The Government has been forced to clarify to insurers what economic margin they have if the health care provision of the million and a half civil servants covered by their system diverts their costs with respect to the tender that is in progress. He has done so by assimilating that Muface should compensate the companies to be able to “rebalance” their contracts when they are “altered” the amount of these initial benefits, in a response to the doubts raised by Asisa to which this newspaper has had access.
The issue is not trivial for that company, the only insurer that continues in the process tender for civil servants’ healthcare after Adeslas and DKV decided to abandon the contract despite the fact that the Ministry of Public Service – the one competent in this matter – iThe premium will increase by 33.5% with respect to the amount of the previous contract. That firm, the one interested in the process, has received a communication in the form of a response from Muface, within the process that is being negotiated, due to doubts about whether the public organization would have the obligation to adjust the amounts upwards in the event of “a sudden change in circumstances.”
In his clarification, Muface admits that he will be obliged to “respond on a case-by-case basis, in light of the circumstances that occurred.” if the rupture of the economy of the contract occurs« even beyond the establishment of a percentage that, if there is unforeseeable risk, could even be lower than that 5%. This limit is key since Public Service mentions two sentences -one from the Supreme Court, from 2019, and another from the National Court, from 2014- in which both judicial instances referred to percentages of deviation that ranged from 2.5% to 3.5% (5% in total) in reference to the health agreement that was in force between 2021 and 2024, but which has had to be extended due to the lack of agreement with corporations to maintain it starting this year. There is also an opinion of the Council of State, of 2019, which mentions “a radical breakdown of the contractual economic-financial balance, due to its excessive onerousness.”
With this clarification on the table -Muface has included it in the Public Sector Contracting Platform-, Asisa has another variable with which continues studying the conditions of the tender to determine if it is worth it for them to finally go to the contest after abandoning the two companies with which they shared it until now.
The question of this financial rebalancing and the possibility of compensating for this deviation in the cost of health for civil servants is not trivial, because it is an episode in which insurers already have experience precisely since the last contract that began four years ago. The Muface system is in question because insurers have been insisting for some time that they cannot account for a procedure in which that 1.5 million public workers decide each year if they move to public healthcare or continue in private healthcare. Because several setbacks, such as inflation in recent years or the progressive aging of civil servants – who use health systems more – have increased the real bill for the system, compared to what was initially agreed upon in the previous tender: 600 million euros in losses, say Adeslas, Asisa and DKV.
The clock is ticking waiting for Asisa to decide its final position with the tender. The final deadline for you to communicate it expires on the 27th. January at 10:00 am. In principle, the limit was established for January 15, but given the controversy generated between insurers and the Ministry, the Public Service decided to extend the deadlines. “It is considered necessary for the public interest and in order to encourage competition, to extend the deadline for submitting offers, so that potential interested bidders can prepare the documentation to submit to this tender,” indicates the Ministry for Transformation. Digital and Public Service.
Demonstrations and warnings ‘in extremis’
Meanwhile, police, teachers and senior officials they will take to the street to demand a solution for Muface next January 22 at a rally summoned before the headquarters of the mutual society. They will do so, they allege, due to “the incompetence of politicians and the lack of ethics of insurers.”
The majority public service union, CSIFyesterday sent a letter to Muface demanding that he put an end to the situation of helplessness they are facing mutualists and beneficiaries who are being denied due benefits health, despite the order of continuity of care issued by the Government, and warning them of possible legal actions.
The organization has warned that “Legal action will be taken opportune information on the possible administrative, civil and criminal liabilities arising as a result of the lack of attention on the part of the insurance companies, as well as in those cases in which Muface does not guarantee the provision of assistance to those affected.”
On the other hand, the Spanish Private Health Alliance (ASPE) has positively valued the fact that solutions are being explored that imply an improvement in premiums for insurers; however has warned that Muface risks failing “if adequate remuneration for health provision is not guaranteed.”
According to ASPE, the current system, which covers more than 1.4 million mutual members, depends on a structure in which health centers provide care and insurance companies finance it. However, ASPE denounces that health provision – hospitals and private care centers – “is left out of the negotiations, despite being an essential part of the system.”
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