Adeslas stops treating 1 million Muface members on Jan 31

Adeslas to cease care for 1 million Muface members on Jan 31

A two-paragraph email with the date highlighted: January 31. That is the message Adeslas sent this Monday to Muface mutualists to warn them that it will not bid for the 2025-2027 health contract and, therefore, will stop serving them after the first month of the year. The company claims the offered terms do not allow it to provide the quality service it has offered since 1975. Notable about the calendar: the insurer announced its exit before even knowing the second tender planned by the Government.

The three health contract insurers and a first empty bid

The Muface health contract was provided by Adeslas, Asisa, and DKV as awarded companies. The previous call for the 2025-2026 period was declared empty despite including, according to the entity, the largest increase in history in the offered premium: a 17.12% for 2025 and 2026. The three companies found it insufficient in economic terms. DKV bid farewell to its mutualists by letter even before the Health Ministry report was published and Muface launched its preliminary consultation. Now it is Adeslas that steps down, leaving Asisa as the only piece of the original trio that has not yet made a move.

What are the preliminary consultations launched by Muface?

These are a mechanism provided for in the Public Sector Contracts Law for the Administration to survey the market before tendering, and Muface published two on Wednesday: one for mutualists residing in Spain and another for those living abroad. The deadline is ten working days, until December 4, and in their response insurers must detail the fixed premiums they ask for each age group and for each year of the new contract (2025, 2026, and 2027), as well as the breakdown of direct, indirect, and occasional costs. The consultation is open to the entire sector, not just the three usual ones, and Muface emphasizes that it generates "no obligation or commitment to contract." The estimated period is three years, although the final tender may propose a different one depending on what is sought.

A little over a million mutualists and the age map

At the end of October, Muface had 1,573,382 mutualists: 1,143,162 holders and the rest, beneficiaries. Just over a million had chosen contracted health care and almost 504,000 public care. The age breakdown of the group now left without an insurer explains much of the standoff: there are 26,331 minors under four years old and 108,816 aged between 5 and 14, but the bulk concentrates in the higher brackets. The age groups from 55 to 64, 65 to 74, and over 74 years old add up to more than half a million people, while the 15 to 44 years old group stands at 254,806. For any company, this pyramid is the key to the negotiation: the average premium charged by a 70-year-old mutualist is nothing like that of a 30-year-old.

What would happen if the little over a million insured move to public health?

This is the question running through the entire matter, and the answer depends on who you ask. Almost 504,000 mutualists are already in the public system, so the transfer would mainly affect the million who had opted for contracted care. Some argue that many of them will pay for a private policy themselves and that the impact will be smaller, while others recall that older age groups often face rejections or prohibitive premiums when contracting independently. Opposing this is the counterargument: that a contingent of this size, and with this age profile, would swell waiting lists that are already saturated. A nuance that repeats itself: until now, care in Muface allowed entry in the morning, resolution, and return to the workplace in no time.

The Health Ministry report, the December 14 demonstration, and background noise

Adeslas's move comes after the publication of a report by the Ministry of Health, directed by Mónica García, which considers it "reasonable" to end Muface as unsustainable and sees it viable for civil servants to move to the public health system. The Independent and Civil Servants Union (CSIF) states that the insurer's communication "will further increase the uncertainty of those affected" and warns that "the Government is running out of time." The union is organizing a major demonstration in Madrid on December 14, with buses chartered from all over Spain, to protest what it describes as the Executive's abandonment and demand quality health care in administrative mutualism.

The decree extension and who ends up paying

While the future of the contract is clarified, Muface has guaranteed that mutualists will receive the same benefits, because the law allows extending the service for up to nine months for reasons of public interest. The provisional outcome, with the matter already stuck in the courts —there are associations of self-employed doctors challenging tenders—, was a decree extension until the end of April and a deadline until mid-January for insurers to bid for the new tender. The bill will ultimately be covered by the treasury: the figure discussed points to an additional 1,000 million for the contract, and with ISFAS and MUGEJU in the same situation, the figure could reach 1,300-1,500 million.

There lies the knot. Adeslas is leaving, DKV has already left, Asisa is waiting, and mutualists are watching the calendar. What no one has explained yet is how a model is sustained in which the oldest age bracket of the registry concentrates most of the risk and, at the same time, is the one any private insurer most easily leaves out.