On November 30, 2022, the third chamber of the Supreme Court issued a ruling against 4 protection appeals that were presented regarding the increase in health plans imposed by the Isapres.
Next, we will share the most relevant aspects of the ruling:
I. The highest court annulled the Isapres increase due to four central elements:
• They must only have a base plan for each health contract and not for each beneficiary.
• The Isapres cannot prepare a table of factors by sex and age because it is unconstitutional, and must use the table developed by the Superintendence of Health.
• The unborn and those born up to 2 years of age are completely covered by the GES, therefore, a table of factors cannot be applied to them. Afterwards, a two-year plan is applied that cannot be modified over time, unless it is one that reduces its price.
• The table of factors designed by the Superintendency of Health is applied only when the contributor enters the ISAPRE and is unmodifiable over time, unless it is beneficial for the contributor.
II. Table of factors: The table of factors designed by the Superintendency of Health is applied only when the contributor enters the Isapre and is unmodifiable over time, unless it is beneficial for the contributor.
III. Deadline for new price adjustment:
The Supreme Court, in its ruling, established a period of 6 months for the Health Superintendence to determine how the new adjustment in the prices of Isapres plans will be carried out. Any refunds of excess collected must also be evaluated, where those that have not expired must be returned as surplus.
The Isapres, for their part, must “calculate the final price of all the health contracts that they administer, multiplying the value of the corresponding base plan by the sum of the factors of the family group, applying to this end the Single Table of Factors contained in the Circular IF/N° 343 of the Superintendency of Health", states the ruling.