The Ministry of Health and Social Protection announced on March 17 that it has published a draft decree for public comment, which would modify the coverage of health services provided to victims of traffic accidents, natural disasters, and terrorist events.
The proposed changes aim to ensure comprehensive and continuous healthcare for victims covered by SOAT differential rate policies and to improve the flow of resources. Under the new rules, insurance companies and ADRES would conduct a single audit for these cases.
For traffic accidents where the cost of care does not exceed the SOAT differential rate limit, healthcare providers would submit claims directly to the insurance company. If additional claims arise from the same event, they would also be presented to the insurer, which would handle auditing and payment before seeking reimbursement from ADRES for any amounts above its responsibility.
If the cost of care exceeds the SOAT differential rate limit, providers would submit claims directly to ADRES. After auditing and determining payment amounts, ADRES would pay healthcare institutions in full and recover from insurers any amounts within their responsibility.
Both insurers and ADRES will make information about submitted claims available in SIRAS, the reporting system for health services provided to traffic accident victims. This will allow other healthcare providers involved in ongoing care to identify which entity is handling audits related to each event. The Ministry invites stakeholders to submit comments on this proposal by March 24.
