Directive establishing Disease Special Coverage for the Subsidized Regime Security Integral Health in the field of Universal Health Insurance and its Annexes
Resolution Jefatural N º 134-2010-SIS
Lima, October 15, 2010
SEEN: The Memorandum No. 568-2010-SIS-GO Operations and Management Report No. 283-2010-SIS/OAJ of the Office of Legal Affairs;
WHEREAS, by law N º 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 and Public Executing Agency, whose mission is to administer the funds used to finance individual health benefits of the poorest and most vulnerable lacking health insurance, in accordance with the policy of the Sector;
That Article 13 of the Regulations of the Law of the Ministry of Health, approved by Supreme Decree N º 013-2002-SA, provides that Chief of the Comprehensive Health must design, redesign and continuously improve the processes of SIS;
That Article 30 of the Rules of Organization and Functions of Comprehensive Health Insurance, approved by Supreme Decree N º 009-2002-SA, says Operations Management is the online authority proposes, evaluates and supervises benefit plans by type of population, offering benefits in terms of costs, fees, financing and provision 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 Assurance Fund (IAFA)
That Article 13 of said Act provides that the Plan Essential Health Insurance (PEAS), is the prioritized list of conditions and interventions insurable are funded at least to all insured by the institutions that administer health insurance funds, whether public, private or mixed, and includes guarantees explicit timeliness and quality for all beneficiaries;
That by Supreme Decree N º 016-2009-SA, approving the Plan Essential Health Insurance (PEAS) and the list of conditions ensure, Interventions and Services and Guarantees explicit, that at least are funded by all insured institutions that administer health insurance funds, whether public, private or mixed;
That the above-mentioned Article 4 of Supreme Decree provides that in the case of SIS, the disregarded the LPIS in 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. The PEAS event coverage provides benefits in referential character maximum and its application is subject to existing clinical practice guidelines.
That Article 99 of the Rules of Law N º 29344, Law Framework for Universal Health Insurance, approved by Supreme Decree N º 008-2010-SA, provides that the administrative institutions of Funds Health Insurance (IAFAS) as 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 them is determined according to the size and characteristics of offered coverage;
That, Departmental Resolution No. 133-2010/SIS, Directive No. 05-2010-SIS/GO "directive regulating performance based coverage Subsidized Financing Regime under the Universal Health Insurance and its Annexes. " The Supplementary Plan is the list of insurable conditions that are complementary to the PEAS-funded comprehensive health insurance to its policyholders the Subsidized;
also Administrative Directive No. 05-2010-SIS/GO provides that the Schedule of Benefits SIS is made up of all benefits regularly funded by the Comprehensive Health Insurance Health for all insured the subsidized system, and includes the PEAS, the Supplemental Plan, emergency care and administrative services;
That, as assessed by the Operations Department, diagnoses and interventions exist that exceed the maximum limits referential or are outside the SIS Benefit Plan and provided to the insured SIS subsidized regime in exceptional circumstances and provided they are not included in the List of Diseases with High Cost FISSAL provided by the specific exclusions or SIS;
That, according to documents seen the Operations Department supports the passage of the Directive establishing Special Coverage Disease for the subsidized system of comprehensive health insurance in the field of Universal Health Insurance ";
That, with the approval of the Assistant Chief of the SIS, General Secretary, Finance Management, Operations Management and a favorable opinion 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 a directive establishing Disease Special Coverage for subsidized system of comprehensive health insurance in the field the Universal Health Insurance and its Annexes, which form an integral part of this resolution. Article 2 .-
rescind pilot areas AUS any provision that is opposed to the provisions of the 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/a_trans_infor_resol . html .
recorded, communicated and published.
QUINTANILLA LUIS ALBERTO Huarachi
Institutional Security Chief Integral Health
Resolution Jefatural N º 134-2010-SIS
Lima, October 15, 2010
SEEN: The Memorandum No. 568-2010-SIS-GO Operations and Management Report No. 283-2010-SIS/OAJ of the Office of Legal Affairs;
WHEREAS, by law N º 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 and Public Executing Agency, whose mission is to administer the funds used to finance individual health benefits of the poorest and most vulnerable lacking health insurance, in accordance with the policy of the Sector;
That Article 13 of the Regulations of the Law of the Ministry of Health, approved by Supreme Decree N º 013-2002-SA, provides that Chief of the Comprehensive Health must design, redesign and continuously improve the processes of SIS;
That Article 30 of the Rules of Organization and Functions of Comprehensive Health Insurance, approved by Supreme Decree N º 009-2002-SA, says Operations Management is the online authority proposes, evaluates and supervises benefit plans by type of population, offering benefits in terms of costs, fees, financing and provision 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 Assurance Fund (IAFA)
That Article 13 of said Act provides that the Plan Essential Health Insurance (PEAS), is the prioritized list of conditions and interventions insurable are funded at least to all insured by the institutions that administer health insurance funds, whether public, private or mixed, and includes guarantees explicit timeliness and quality for all beneficiaries;
That by Supreme Decree N º 016-2009-SA, approving the Plan Essential Health Insurance (PEAS) and the list of conditions ensure, Interventions and Services and Guarantees explicit, that at least are funded by all insured institutions that administer health insurance funds, whether public, private or mixed;
That the above-mentioned Article 4 of Supreme Decree provides that in the case of SIS, the disregarded the LPIS in 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. The PEAS event coverage provides benefits in referential character maximum and its application is subject to existing clinical practice guidelines.
That Article 99 of the Rules of Law N º 29344, Law Framework for Universal Health Insurance, approved by Supreme Decree N º 008-2010-SA, provides that the administrative institutions of Funds Health Insurance (IAFAS) as 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 them is determined according to the size and characteristics of offered coverage;
That, Departmental Resolution No. 133-2010/SIS, Directive No. 05-2010-SIS/GO "directive regulating performance based coverage Subsidized Financing Regime under the Universal Health Insurance and its Annexes. " The Supplementary Plan is the list of insurable conditions that are complementary to the PEAS-funded comprehensive health insurance to its policyholders the Subsidized;
also Administrative Directive No. 05-2010-SIS/GO provides that the Schedule of Benefits SIS is made up of all benefits regularly funded by the Comprehensive Health Insurance Health for all insured the subsidized system, and includes the PEAS, the Supplemental Plan, emergency care and administrative services;
That, as assessed by the Operations Department, diagnoses and interventions exist that exceed the maximum limits referential or are outside the SIS Benefit Plan and provided to the insured SIS subsidized regime in exceptional circumstances and provided they are not included in the List of Diseases with High Cost FISSAL provided by the specific exclusions or SIS;
That, according to documents seen the Operations Department supports the passage of the Directive establishing Special Coverage Disease for the subsidized system of comprehensive health insurance in the field of Universal Health Insurance ";
That, with the approval of the Assistant Chief of the SIS, General Secretary, Finance Management, Operations Management and a favorable opinion 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 a directive establishing Disease Special Coverage for subsidized system of comprehensive health insurance in the field the Universal Health Insurance and its Annexes, which form an integral part of this resolution. Article 2 .-
rescind pilot areas AUS any provision that is opposed to the provisions of the 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/a_trans_infor_resol . html .
recorded, communicated and published.
QUINTANILLA LUIS ALBERTO Huarachi
Institutional Security Chief Integral Health
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