From February 1, significant changes in the ADSE, the protection system in state workers and retirees, and among the main changes is the introduction of a maximum limit of 500 euros in the co-paying of surgeries performed surgeries In the agreed regime, a measure that aims to relieve the charges of the beneficiaries. In addition, there are changes in consultation prices and ophthalmological examinations, with the objective of making the system more sustainable and attractive to health service providers.
Co-paving surgeries with a maximum ceiling of 500 euros
One of the most relevant changes is to set a maximum limit of 500 euros in the amount that ADSE beneficiaries will have to pay for surgeries under the agreed regime. According to the newspaper Publicthis rule applies to all surgeries performed from February 1 in agreed hospitals and clinics, regardless of the date of prior authorization.
With this change, if a beneficiary previously paid 750 euros for surgery co-paying, the amount will be reduced to 500 euros. The same applies to more expensive interventions, such as surgery that costs 1,800 euros, whose co-paying will not exceed the new ceiling. However, if co-payment was less than this value, there will be no changes and the rules previously defined in the table in force apply.
According to ADSE calculations, this measure will represent an annual savings of about 13 million euros for the beneficiaries, being the amount now assumed by the system itself.
Ophthalmic exams are no longer included in the consultation
Another relevant change affects ophthalmology consultations, in which ophthalmological examinations are no longer included in the consultation price. From now on, these tests are charged separately, with an extra cost of 2.20 euros.
The co-paying of the ophthalmology consultation remains in the seven euros, but the beneficiaries will have to pay separately for the additional exams that are necessary.
Changes in consultations prices to attract providers
In order to make the regime agreed more attractive to health service providers, ADSE has increased the amounts paid to private health units by medical consultations.
General clinic consultations start to cost 30 euros, an increase of 25%. Of this amount, ADSE will cover 25 euros instead of the previous 20 euros, while the co-paid of beneficiaries rises from four to five euros.
Specialty consultations have also changed, with the reimbursement of ADSE to increase from 25 to 35 euros. The co-payment of the beneficiaries goes from five to seven euros.
Teleconsultures, which have been growing in adhesion, cost 20 euros compared to the previous 18.46 euros, and the beneficiary will now pay four euros.
In addition, ADSE’s agreed regime includes clinical psychology and nutrition consultations, each costing four euros for the beneficiaries.
Changes in the free regime already in force since January
The changes that came into force this month join other changes implemented by ADSE in early January, namely in the free regime. In this system, which allows beneficiaries to choose health providers outside the agreed network and request reimbursement, the reimbursement was reviewed.
In -person consultations had a reimbursement of 25 euros instead of the previous 20.45 euros. Clinical psychology consultations were reimbursed in 16 euros.
In addition, new modalities have been included in the free regime, such as nutrition and teleconsulture consultations, both with a reimbursement of 16 and 20 euros, respectively.
Sustainability and impact of new measures
These changes are part of ADSE’s broader strategy to ensure system sustainability and attract more healthcare providers to the agreed network. The increase in amounts paid to professionals and the reduction of direct charges of beneficiaries seek to balance access to health care with the financial viability of.
The impact of these new rules on surgeries will be closely monitored by beneficiaries and health service providers, in a context where ADSE remains one of the main complementary health systems in Portugal.
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