• The Commission on Benefits and Quality of Care of the Concert is created and the electronic emission of the parts of temporary disability and risk during pregnancy and lactation is introduced for the first time

The Secretary of State for Public Service, Clara Mapelli, has presided over the signing of the national health care concert between MUFACE and the insurers Adeslas and Asisa for the years 2025, 2026 and 2027 destined to a collective that reaches the million mutualists. Mapelli, in addition to thanking the work of all those who have made the agreement possible (insurers, unions and the MUFACE team) has highlighted how the Government has had as priorities the protection of mutualists, transparency and information in the governance bodies of the mutuality and the mission of collaboration and negotiation within the framework of the social dialogue.

The leaders of the insurers, for their part, have shown their gratitude in particular to the Minister for Digital Transformation and Public Service, Óscar López, for his “dedication and will” to reach an agreement, as well as to the Secretary of State and the General Director of MUFACE, Myriam Pallarés.

Protected collective

The concert will enter into force on 1 May 2025 and will last until 31 December 2027 and will, in principle, cover the socio-sanitary assistance of 734,000 holders and 280,000 beneficiaries. Of the total of 1,014,692 mutualists, more than half are women and the largest group is concentrated in the 15-44 age group. The rest of the mutualists, up to 1.5 million, have opted for public health, a situation that may vary during the periods allowed for the change of entity.

The total amount of the contract budget amounts to EUR 4,808.5 million, which is EUR 1,276.5 million more than the previous concert and includes a new structure of incremental premiums depending on the age groups. The weighted average premium will increase cumulatively during the agreement’s three-year term by 41.2%.

News of the concert

The new health care concert establishes as a novelty a second period for the ordinary change of entity. In addition to January, as the previous concert recorded, from now on the mutualists will also be able to request in June the change of entity, (from public to private, vice versa or between insurers). This year, in addition, a special period has been opened for the change that will extend from 1 to 31 May. The reason is that, in January, it was only possible to request the change from the private to the public entities, since the new concert was being processed.

Thus, in May all the mutualists will be able to choose, if they wish, the entity they freely consider, whether it be public (INSS) or concerted (ADESLAS or ASISA). In addition, the mutualists currently attached to DKV will have the same deadline to make the forced change to another entity (INSS, ADESLAS or ASISA). If they do not make this change between 1 and 31 May, they will be attached to the INSS ex officio.

Among the novelties that the new concert incorporates is the creation of the Commission of Benefits and Quality Assistance of the Concert. Its functions will include informing the entities about regulatory projects or other provisions that affect the content of the Common Portfolio of Services of the National Health System; establishing common guidelines or protocols of indication for certain techniques, technologies or procedures, as well as carrying out studies of areas of improvement of processes that impact on the quality of care.

The entities will send to MUFACE in the first half of the following year a detailed and externally audited report of the effective annual cost of the service derived from the concert.

MUFACE will be able to prepare prescription guides for certain medicines or pathologies for the establishment of common criteria of indication and prescription, especially in chronic pathologies.

In addition, a system of electronic emission of the parts of temporary disability (IT), risk during pregnancy (RE) and risk during natural lactation (RLN) will be implemented.

Regarding the concert’s portfolio of services, among others:

- Rehabilitation includes hospital rehabilitation services for the prescription of prostheses subject to special protocol.

- The provision in oral health is adapted to the plan for the expansion of the common portfolio of oral health services in the SNS.

- In pharmacy, the use of protocols for the dispensing of medicines in non-presential mode will be promoted.