any of their dependents have been denied health service for an unjustifiable reason such as non-payment by the ARS to the Social Security Plan. Other reasons are when the lead affiliate or their dependents are subject to periods of minimum payments that are not in the law or the regulations or when coverage is denied to them or their dependents or reasons of age, pre-existing conditions, genetic or hereditary conditions in violation of the legal dispositions contained in Law 87-01 and its regulations.
More... (http://www.dr1.com/index.html#5)
The disposition is contained in Resolution176-09 on the process for transferring from an ARS due to delays, suspension or denial of service to affiliates of the Family Health Insurance program.
Superintendent of Health and Labor Risks Fernando Caamano pointed out that while Law 87-01 establishes that affiliates can change from one ARS to another once a year, he says they can also change at any other time when they feel that the service of their health service provider does not satisfy their needs. For instance, if the ARS denied coverage to one or several services covered in the Dominican Program of Social Services, or that due to negligence it did not authorize or administer a procedure, with the exception of cases mentioned in Law 87-01.
Caamano said that the new resolution establishes a mechanism that allows faster processing between the entities involved in the transfer request and the company that is processing the Dominican Social Security System database, Unipago.
The resolution establishes that the affiliate can request a transfer if they or any of their dependents have been denied health service for an unjustifiable reason such as non-payment by the ARS to the Social Security Plan. Other reasons are when the lead affiliate or their dependents are subject to periods of minimum payments that are not in the law or the regulations or when coverage is denied to them or their dependents or reasons of age, pre-existing conditions, genetic or hereditary conditions in violation of the legal dispositions contained in Law 87-01 and its regulations.
More... (http://www.dr1.com/index.html#5)