Resolution SBS No. 3869-2018: Incorporates Section 3.13 into Chapter III Rheumatology of the Manual for Evaluation and Qualification of Degree of Invalidity and Amends Article 4 of Title VII of the Compendium of Norms

Los Laureles Nº 214 - Lima 27 - Peru Tel.: (511) 6309000 Fax: (511) 6309239 Lima, October 3, 2018

Resolution S.B.S. No. 3869-2018

The Superintendent of Banks, Insurance and Private Pension Fund Administrators

CONSIDERING:

That, by Supreme Decree No. 054-97-EF, the Single Text of the Law on the Private System for the Administration of Pension Funds was approved;

That, by Supreme Decree No. 004-98-EF, the Regulations of the aforementioned Law were approved;

That, additionally, in accordance with the Third Final and Transitory Provision of the Regulations of the Law, the Superintendence is empowered to issue the complementary operational norms necessary for the proper functioning of the Private System for the Administration of Pension Funds;

That, by Supreme Decree No. 061-2007-EF, Article 129 of the aforementioned Law's Regulations was modified, referring to the Medical Technical Commission (CTM), which establishes that it is responsible for reviewing the technical norms for the evaluation and qualification of the degree of invalidity, reaching the Superintendence with the proposals corresponding to the modification of the respective Manuals for Evaluation and Qualification of the Degree of Invalidity to which the Medical Committee of the AFPs (COMAFP) and the Medical Committee of the Superintendence (COMEC) must adhere, as well as to the other functions assigned to it by the Superintendence;

That, through SBS Resolutions No. 2321-2017, 3232-2017, 4121-2017 and 4768-2017, provisions were incorporated into Chapter III Rheumatology of the Manual for Evaluation and Qualification of the Degree of Invalidity (MEGCI), to carry out the procedure for evaluation and qualification of invalidity for diagnoses of rheumatoid arthritis, ankylosing spondylitis, systemic lupus erythematosus and osteoarthritis in weight-bearing joints, in order to improve the criteria and establish procedures that represent a higher degree of objectivity for the evaluation of impairment and qualification of corresponding invalidity, incorporating advances in medical science in the matter;

That, the Superintendence through Office No. 10887-2018-SBS requested the CTM to review a proposal to carry out a general procedure for evaluation and qualification of invalidity linked to rheumatological pathologies other than those that already have a specific procedure;

That, in this regard, the CTM, as part of the tasks entrusted by the Superintendence, has carried out the technical review of the modification proposal subject of this resolution, sending the respective justifications with Report No. 001-2018-CTM;

That, in order to collect public opinions regarding the modification proposals to the regulations of the Private System for the Administration of Pension Funds, the pre-publication of the draft resolution on the matter was arranged on the electronic portal of the Superintendence in accordance with what is established in Supreme Decree No. 001-2009-JUS;

Having the approval of the Adjunct Superintendencies of Private Pension Fund Administrators, and of Legal Advice; and,

In exercise of the powers conferred by numeral 9 of article 349 of the General Law of the Financial System and the Insurance System and Organic Law of the Superintendence of Banks and Securities, Law No. 26702 and its amendments, subsection d) of article 57 of the SPP Law, as well as by what is established in the Third Final and Transitory Provision of its Regulations;

RESOLVES:

Article First.- Incorporate numeral 3.13 in Chapter III Rheumatology of the Manual for Evaluation and Qualification of the Degree of Invalidity (MECGI), approved by Resolution No. 058-94-EF/SAFP and its amendments, as follows:

“3.13 EVALUATION OF IMPAIRMENT DUE TO RHEUMATOLOGICAL PATHOLOGIES IN DIAGNOSES OTHER THAN RHEUMATOID ARTHRITIS, ANKYLOSING SPONDYLITIS, SYSTEMIC LUPUS ERYTHEMATOSUS AND OSTEOARTHRITIS IN WEIGHT-BEARING JOINTS

1. • PERSONAL ASPECTS (max impairment 10%)

Aspects to value Factors (prognostic) Scales Percentage Mark what corresponds

Age Less than or equal to 30 years 0% Greater than 30 and less than 50 years 1% Greater than or equal to 50 years 2%

Education Level Elementary studies 2% Secondary studies 1% Higher studies 0%

Economic situation Poor 2% Medium 1% Good 0%

Support from the environment (family or other type) No support 2% Partial support 1% Complete/good support 0%

Employment situation: Unemployed, or if working: time of subsidy 1 in the last year Unemployed 1% Without subsidy 0% Less than 3 months 0.5% Greater than or equal to 3 and less than or equal to 5 months 1% Greater than 5 months 2%

1 Subsidy: It must be understood as temporary incapacity established by EsSalud.

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Global percentage of impairment attributable to personal aspects =

