directive regulating the coverage performance based Regime finance subsidies under the Universal Health Insurance and its Annexes
RESOLUTION Head Office N º 133-2010-SIS
Lima, 15 October 2010
VIEW: Memorandum No. 546-2010-SIS-GO and Operations Management Report No. 280-2010-SIS/OAJ of the Office of Legal Affairs;
That WHEREAS, by Act No. 27657 - Law of the Ministry of Health, created the Comprehensive Health Insurance (SIS) as a decentralized public health sector, described by Supreme Decree N º 034-2008-PCM as a public Executor, whose mission is to administer the funds used to finance health benefits individual poorest and most vulnerable lacking health insurance, in accordance with Policy Sector;
That the Article 13 of the Rules of the Law of the Ministry of Health, approved by Supreme Decree N º 013-2002-SA, provides that the Chief of the Comprehensive Health must design, redesign and continuously improve the processes of the SIS;
That Article 30 Rules of Organization and Functions of Comprehensive Health Insurance, approved by Supreme Decree N º 009-2002-SA, said that the Operations Department is the body proposed line, evaluates and supervises benefit plans by type of population, offering benefits in terms of costs, fees, financing and supply of facilities, service providers, as well as proposes mechanisms for negotiation;
That Article 7 of Law N º 29344, Law Framework for Universal Health Insurance, said the Comprehensive Health Insurance as a managing institution of Insurance Funds (IAFA)
That Article 13 of said Act provides that the Plan Essential Health Assurance (PEAS), is the prioritized list of conditions and interventions insurable are financed at least all insured institutions fund managers, health insurance, whether public, private or mixed, and contains explicit guarantees of timeliness and quality for all beneficiaries;
That by Supreme Decree N º 016-2009-SA, approving the Essential Plan Health Insurance (PEAS) and the list of conditions ensure, Interventions and Performance and Explicit Guarantees, which are financed at least all institutions insured by the fund managers, health insurance, whether public, private or mixed;
That Article 4 of this Decree provides that in the case of SIS, becomes void in the LPIS the pilot areas, where at least be offered the PEAS, except those benefits that were granted in exceptional circumstances, which form part of the insured's coverage until his total attention;
That Article 99 of the Regulation of Law No. 29344, Framework Law on Universal Health Insurance, approved by Supreme Decree N º 008-2010-SA, provides that the institutions administering the Health Insurance Funds (IAFAS), as the SIS, can offer supplemental plans to PEAS. Furthermore, Article 100 of that Regulation empowers the IAFAS to structure the supplementary schemes under the conditions of PEAS. The value of the assets is determined as the extent and nature of the coverage offered;
That Article 1 of Resolution No. 092-2010/SIS Jefatural, published on July 23, 2010, adopted the Directive No. 003-2010-SIS/GO "directive regulating the process of joining the Scheme of Financing Subsidized comprehensive health insurance under the Universal Health Insurance - Law N º 29344 * and its Annexes;
That, according to documents seen the Operations Department supports the adoption of Directive regulating the performance based coverage and care processes in Subsidized Financing Scheme;
That, with the approval of the Assistant Chief of the SIS, General Secretariat Management of Finance, Operations Management and a favorable opinion of the Office of Legal Affairs;
In accordance with the provisions of paragraph i) of Article 11 of the Rules of Organization and Functions of Comprehensive Health Insurance, approved by Supreme Decree N º 009-2002-SA;
RESOLVED:
Article 1 .- To approve the Directive No. 05-2010-SIS/GO directive regulating performance based coverage Subsidized Financing Scheme under the Universal Health Insurance and its Annexes, forming an integral part of this Resolution. Article 2 .-
rescind pilot areas AUS any provision that is opposed to the provisions of Directive approved by this resolution.
Article 3 .- To instruct the General Secretariat of publication of this resolution, adopted Directive and its annexes, on the website of the Comprehensive Health Insurance, http://www.sis.gob.pe/Portal/transparencia / disposiciones.html .
recorded, communicated and published.
