What is AUGE?
AUGE is a universal health plan which provides explicit healthcare guarantees (garantías explícitas de salud, GES) with regard to coverage for 80 health problems which have been established by law. All Chilean men and women, whether they are in the public healthcare system (FONASA) or have a private health insurance plan (ISAPRE), are guaranteed coverage for these health problems. These guarantees constitute a right which must be granted whenever any Chilean is diagnosed with one of these pathologies and meets the requirements set for each one.
What does it guarantee?
Access – the right to receive attention and different health interventions, in the manner and under the conditions established for each AUGE health problem.
Financial Protection – the cost a person must pay for the attention is determined (in accordance with the GES Price, the rules that govern the calculation of copayment and maximum authorized limits).
The right to receive guaranteed and prompt attention within the time periods established.
Quality – the guaranteed benefits of AUGE must be provided by a healthcare giver that is registered and accredited by the Superintendence of Health.
What to do if a guarantee is not met?
If a guarantee is not fulfilled, you can file a complaint demanding compliance with your healthcare cover, be it FONASA or an ISAPRE insurance plan. As a last resort, you can make a complaint with the Superintendence of Health.
Some of AUGE’s achievements
- Unified treatment protocols and allowing follow-up of diagnostic results, which was not previously a right.
- Provides better financial coverage for highly prevalent pathologies among people of greater economic vulnerability.
- Reduced gallbladder cancer with the introduction of preventive cholecystectomy.
- Provides access to HIV/AIDS treatment to all people who need it. Today, there is greater detection, more treatment and a lower mortality rate.
Explicit guarantees in Fonasa and Isapre
- Chronic kidney disease, stage 4 and 5
- Operable congenital heart disorders in children under the age of 15 years
- Cervical cancer
- Pain relief and palliative care for advanced cancer
- Acute myocardial infarction
- Type I diabetes mellitus
- Type II diabetes mellitus
- Breast cancer in people aged 15 years and older
- Spinal dysraphism
- Scoliosis surgery for people under the age of 25 years
- Cataract surgery
- Total hip endoprothesis for people aged 65 years and older and arthrosis of the hip with severe functional limitations
- Cleft lip and palate
- Cancer in children under the age of 15 years
- Schizophrenia
- Testicular cancer in people aged 15 years and older
- Lymphomas in people aged 15 years and older
- Human Immunodeficiency Virus and Acquired Immunodeficiency Syndrome (HIV/AIDS)
- Outpatient care for Acute Respiratory Infection (ARI) in children under the age of 5 years
- Outpatient care for community-acquired pneumonia in people aged 65 years and older
- Primary or essential arterial hypertension in people aged 15 years and older
- Refractory epilepsy in children between the ages of 1 and 15 years
- Integral dental health care for girls and boys aged 6 years old
- Premature birth prevention
- Impulse and conduction disorders in people aged 15 years and older who require a pacemaker
- Cholestycectomy for the prevention of gallbladder cancer in people between the ages of 35 and 49 years
- Gastric cancer
- Prostate cancer in people aged 15 years and older
- Refractive errors in people aged 65 years and older
- Strabismus in children under the age of 9 years
- Diabetic retinopathy
- Nontraumatic rhegmatogenous retinal detachment
- Hemophilia
- Depression in people aged 15 years and older
- Treatment for benign prostatic hyperplasia in symptomatic people
- Orthosis (or technical help) for people aged 65 years and older
- Ischemic stroke in people aged 15 years and older
- Outpatient treatment for chronic obstructive pulmonary disease
- Moderate and acute bronchial asthma in children under the age of 15 years
- Respiratory distress syndrome in the newborn
- Medical treatment for people aged 55 years and older with light or moderate hip and/or knee arthrosis
- Secondary subarachnoid hemorrhage to rupture of brain aneurysms
- Primary tumors of the central nervous system in people aged 15 years and older
- Surgery for herniated nucleus pulposus
- Leukemia in people aged 15 years and older
- Outpatient treatment for odontological emergencies
- Integral dental health care for 60 year old adults
- Serious polytrauma
- Moderate and serious traumatic brain injury
- Serious eye trauma
- Cystic fibrosis
- Rheumatoid arthritis
- Heavy consumption or low to moderate risk of addiction to alcohol and drugs in people under the age of 20 years
- Analgesia in childbirth
- Severe burns
- Bilateral hearing loss in people aged 65 years and older requiring hearing aids
- Retinopathy in premature babies
- Bronchopulmonary dysplasia in premature babies
- Bilateral sensorineural hearing loss in premature babies
- Nonrefractory epilepsy in people aged 15 years and older
- Bronchial asthma in people aged 15 years and older
- Parkinson’s disease
- Juvenile idiopathic arthritis
- Secondary prevention of end-stage chronic kidney disease
- Hip dysplasia
- Integral dental health care for pregnant women
- Relapsing-remitting multiple sclerosis
- Chronic hepatitis due to hepatitis B virus
- Hepatitis C
- Colorectal cancer in people aged 15 years and older
- Epithelial ovarian cancer
- Bladder cancer in people aged 15 years and older
- Osteosarcoma in people aged 15 years and older
- Surgical treatment of chronic lesions of the aortic valve in people aged 15 years and older
- Bipolar disorder in people aged 15 years and older
- Hypothyroidism in people aged 15 years and older
- Treatment for moderate hearing loss in children under two
- Systemic lupus erythematosis
- Surgical treatment for chronic lesions of the mitral and tricuspid valves in people aged 15 years and older
- Treatment for the eradication of helicobacter pylori.