Draft bill 190.

Summary.

The draft bill guarantees people aged 60 or older who hold or benefit from private health insurance uninterrupted coverage against cancellation, suspension, or refusal to renew on grounds of age. It would apply to insurers defined in Law 12 of 2012 that are authorized to offer health insurance and recognized by the Superintendence of Insurance and Reinsurance of Panama (Superintendencia de Seguros y Reaseguros de Panamá). It covers individual and group health, medical expense, and hospitalization policies issued or sold nationwide. It defines preexisting conditions, waiting periods, accumulated coverage history, age bands, and enrollment periods. Coverage history would remain continuous if a gap did not exceed 60 calendar days.

Policies covering people aged 60 or older could be renewed throughout their lives. An insurer could not exclude an insured person, terminate coverage, or refuse renewal because of age, conditions arising during coverage, claims, retirement, or a change in employment status. Termination would be limited to nonpayment after the grace period and written notice at least 30 calendar days in advance; proven fraud or intentional misconduct; proven misrepresentation or inaccurate disclosure raised within two years after issuance; and the insured person's express request. The bill distinguishes an unpaid initial premium, governed by Article 154 of Law 12 of 2012, from nonpayment on renewal. On renewal, the insured person would retain contracted limits, benefits, and coverage. General product changes would require prior approval by the Superintendence of Insurance (Superintendencia de Seguros).

If an insurer discontinues a product, it would have to offer an equivalent or better one without a new risk assessment, additional waiting periods, or new exclusions, while recognizing accumulated coverage history. If it leaves the health insurance line, lifetime coverage would pass to the assignee under Law 12 of 2012. A person leaving a group policy because of retirement or the end of employment could convert coverage to an individual policy under Article 163 of that law. For insured people aged 60 or older with at least one year in the group policy, accumulated coverage history would count toward waiting periods.

Insurers selling health insurance would offer at least one plan for people aged 60 or older, admitting applicants with or without preexisting conditions during enrollment periods. Applicants moving from another policy after a gap of no more than 60 calendar days could enroll at any time. Declared preexisting conditions would be covered after a waiting period of no more than 12 months and could attract a regulated technical premium surcharge. Enrollment would be voluntary. Premiums could change only at renewal under an approved technical filing, applied uniformly by product and age band rather than according to an individual's claims. The Superintendence would set annual caps and could approve exceptional increases by a reasoned decision. Insurers would give written notice of an increase at least 60 calendar days before renewal.

The Superintendence of Insurance would approve technical filings and policy forms, hear claims, and sanction breaches under Law 12 of 2012; an insurer would also have to restore affected coverage. Clauses allowing termination contrary to the bill would be treated as unwritten. The Executive Branch (Órgano Ejecutivo) would issue regulations within 120 calendar days after promulgation. Existing policies would be brought into compliance at their first subsequent renewal, with reference to Article 46 of the Political Constitution (Constitución Política). The bill makes its rights nonwaivable, gives its provisions priority over specified provisions of Law 12 of 2012, and refers supplementary matters to the Commercial Code (Código de Comercio) and Civil Code (Código Civil). It excludes termination of these policies for excessive hardship under Article 1161 of the Civil Code. It would take effect six months after promulgation. The measures concern insurers, private health insurance policyholders, older people, and people with preexisting conditions.