Dominican Republic: Restructuring of family health insurance

New regulations concerning family health insurance (Seguro Familiar de Salud, SFS) were adopted in February 2007 to provide global physical and mental health cover for members of the social security scheme and their families. The object of the new regulations is to provide universal cover for all members of the family unit with guaranteed access to basic health care for the most vulnerable social groups.

Membership of family health insurance is mandatory. It is financed through contributions from employers and workers which must cover the amount of the premium for each member's family unit. Retirees and their families will also be able take out sickness insurance through payment of a percentage of their pensions.

The legally recognised family unit is composed of the insured member, his or her spouse or partner, dependent or underage children (under 18 or with no age limit if the child is handicapped) and children aged between 18 and 21 if full-time students. The children of a spouse or partner are also covered. All the members of one family unit must be members of the same risk management administrative body; this may be one of the private administrations for health risks (Administradora de Riesgos de Salud, ARS) or the National Health Insurance Fund (Seguro National de Salud, SENASA).

Members of the contributory SFS scheme are eligible for health and maternity benefits, paediatric care and the scheme's basic health programme (Plan Basico de Salud, PBS), which provides global health care including preventive care, medical and surgical treatment, diagnosis and rehabilitation as well as essential medication. The basic health scheme will be administered by the SENASA and the ARS and will be financed from social security funds.

Employees who do not register with an ARS or the SENASA on their own initiative will automatically be registered by the enterprise responsible for the data bases (Empresa Procesadora de la Base de Datos, EPBD). The ARS will be informed of members automatically assigned to them for inclusion in their respective data bases.

Members who lose their jobs will no longer have family health insurance cover unless they are declared as beneficiaries of another member of an ARS or the SENASA. This also applies to members' children who come of age or reach the end of their studies, who are not employed and who have not been registered as dependents of a member of the social insurance scheme.