The former director of the Directorate of Information and Defense of Social Security Affiliates (DIDA), Nésida Marmolejos, the National Social Security Council, from 2007 to date, is violating Law 87-01, producing resolutions that they mutilate the benefits that it contemplates for the workers.
He deplored the fact that, 15 years after the start of a Pilot Plan for the Social Security Law, there are still exclusions, difficulties, denial of coverage, cutbacks in medications and other limitations to the detriment of the affiliate, which are not expressed in its text, but in the regulations that have been added to it, decimate the quality of that provision.
Speaking on the TV Program Periodismo y Sociedad, hosted by journalists Andrés Matos and Isabel Acevedo, Marmolejos said that he sees the need for the Social Security Law to be modified because “they have cannibalized it.”
In this sense, he mentioned that regulations that have been made to this law, violate in some way the affiliate in his benefits, and cites as an example, that when a person reaches his pension moment, he loses the medical insurance, “and he should not be so, according to article 123 in its second paragraph.
“The National Social Security Council has been violating the law from 2007 to date, since no pensioner can be left without health insurance,” Marmolejos pointed out.
He reported that the Superintendence of Health and Occupational Risks (SISALRIL) has carried out studies on the viability of this law and it has not been implemented.
He said that it is necessary for the pensioners in Social Security to be included in the modification, and it must begin by complying with it, providing coverage in the National Health Insurance (SENASA).
The experienced trade unionist called on SENASA to set an example, assuming its pensioners and complying with the Law, giving them the insurance that it indicates, not the insurance that has been maliciously placed on them, since it makes the situation of many pensioners unfair, in the that the member’s fee must be regularized, taking into account their economic condition and income.
“Already the pensioner in his useful life paid to the Health System, and this must return those benefits to the affiliate,” Marmolejos stressed.
He stressed that article 5 of the Social Security Law mandates that parents, if they do not work and are not retired, can be included in the family nucleus.
He assured that the National Health Council and the employers are responsible for not complying with these articles of the Law.
Social security was a qualitative leap in quality of life in 2002
He said that, starting in 2002, the Dominican Republic made a qualitative leap in the quality of life of the population in terms of health, pensions and occupational risks, where it went from a compulsory social security law, in which only the member had access to health to an inclusive social security, for all. “Without discrimination of their condition, since people who had cancer did not apply and other provisions that prevented the majority from having access.”
It was seen as insurance for “healthy” people, and the new law, although it began with difficulties, because it excluded people with catastrophic health conditions, people over 60 years of age and other conditions, began to improve when the subsidized regime of Pensions in Region 4 of Health, located in the Barahona province, inaugurated by former President Hipólito Mejía, starting with those who had the least health protection.
good and bad points
The former director of the DIDA said that the Social Security Law has been modified and handled in two ways, on the one hand, to the detriment of the member, and on the other, for the benefit.
He recalled that the law began with 385 thousand pesos for “high cost” illnesses in general terms, and now, after resolutions to the law, it has 2 million pesos for each event, apart from the 90 thousand pesos for outpatient cases for medications and other procedures, added to the cost of chemotherapy treatments, in case of cancer.
Likewise, the family can monitor their children in the laboratories. There is a prevention of diseases in favor of the member’s health.
However, he said that the Social Security system started and was left open, which has allowed that there is no necessary control for a person to have preventive health, “there is no Primary Care Unit.”
He recalled that, in 2007, a pilot plan of the Social Security Law began and has been maintained to date, that is, 15 years, and with that basic plan, work is being done with exclusions, difficulties, denial of coverage, cuts of medicines, and other limitations that the law does not say, but the regulations that have imposed it, which are the ones that have decimated the quality of that provision in favor of the member.
He said that when he presided over the DIDA, it was demanded that the member be given the treatment he deserved, according to the law, because he must first guarantee a basic health plan, where the member has a family doctor, of the first level of attention, that can treat without any problem, a “flu” or other common illness, without having to go to a specialist and pay large sums of money.
“There is a very expensive medicine and exclusions from insurers to some doctors who do not give them billing codes, because they are not renowned,” Marmolejos denounced.
He said that each doctor who has his exequatur is ready to report to a Health Risk Administrator (ARS).
“Not everything is bad with social security, but people must demand that these irregularities change,” he said.
Champion the member’s cause
Marmolejos, who has dedicated a large part of his life in favor of social and trade union struggles, indicated that his greatest satisfaction in the DIDA was leaving Law 13-20 with legal status and a budget.