QUINTANILLA LUIS ALBERTO Huarachi
Chief Institutional Comprehensive Health Insurance
RESOLUTION Head Office N º 133-2010-SIS
Lima, 15 October 2010
VIEW: Memorandum No. 546-2010-SIS-GO and Operations Management Report No. 280-2010-SIS/OAJ of the Office of Legal Affairs;
That WHEREAS, by Act No. 27657 - Law of the Ministry of Health, created the Comprehensive Health Insurance (SIS) as a decentralized public health sector, described by Supreme Decree N º 034-2008-PCM as a public Executor, whose mission is to administer the funds used to finance health benefits individual poorest and most vulnerable lacking health insurance, in accordance with Policy Sector;
That the Article 13 of the Rules of the Law of the Ministry of Health, approved by Supreme Decree N º 013-2002-SA, provides that the Chief of the Comprehensive Health must design, redesign and continuously improve the processes of the SIS;
That Article 30 Rules of Organization and Functions of Comprehensive Health Insurance, approved by Supreme Decree N º 009-2002-SA, said that the Operations Department is the body proposed line, evaluates and supervises benefit plans by type of population, offering benefits in terms of costs, fees, financing and supply of facilities, service providers, as well as proposes mechanisms for negotiation;
That Article 7 of Law N º 29344, Law Framework for Universal Health Insurance, said the Comprehensive Health Insurance as a managing institution of Insurance Funds (IAFA)
That Article 13 of said Act provides that the Plan Essential Health Assurance (PEAS), is the prioritized list of conditions and interventions insurable are financed at least all insured institutions fund managers, health insurance, whether public, private or mixed, and contains explicit guarantees of timeliness and quality for all beneficiaries;
That by Supreme Decree N º 016-2009-SA, approving the Essential Plan Health Insurance (PEAS) and the list of conditions ensure, Interventions and Performance and Explicit Guarantees, which are financed at least all institutions insured by the fund managers, health insurance, whether public, private or mixed;
That Article 4 of this Decree provides that in the case of SIS, becomes void in the LPIS the pilot areas, where at least be offered the PEAS, except those benefits that were granted in exceptional circumstances, which form part of the insured's coverage until his total attention;
That Article 99 of the Regulation of Law No. 29344, Framework Law on Universal Health Insurance, approved by Supreme Decree N º 008-2010-SA, provides that the institutions administering the Health Insurance Funds (IAFAS), as the SIS, can offer supplemental plans to PEAS. Furthermore, Article 100 of that Regulation empowers the IAFAS to structure the supplementary schemes under the conditions of PEAS. The value of the assets is determined as the extent and nature of the coverage offered;
That Article 1 of Resolution No. 092-2010/SIS Jefatural, published on July 23, 2010, adopted the Directive No. 003-2010-SIS/GO "directive regulating the process of joining the Scheme of Financing Subsidized comprehensive health insurance under the Universal Health Insurance - Law N º 29344 * and its Annexes;
That, according to documents seen the Operations Department supports the adoption of Directive regulating the performance based coverage and care processes in Subsidized Financing Scheme;
That, with the approval of the Assistant Chief of the SIS, General Secretariat Management of Finance, Operations Management and a favorable opinion of the Office of Legal Affairs;
In accordance with the provisions of paragraph i) of Article 11 of the Rules of Organization and Functions of Comprehensive Health Insurance, approved by Supreme Decree N º 009-2002-SA;
RESOLVED:
Article 1 .- To approve the Directive No. 05-2010-SIS/GO directive regulating performance based coverage Subsidized Financing Scheme under the Universal Health Insurance and its Annexes, forming an integral part of this Resolution. Article 2 .-
rescind pilot areas AUS any provision that is opposed to the provisions of Directive approved by this resolution.
Article 3 .- To instruct the General Secretariat of publication of this resolution, adopted Directive and its annexes, on the website of the Comprehensive Health Insurance, http://www.sis.gob.pe/Portal/transparencia / disposiciones.html .
recorded, communicated and published.
QUINTANILLA LUIS ALBERTO Huarachi
Chief Institutional Comprehensive Health Insurance
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