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“Dear Andrónico, we appreciate your preference for Colmena and we hope that your experience with us in the last year has been satisfactory. Our commitment drives us every day to develop better services, agreements and benefits that fit your needs, and that we hope will continue to contribute to the care of your health and that of your family ”.
Thus begins the letter he sent on May 18, Hive Golden Cross a Andronicus Luksic Lederer (38), Director of Quiñenco -matrix Chile bank, United Breweries Company (CCU) and the South American Vapor Company (CSAV) among other companies- and homonymous son of the owner of Channel 13. In the letter, the isapre linked to Group Bethia, of Charles Rather He explained that his health plan had to be readjusted due to a sharp increase in costs and average claims of its members. For this reason, he gave him two alternatives to choose: accept the change or claim. In case of opting for that last option, he explained, he would have a fatal deadline that expired on the last business day of August and that “he may claim before the Superintendency of Health” or outright disenroll. But Luksic – a member of one of the wealthiest families in Chile, whose fortune is valued at US $ 10.8 billion, according to the Forbes 2020 ranking – decided to do what thousands of affiliates do when they do not agree with the increase in their health plan and took the case to court.
Last Friday, August 28, he also Vice President of Development of Minerals of Antofagasta filed a protection appeal against the isapre for the rise in the price of its health plan before the Court of Appeals of Santiago. In his writing he asks to leave the adaptation without effect, because in his opinion the increase is “excessive and unfair” and “only seeks to generate higher profits” or to withdraw from the isapre. The fact is that, if he went ahead with his appeal, Luksic would get the courts to annul the 4.9% increase on the base price of his health plan and, at the same time, continue to benefit from the Circular No. 15 of the Superintendency of Health of July 22, 2019 that allows an adjustment in favor of the affiliates in the factor table.
As Colmena explained to him in the adequacy letter that the lawyer attached to the appeal, Luksic currently pays 22.28 UF ($ 639,019) for his health plan and once readjusted it would go to 22 UF ($ 630,989). Although after the readjustment he would end up paying $ 8,030 less, the employer’s questioning -according to his protection appeal- points to the increase in the base price of your health plan, which goes from 3.96 UF ($ 113,582) to 4.15 UF ($ 119,031), considering an increase of 4.9%. In fact, in your letter it was explained that you currently have a Complementary Plan LINE CLC 7114 for which you pay 20.20 UF ($ 579,397) and starting from the month of August, the base price of your plan will be readjusted by 0.19 UF ($ 5,450), which after applying the sum of the factors of your family group, which in your particular case has been lowered due to a change in the age group of one or more of your beneficiaries, equivalent to a total price of 19.92 UF ($ 571,365) monthly. His defense is led by Luciana Caro, founding partner of “Defend Your Plan” -according to its LinkedIn page-, which according to the records of the Judicial Power, from 2012 to date accumulates a total of 1,483 protection appeals filed against isapres.
All this in the midst of an increasingly uphill context. According figures from the Isapres Association this year the payment of costs is projected for US $ 65 million, an amount equivalent to providing health care for one year to 100 thousand people. “It is urgent to advance in a reform that takes charge of improving the system and gives certainty to contributors, courts and public opinion, regarding the determination of prices of the plans. In parallel, the Isapres are making efforts to communicate to their affiliates the growth of health costs and this year the adjustments were reported based on the indicator established by the INE and the Superintendency of Health (IRCSA) ”, she told. The Third PM, said the president of the union Gonzalo Simón, on August 13.
But Luksic is not the only businessman who has gone to court to avoid the increase in his health plan, being favored by the jurisprudence that ends up benefiting members.
Gonzalo Said Reliable (55), vice president of the Sofofa and shareholder of Bottler Andean, Scotiabank and Fishery Colossus She also received a letter of adaptation of her health plan in Colmen, in December 2018. In it, isapre explained that The final price of his plan would rise from 21.71 UF ($ 622,708) to 22.65 UF ($ 649,670), but the arguments put forward by the isapre did not convince him and he filed a protection appeal on January 17, 2019. Unlike the previous case, which is just beginning, this one was already settled in favor of the affiliate and the costs were finally paid by the isapre with a voucher view on August 27.
In his appeal for protection, Said warned that “It is not acceptable” the exceptional circumstance of modifying the price of the health plan due to higher costs than when it was originally contracted. “If Isapre acts in this way, it violates the constitutional guarantees of free choice of the health system and property rights, since it establishes unfounded discrimination that prevents a person from staying in a plan freely chosen by her,” he said. in his brief, presented by attorney Carolina González.
At the same time, Jorge Yarur Rey (75) -businessman- This year he also presented a protection appeal to stop the rise of his health plan against isapre Cruz Blanca, which increased from $ 551,341 to $ 596,314 per month. In his action, the brother of Luis Enrique Yarur, chairman of the BCI board, stated that the readjustment “It lacks any justification, so it is arbitrary”. “Neither the Law nor the health contract establish any norm that authorizes the respondent to raise the base price of a health plan without any cause. If this were the case, the contract would immediately cease to be onerous and commutative, In other words, it would cease to be a contract to become a despotic instrument of Isapre over its affiliates”Said the brief presented by the lawyer Ricardo González and entered on March 18, 2020.
However, unlike the previous cases, Cruz Blanca acquiesced in the affiliate’s request and asked the court to be exempt from paying costs.
In your letter, Hive explained to Luksic that in 2019 the operating result of the Isapres as a whole was a total loss of $ 25 billion. Among the causes that explain these results are the judicialization of the price readjustments themselves, the regulatory changes that have recently entered into force, and the growth in health costs mentioned above. In fact, “in the case of Colmena, in 2019 there were net losses of $ 384 million,” he said. According to the same document, the average loss ratio of the LINE CLC 7114 complementary plans during the last year was 119.6%, which means that for every 1,000 pesos of contribution the average use is $ 1,196. In addition to these costs, Isapre has administrative and sales expenses of 11.6% of revenues. “Both factors added together make the accident rate unsustainable, so it is necessary for the base price of these plans to be readjusted,” said Felipe Galleguillos, Commercial Manager of Colmena Golden Cross in his letter.
Meanwhile, Colmena also explained to Said that “The expenditure on health benefits originates from the providers (clinics, hospitals, medical consultations, laboratories, etc.) and our isapre cannot intervene in the private relationship that exists between doctors and patients”. In this context, the increase in health expenditures is due – according to the public record – to five reasons: the increase in the life expectancy of the population; an increase in the cost of the providers; an increase in the number and cost of medical leave and an increase in the use of benefits in conjunction with greater technology and medical equipment.
In the case of Jorge Yarur, Cruz Blanca explained in his letter of adaptation that according to the Isapres Law, “You cannot adjust the base price of your plan beyond the maximum limit equivalent to 30% above the average adjustment to the set of all current plans for all members.” This means -according to the company- that if the price adjustment calculated for its plan exceeds said maximum limit, such excess must be distributed jointly and severally among the affiliates belonging to the other plans within the lsapre.
“We take this adaptation process with the utmost responsibility, because we want to continue giving you the confidence that we are the only isapre with an international group such as Bupa and also, we have solid financial strength for the peace of mind of our users,” he explained in his letter Andrés Guimpert, Commercial and Client Manager lsapre CruzBlanca.
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