Economy and Business Info

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The full Congress unanimously approved a bill obliging the EPS to maintain coverage of pre-existing illnesses for those policyholders who change jobs or insurance contract, if the new insurance is recruited within 90 days of termination of previous insurance. The rule has been well received, overall, benefited both the insured and by representatives of insurance companies, although the latter have identified some concerns regarding the application of the law.
In our view, the rule is of great importance to strengthening the private system of health benefits and ensures fair treatment of the staff members. The proper regulation of insurance systems, other than health, life or other, is fundamental to the functioning of a system based on trust in the long term, prudent management of resources contributed by the insured and the efficient allocation costs generated by the risks of the insured population. The continuity of health insurance, i.e. the maintenance of safe conditions between a contract and another is an important feature for a successful system because it ensures the possibility of competition and offers options to the insured. Thus, continuity is ensured by the health insurance systems in different countries.
It should be noted, moreover, that as health insurance schemes operate based on average use of statistics of large populations, and the movements of individual policyholders between an insurer and another should be considered taken together estimates of costs for insurers. Therefore, the mere fact of being forced to keep the insurance in case of so-called pre-existing diseases should not generate additional costs for the system as a whole, while representing a great benefit to the insured.
A different issue is how to distribute the costs associated with these pre-existing diseases among the companies that comprise the system. This is particularly important in the Peruvian case as to policyholders of the EPS; Sealed maintains responsibility for the case of more complex diseases. Therefore, it is also important that the costs of the services covered by the EPS and Sealed be properly distributed according to the actual services provided to policyholders as a whole. This must be modern and complete information to identify the incidence of diseases and their treatment costs, which also identifies best practices and benefits of prevention over treatment of disease. Considering that this market is one in which there is a huge asymmetry of information between policyholders and insurers, it is for the regulator to avoid that this asymmetry creates situations of abuse of that advantage by insurers. This is especially true in the case of Peru, in which there is a high concentration in the insurance market.