2. • CLINICAL-THERAPEUTIC ASPECTS (max impairment 74%)

PAIN INTENSITY* Scales Percentage Minimal (1%) Mild (2%) Moderate (3%) Marked (5%)

Percentage of impairment due to pain intensity in the case valued:

PAIN FREQUENCY Scales Percentage Intermittent (1%) Sporadic (2%) Frequent (3%) Constant (5%)

Percentage of impairment due to pain frequency in the case valued:

*See Annex No. 1

LIMITATION OF MOBILITY Only the affected joint or zone will be valued

CERVICAL Type of movement Degrees normal mobility Impairment 0 – 10% 11 – 40% 41 – 70% 71- 100%

Flexion 65º 0 Points 1 point 2 points 3 points

Extension 65º 0 Points 1 point 2 points 3 points

Lateralization 45º 0 Points 1 point 2 points 3 points

Rotation 75º 0 Points 1 point 2 points 3 points

Total score = (from 0 to 12 points)

Percentage of impairment by the cervical spine: (max 3% disability)

0-2 points: 0% 3-5 points: 1% 6-8 points: 2% 9-12 points: 3%

LUMBAR Type of movement Degrees normal mobility Impairment 0 – 10% 11 – 40% 41 – 70% 71- 100%

Flexion 60º 0 Points 1 point 2 points 3 points

Extension 35°- 40º 0 Points 1 point 2 points 3 points

Lateralization 30º (for each side) 0 Points 1 point 2 points 3 points

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Rotation 20º 0 Points 1 point 2 points 3 points

Total score = (from 0 to 12 points)

Percentage of impairment by the cervical spine: (max 3% disability)

0-2 points: 0% 3-5 points: 1% 6-8 points: 2% 9-12 points: 3%

SHOULDER Movement Degrees normal mobility Impairment 0-10% 11-40% 41-70% 71-100%

Flexion 180º 0 Points 4 points 8 points 12 points

Extension 60º 0 Points 1 point 2 points 3 points

Abduction 180º 0 Points 2 points 4 points 6 points

Adduction 45º 0 Points 1 point 2 points 3 points

Internal rotation 80º 0 Points 1 point 2 points 3 points

External rotation 90º 0 Points 1 point 2 points 3 points

Total score = (from 0 to 30 points)

Percentage of impairment due to shoulder: (max 2.5% each shoulder)

0-7 points: 0% 8-14 points: 1% 15-22 points: 1.5% 23-30 points: 2.5%

Value each shoulder separately. If both are affected, sum the disability percentages

ELBOW Type of movement Degrees normal mobility Impairment 0-10% 11-40% 41-70% 71-100%

Flexion 135° - 150º 0 Points 1.5 point 3 points 4.5 points

Extension 0 - 5º 0 Points 1.5 point 3 points 4.5 points

Pronation 90º 0 Points 1 point 2 points 3 points

Supination 90º 0 Points 1 point 2 points 3 points

Total score = (from 0 to 15 points)

Percentage of impairment due to elbow: (max 2% each elbow)

0-3 points: 0.5% 4-7 points: 1% 8-11 points: 1.5% 12-15 points: 2%

Value each elbow separately. If both are affected, sum the disability percentages

WRIST Type of movement Degrees normal mobility Impairment 0-10% 11-40% 41-70% 71-100%

Dorsal flexion 70º 0 Points 2 point 4.5 points 7 points

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Palmar flexion 75º 0 Points 2 point 4.5 points 7 points

Ulnar inclination 35º 0 Points 1 point 2 points 3 points

Radial inclination 20º 0 Points 1 point 2 points 3 points

Total score = (from 0 to 20 points)

Percentage of impairment due to wrist: (max 2.5% each wrist)

0-5 points: 0% 6-10 points: 0.75% 11-15 points: 1.5% 16-20 points: 2.5%

Value each wrist separately. If both are affected, sum the disability percentages

HAND Value each hand separately. If both are affected, sum the disability percentages at the end.

