Healthcare for MUFACE beneficiaries is provided in accordance with the Services List established in the Agreement
The Services List is the set of techniques, technologies, or procedures, understood as each of the methods, activities, and resources based on scientific knowledge and experimentation, through which are effected healthcare services.
The MUFACE Agreement for 2018 and 2019 ensuring beneficiaries access to healthcare throughout Spain is published in the Resolution of December 28, 2017, of the General Mutual Society of State Civil Servants (MUFACE).
The new agreement signed by MUFACE along with collaborating organisations -SegurCaixa Adeslas, Asisa, DKV Insurance and Igualatorio Médico de Cantabria in Spain, and DKV abroad- involves an increase in the premium of 114 million euros, representing a 5.62% increase on the previous biannual agreement, within a budget of close to 2,200 million euros.
The 2018-2019 agreement (Agreement for national and international healthcare) has been developed with the double objective of ensuring the sustainability of the MUFACE model and improving the quality of the healthcare provided to our members.
The Muface 2018-2019 agreement transmits the sensation and message that it is a viable model with guaranteed continuity: it is expected that the number of MUFACE members will grow again; the budget of the agreement and the associated premium represent a very significant rise; the insurers included in the current agreement remain the same, and a line of action has been initiated with the rest of companies in the sector for their future incorporation into the model; and the service to the members is strengthened both with regard to management possibilities and direct healthcare options. In this way, the more than four decades of history of this public-private collaboration model will be revitalised and improved.
The MUFACE model has suffered stresses as a result of various factors, to a great extent common to the general health system. In a context of economic crisis and budget constraints, it has been necessary to care for an ageing population (that consequently has greater healthcare needs) with increasingly advanced (and expensive) healthcare technologies.
The 18-19 agreement faces these challenges via three conditions, which make the model sustainable:
- A period of validity of 2 years. This allows a desirable balance between stable collaboration and the flexibility to adapt to a changing context.
- A significant premium increase, of 5.62%, that is well above those of recent years, and which represents an injection of €114 M. A total budget of almost €2,200 M (€2,191 M).
- The incorporation of around 100,000 new mutual society members, as a result of the agreement for the improvement of public employment signed on 29 March between the Ministry of Finance and Civil Service and trade union representatives from CCOO, UGT, and CSI-F, and Public Employment Offers. Is expected that the average age of these new cohorts, and their associated beneficiaries, will rejuvenate the average age of the insured group. It is also necessary to add the mutual society members who gain access by internal promotion to non-MUFACE organisations and who wish to remain in the mutual society system based on the right of option created by the State General Budget Law for 2017.
Together with the previous objective, the fundamental purpose of this agreement is to improve the quality of service received by the mutual society members.
The agreement is based on the guaranteed healthcare content in the current agreement that, of course, guarantees in all cases the healthcare level in the National Health System common service list. In addition, the agreement adds a series of new aspects, among which we must highlight:
- Establishment of two regular change periods (January and June), which expands the members' choices and promotes competition among the organisations regarding the improvement of their services.
- Increased healthcare at a provincial level and in major cities or Level III specialist care -including all the provincial capitals, Ceuta and Melilla, and other important town and urban centres- which is now found in 13 new municipalities: Talavera, Alcalá de Henares, Torrejón de Ardoz, Alcorcón, Fuenlabrada, Móstoles, Gandía, Oliva, Lorca, Mérida, Almendralejo, Jerez de la Frontera, and El Puerto de Santa María. This means that the mutual society members living in these towns will now have access to a large number of specialists (neurology, urology, pneumology, intensive care units, etc.). Level III care will be available in a total of 60 towns.
- Better protection in the smaller islands. The healthcare resources on La Gomera have increased, passing to Level I, and, for the first time, there is fixed cover of travel expenses from Level I and II islands for receiving specialist care on Level III and IV islands.
- Inclusion of robotic surgery and intraoperative radiotherapy as new reference services. This will allow serious patients access to surgical techniques characterised by a faster and more comfortable recovery, avoiding possible repeat surgery.
- Coordination with the autonomous emergency services 112. On the one hand, the concept of vital risk is objectified according to the symptoms assessed when they occur (and not a posteriori, in the health centre). On the other hand, MUFACE commits to promoting tools for collaborating with the healthcare services of the Autonomous Communities, which care for mutual society members in emergency situations, to favour the referral of the patient to a private centre, provided that this has the means to deal with the emergency. This avoids cost problems that the mutual society member could face from receiving public healthcare.
- Promotion of electronic prescriptions. A new incentive has been created to promote the implementation of the electronic prescription project mentioned in the MUFACE Promotional Plan and its use by doctors from the organisations.
- Better protection of our elderly. An incentive has been set up to reward the fidelity or permanence of members aged over 65. It is intended that organisations work hard in their service to the elderly and in no case transfer age-related risks to other entities
- Healthcare service offer exceeding that demanded in the agreement. An incentive has been created so that an organisation can offer additional services related to healthcare provision, which involve an improvement in the object of the agreement, whether these are healthcare-related (oral health, etc.) or technological (telemedicine).
- Ban on the transfer of risks. For the first time, it is expressly forbidden to transfer risks between companies: that a company promotes the change of its members to another company with more expensive treatments.
- Ban on treatment differences for mutual society members. It is expressly forbidden that a mutual society member receives, due to their status as such, different treatment from the organisation with respect to other privately insured clients (shorter appointments, schedule delays, etc.). Of course, this does not prevent the existence of different medical scenarios for each group.
In conclusion, the significant increase in funding for the agreement directly affects the improved benefits mutual society members will receive.
Members must understand the following general contents relating to the insurance for civil servants:
- Financial budget
- Family benefits
- Agreement between MUFACE and Paradores
- Permanent disability: application form
- Retirement forms
- Declaration of economic aids
- Application for severe disability benefit
- Change of entity
- Psychiatric report
- Service Charter
- Emergency care in the Social Security or insurer
- Pension rights: Obtaining the contribution
- Risk during pregnancy and risk during breastfeeding
- Health insurance companies
- Certificate of entitlement
- Changing your address in your employment history
- Social Security for State Civil Servants Act
- Maternity leave
- Assisted reproduction techniques
- General regulation on administrative mutualism
- Calculating civil service pensions
- Judicial General Mutuality membership document
- Voluntary leave of civil servants
- What is MUFACE?
- Electronic prescriptions for all mutual society members
- MUFACE medical report
- Compulsory and voluntary mutual society members
- The MUFACE website
- Download the application forms
- Temporary disability
- Receipt template
- Request a prescription book online
- How to consult the employment history of MUFACE mutual society members
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