SUPERINTENDENCY OF BANKING, INSURANCE AND AFP Republic of Peru

Lima, 24 May 2013

Resolution S.B.S. No. 3203-2013 The Superintendent of Banking, Insurance and Private Pension Fund Administrators

WHEREAS:

That, the Insurance Contract Law, Law No. 29946, incorporates as part of "personal insurance" the definition and scope of health insurance and of pre-existing conditions applicable to the aforementioned insurances;

That, by Law No. 28770 the Law regulating the use of pre-existing conditions in contracting a new sickness and/or medical care insurance with the same insurance company to which one was affiliated in the immediately preceding period was approved;

That, by Law No. 29878 establishing protection and supervision measures for the general conditions of medical, health or medical care insurance policies and its regulation, approved by Supreme Decree No. 174-2012-EF, the main coverages of these policies are established, as well as the application of the right of renewal of health insurances;

That, subsection 28.2 of article 28 of the General Law on Persons with Disabilities, approved by Law No. 29973, establishes that the Superintendency guarantees access for persons with disabilities to the products or services offered by insurers and supervises that insurance premiums are set fairly and reasonably on the basis of actuarial and statistical calculations, and individually assessed;

That, consequently it is necessary to issue the corresponding provisions that allow the adequate regulatory application of health insurances;

That, in order to gather the opinions of the general public regarding the regulatory proposal, its pre-publication was ordered, under the provisions of Supreme Decree No. 001-2009-JUS;

With the approval of the Deputy Superintendencies of Private Pension Fund Administrators and Insurance, and of Legal Counsel, as well as of the Management of Products and Services to the User;

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In use of the powers conferred by numerals 6 and 9 of article 349 of the General Law of the Financial System and the Insurance System and Organic Law of the Superintendency of Banking and Insurance, Law No. 26702 and its amendments;

RESOLVES:

Article One.- To approve the Complementary Rules Applicable to Health Insurances, with the following text:

COMPLEMENTARY RULES APPLICABLE TO HEALTH INSURANCES

Article 1.- These provisions are applicable to the insurance companies referred to in literal D of article 16 of the General Law, hereinafter the companies.

Article 2.- Health insurances are those contracts whose main coverage is the following:

a) The reimbursement to the insured of expenses derived from medical care,

b) Guaranteeing the insured the provision of medical care services, with the insurance company being required to make said services available to the insured and their dependents and to assume their cost directly.

c) A lump-sum or periodic indemnity in case of temporary or permanent disability or other contingencies agreed in the policy, up to a determined amount and term,

d) Others determined by the Superintendency

Article 3.- The scope of the term pre-existing condition indicated in Law No. 28770 must be understood as stated in the second paragraph of article 118 of Law No. 29946. In this sense, in accordance with the aforementioned Law, insurance companies must provide coverage for pre-existing conditions in health insurances under the terms indicated in Law No. 28770. Therefore, individual insurance policies must have the same treatment as group insurance policies, in accordance with the provisions of Law No. 28770. Likewise, the continuity of coverage of pre-existing conditions in health insurances is in no case restricted to a single insurance company but to any company that is part of the Peruvian insurance system, as indicated in the aforementioned Law.

Likewise, the term "unresolved" referred to in the aforementioned article 118 applies to illnesses that require continuity in medical care, and that have been covered by an insurance contract in the immediately preceding period.

To access the continuity of coverage of pre-existing conditions, within the framework of Law No. 28770, the signature of the insured on the insurance application and the corresponding acceptance by the company shall be sufficient for the latter to request from the previous company the corresponding medical records that allow continuity. It should be added that the company may use

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affiliated health establishments, corresponding to its healthcare network, that are equivalent to those offered by the previous company.

Article 4.- Insurance companies that offer health insurances must offer health plans with coverage for persons with disabilities, based on the evaluation they carry out of insurable risks, in accordance with the provisions of subsection 28.2 of article 28 of the General Law on Persons with Disabilities approved by Law No. 29973.

Article Two.- This Resolution shall enter into force on the day following its publication in the official newspaper El Peruano,

Register, communicate and publish

DANIEL SCHYDLOWSKY ROSENBERG
Superintendent of Banking, Insurance and
Private Pension Fund Administrators