Movement FINGERS 2nd to 3rd Impairment 0-10% 11-40% 41-70% 71-100%

Flexion DIP 90º 0 Points 2 points 3.5 points 6.5 points

Flexion PIP 70º 0 Points 3 points 6.5 points 10.5 points

Flexion MCP 90º 0 Points 4 points 8 points 13 points

Total score = (from 0 to 30 points)

Percentage of impairment due to finger: (max 1% each finger)

0-10 points: 0% 11-20 points: 0.50% 21-30 points: 1%

Movement FINGERS 4th to 5th Impairment 0-10% 11-40% 41-70% 71-100%

Flexion DIP 90º 0 Points 2 points 3.5 points 6.5 points

Flexion PIP 70º 0 Points 3 points 6.5 points 10.5 points

Flexion MCP 90º 0 Points 4 points 8 points 13 points

Total score = (from 0 to 30 points)

Percentage of impairment due to finger: (max 0.50% each finger)

0-10 points: 0% 11-20 points: 0.25% 21-30 points: 0.50%

Movement THUMB Impairment 0-10% 11-40% 41-70% 71-100%

Flexion IP 80 º 0 Points 1.5 point 3 points 4.5 points

Flexion MCP 50º 0 Points 1 point 2 points 3 points

Abduction 70 º 0 Points 1 point 2 points 3 points

Adduction 80º 0 Points 2 points 4 points 6 points

Opposition 8 cm 0 Points 4.5 points 9 points 13.5 points

Total score = (from 0 to 30 points)

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Percentage of impairment due to thumb: (max 2% each thumb)

0-10 points: 0.5 % 11-20 un: 1 % 21 to 30 points: 2 %

Total percentage of impairment due to the hand (max 5% each hand)

Total percentage of impairment due to both hands: (max 5%)

HIP Type of movement Degrees normal mobility Impairment 0-10% 11-40% 41-70% 71-100%

Flexion 0 º - 20º 0 Points 1 point 2 points 3 points

Extension 45º - 50º 0 Points 1 point 2 points 3 points

Abduction 40º - 45º 0 Points 1 point 2 points 3 points

Adduction 45º 0 Points 1 point 2 points 3 points

Internal rotation 40º - 45º 0 Points 1 point 2 points 3 points

External rotation 0 º - 20º 0 Points 1 point 2 points 3 points

Total score = (from 0 to 18 points)

Percentage of impairment due to hip: (max 2 % each hip)

0-4 points: 0% 5-8 points: 0.50% 9-13 points: 1% 14-18 points: 2%

Value each hip separately. If both are affected, sum the disability percentages

KNEE Type of movement Degrees normal mobility Impairment 0-10% 11-40% 41-70% 71-100%

Flexion 0º 0 Points 1 point 2 points 3 points

Extension 130º - 140º 0 Points 1 point 2 points 3 points

Total score = (from 0 to 6 points)

Percentage of impairment due to knee: (max 1.5% each knee)

0 points: 0% 1-2 points: 0.50% 3-4 points: 1% 5-6 points: 1.5%

Value each knee separately. If both are affected, sum the disability percentages

ANKLE/FOOT Type of movement Degrees normal mobility Impairment 0-10% 11-40% 41-70% 71-100%

Plantar flexion 45º 0 Points 1 point 2 points 3 points

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Dorsiflexion 20º 0 Points 1 point 2 points 3 points

Eversion 25º 0 Points 1 point 2 points 3 points

Inversion 35º 0 Points 1 point 2 points 3 points

Total score = (from 0 to 12 points)

Percentage of impairment due to ankle/foot (max 1.5% each ankle)

0-2 points: 0% 3-5 points: 0.50% 6-8 points: 1% 9-12 points: 1.5%

Value each ankle/foot separately. If both are affected, sum the disability percentages

SUM OF IMPAIRMENT PERCENTAGES (max 40%) = (cervical + lumbar + shoulders + elbows + wrists + hands + hips + knees + ankles/feet)

MUSCLE BALANCE-STRENGTH Daniels Scale Score Percentage

Absence of contraction 0 9%

Contraction is seen or palpated, but there is no movement 1 7%

Movement occurs in the absence of gravity 2 5%

Movement that overcomes gravity 3 3%

There is force against the examiner's resistance 4 1%

Normal force 5 0%

Percentage of impairment in the case valued:

THERAPEUTIC ASPECTS

Evaluation of the response to the administered treatment (max 4%)

Variable Score Percentage

Good: pain suppression and improvement in functionality Mild 1%

Regular: partial pain relief and partial improvement in functionality Moderate 2%

Bad: no improvement in pain or functionality Severe 4%

Evaluation of the adverse effects of treatments (max 2%)

Gastric effects Mild = 1 adverse effect 0.5%

Immunosuppressive effects Moderate = 2 or 3 effects 1%

Others: HTA, increased transaminases……etc. Severe > 3 effects 2%

Treatment response score = Adverse effects score = Percentage of impairment due to the therapeutic aspects =

In case of not undergoing treatment, the evaluation will not be applied until it starts and has been taken for at least 3 months.

