The health benefits plan
- System and programme
It is the set of services and technologies every enrollee is entitled to. Since Law 1751, everything is covered except what is expressly excluded.
What it is
The benefits plan is what the SGSSS guarantees its enrollees. Law 100 created the Mandatory Health Plan (POS) as a list of what was included; the Constitutional Court ordered it updated and unified across schemes, and Law 1751 of 2015 changed the logic: everything needed is covered except what the Ministry expressly excludes on the law's criteria. Part of what is covered is funded by the UPC and part is prescribed through a separate route (MIPRES).
How it is organised
- Funded by the UPC: services and technologies the EPS pays for with the per-capita amount.
- Not funded by the UPC but not excluded: prescribed in MIPRES and paid through other mechanisms.
- Excluded: an explicit list from the Ministry of Health, under article 15 of Law 1751.
- Voluntary plans (complementary plans or prepaid medicine): paid by the enrollee on top of their contribution.
Worked example
- A made-up doctor treats a patient with a rare disease who needs a technology not funded by the UPC.
- She checks that it is not on the exclusion list and records the prescription in MIPRES with the clinical justification.
- The EPS must guarantee supply, directly or through its network, within the times set by the rules.
- If the EPS refuses the service, the patient can file a complaint with Supersalud or a tutela action.
Three categories of the plan
| Category | How it is ordered | Who is responsible |
|---|---|---|
| Funded by the UPC | Medical order through the usual route | The EPS with its network |
| Not funded by the UPC, not excluded | Prescription in MIPRES | The EPS, paid outside the UPC |
| Excluded (article 15, Law 1751) | Not funded with public money | Not applicable |
Markers
- PBS
- POS
- UPC
- MIPRES
- Exclusions
In practice
- The treating doctor decides with autonomy and evidence; the prescription must be justified in the clinical record.
- Under Law 100 (article 187), user fees may not become access barriers for the poorest.
Reference norms
- Law 100 of 1993: Mandatory Health Plan (POS).
- Constitutional Court, ruling T-760 of 2008: update and unification of the POS.
- Law 1751 of 2015, article 15: benefits and exclusions.
- Resolution 740 of 2024 of the Ministry of Health and its amendments: technologies not funded by the UPC and MIPRES.
Test yourself
Think of the answer, then tap the question to see it.
What did Law 1751 of 2015 change in the logic of the benefits plan?
It moved from a list of what was included (POS) to a plan where everything is covered except what is expressly excluded on the law's criteria.
Which tool is used to prescribe technologies not funded by the UPC?
MIPRES, the Ministry of Health's tool for recording those prescriptions; the treating professional makes them.
Which two exclusion criteria from article 15 of Law 1751 can you name?
For example: cosmetic or luxury purpose and lack of scientific evidence of safety and efficacy; also being experimental or provided abroad.
Who defines the exclusion list?
The Ministry of Health and Social Protection, through a technical-scientific, public, collective, participatory and transparent procedure.
Connections
Educational content on epidemiological and statistical methods; the examples use made-up numbers to teach the calculation. Not a clinical or legal guide: current Colombian rules are in the official sources.
Sources: Ley 1751 de 2015 (Departamento Administrativo de la Función Pública, Colombia (Gestor Normativo), 2015); Compilación Jurídica SuperSalud - Resolución 740 de 2024 MSPS (Superintendencia Nacional de Salud, Colombia, 2024); Sentencia T-760/08 (Corte Constitucional de Colombia, 2008).
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Representative model, for educational purposes only.