In April 2019, the Superintendency of Health announced the biggest rise in isapres plans for eight years. On the occasion, five isapres (White Cross, Hive, Consalud, Banmédica, Fusat), made an average of 5.1%. Another similar situation occurred in September of the same year, when their GES premiums increased by more than 50%. Such hikes are illegal and can be curbed by affiliates.
Why is it illegal?
“The Supreme Court has ruled on several occasions that isapres cannot unilaterally increase the base prices of health plans,” says Lagos & Co. lawyer Vanessa Ramos Pacheco. “The readjustment can only be done by mutual agreement, with a few exceptions,” he adds.
According to the lawyer, the rise of isapres is based on a skewed interpretation of Article 197 DFL No. 1 of 2005 of the Ministry of Health. “The problem is that the readjustment must be done with objective parameters, based on the increase in costs. Isapres doesn’t do that,” Vanessa explains.
How to stop the rise?
To stop the adjustment, affiliates must go before the respective Court of Appeals in order to curb the increase in their health plan for the period of one year, however, the Isapre will depend on the submission year by year of that adequacy letter , which may or may not be sent for this 12-month period.
To this end, the appeal for protection is brought to the processing, an action granted by the Constitution to all persons who, as a result of arbitrary or illegal acts or omissions, suffer deprivation, disturbance or threat to their rights and guarantees Constitutional. Lawyers’ groups and legal studies such as Lagos & Co. help in this process.
“As regards the period for appealing for protection, persons have a period of 30 days from the occurrence of the act or threat motivating the appeal or since the person made aware of such act or threat, a fact that must be established before the Court of Respective Appeals,” says Ramos.
“If the letters of adequacy once reviewed are within the time limit, we as lawyers exercise this constitutional action called an appeal of protection for the affiliate which will render ineffective the increase, a process that we carry out at no cost to the affiliates” , adds Lagos & Co.’s lawyer.
“To this end, we request, in conjunction with the filing of such an appeal, a request for a order not to innovate, i.e. it is requested to order measures to preserve the factual or legal situation brought at the time of the appeal, so that that for the duration of the processing of such an appeal, the affiliate will not see the increase in their health plan increase,” explains the professional.
This process takes four to six months, depending on the workload each cut has.
Another option is the Superintendency of Health. Affiliates affected by the uprising can make a claim to the agency via the internet, office or charter, and the Superintendency will resolve the problem, free of charge, through an arbitral trial. However, for the duration of this process the user will have to continue paying the reset; only at the time of resolution will you be reimbursed for the difference between the base plan and the hike.
On the Superintendency website you can see in detail the steps to be taken to make the claim.
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