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ASSOCIATED COMORBIDITIES

Diseases Comorbidities Score Percentage

Ophthalmological Yes No

Mild = 1 of the associated pathologies

Renal Yes No 3%

Pulmonary Yes No

Dermatological Yes No Moderate = 2 or 3 of the associated pathologies

Cardiological Yes No 6%

Neurological Yes No

Hematological Yes No Severe > 3 associated pathologies

Vasculitis Yes No 9%

Systemic: fatigue, weakness, infections, amyloidosis, etc. Yes No

Score of the case valued = Percentage of impairment in the case valued:

Global percentage of impairment due to clinical-therapeutic aspects =

3.- LABORAL ASPECTS (max impairment 5%)

Score Percentage Incapacity

0 - 54 1% Mild

55 - 108 3% Moderate

109 - 156 5% Severe

Final score = Percentage of impairment = Degree =

CHECK LIST-LABORAL SITUATION

Tasks Score (between 0 - 6)

Not applicable 1/3 shift 2/3 shift Full shift

Manual handling of loads MMC less than or equal to 5 kg 0 1 2 3

MMC greater than 5 and less than or equal to 10 kg 0 2 3 4

MMC greater than 10 and less than or equal to 25 kg 0 3 4 5

MMC greater than 25 kg 0 4 5 6

Repetitive movements MR Shoulder elevation > 90º 0 2 4 6

MR flexo-ext or prono-sup. of wrist 0 2 4 6

Flex-ext. Trunk 0 2 4 6

Prolonged postures Prolonged ambulation 0 2 4 6

Continuous sitting 0 2 4 6

Continuous standing 0 2 4 6

Organization Continuous work and without alternation of tasks in your work 0 2 4 6

Performs repetitive/monotonous tasks 0 2 4 6

Fixed postures and without alternation of positions in your work 0 2 4 6

Cannot take breaks to Los Laureles Nº 214 - Lima 27 - Peru Tel.: (511) 6309000 Fax: (511) 6309239

during work rest during work

Is able to finish the tasks assigned to him in your work 0 2 4 6

Has shift/night work (evaluate the monthly shift) 0 2 4 6

Laboral conditions The workload is inadequate (excessive, irregular, not adapted to your capacities…) 0 2 4 6

The environmental conditions of your work (temperature, humidity…) worsen your clinical picture 0 2 4 6

Does not have support elements in your tasks (devices, instruments, machines…) 0 2 4 6

Performs work at height (>3 m) 0 2 4 6

Performs work in confined spaces (tunnel, drain, pit…) 0 2 4 6

Performs electrical work under tension 0 2 4 6

Has to drive in your work 0 2 4 6

Handles risky machines or tools 0 2 4 6

Handles dangerous chemical substances 0 2 4 6

Is exposed to biological contaminants 0 2 4 6

Performs tasks that require high attention/concentration 0 2 4 6

(Total maximum score = 156)

Score in the case valued:

4.- SOCIAL ASPECTS-QUALITY OF LIFE-HAQ (max impairment 10%)

HAQ Score Degree of limitation Percentage assigned

0 – 0.625 No limitation/incapacity 0%

0.75 – 1.25 Mild limitation/incapacity 4%

1.375 – 1.875 Moderate limitation/incapacity 6%

2 Severe limitation/incapacity 10%

Score obtained = Percentage assigned =

Impact on activities of daily life (max 10%)

HAQ DISABILITY QUESTIONNAIRE*

Areas Score (0-3) Corrector coefficient* Final score 3

1. Dressing and grooming
2. Getting up
3. Eating
4. Walking
5. Hygiene
6. Reach
7. Grip
8. Other Correcting questions 2

Need for third-person help Need for utensil help

*See Annex No. 1

2 If the score is 2 or 3 there is no corrector coefficient. If it is 0 or 1 and the correcting questions modify it, it is added.

3 The average of the 8 values of each of the areas is calculated. If any area has not been answered, the sum of the answered ones will be divided by the number of areas that have been answered.”

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Article Second.- Repeal any provision that contradicts the provisions contained in the first article of this resolution.

Article Third.- Modify the penultimate paragraph of Article 4 of Title VII of the Compendium of Norms of the Superintendence of the Private System for the Administration of Pension Funds, referred to Benefits, approved by Resolution No. 232-98-EF/SAFP, in accordance with the following text:

“Article 4.- Pension Modalities. […]

The pension products enabled to be offered regarding retirement, invalidity or survivorship benefits, by the AFP or Insurance Companies, are listed in Annex 21 of this title. Benefits can be made effective under complementary products or services within the basic modalities offered by Insurance Companies, as established in Chapter VII of Subtitle III of this Title.”

FINAL COMPLEMENTARY PROVISION

Sole.- This resolution enters into force as of January 1, 2019, with the exception of article three which enters into force as of the day following its publication in the Official Gazette El Peruano.

Register, communicate and publish,

SOCORRO HEYSEN ZEGARRA Superintendent of Banks, Insurance and Private Pension Fund Administrators