Health plan: Portability with readjustment can be the way out – Economy

The National Supplemental Health Agency (ANS) on Thursday (26/5) announced a 15.5% readjustment for individual and family health plans. The increase, the largest since 2000, is the limit for contracts worth around 8 million beneficiaries between May 2022 and April 2023, which is 16.3% of consumers of Brazilian health plans.

A total of 49.1 million beneficiaries have health plans in the country, according to data from March 2022. The adjustment can be made by the operator from the anniversary of the contract, which is the month of contracting the plan.

In a survey conducted by the National Association of Benefit Administrators (Anab) at the end of 2021, 49.2% of health plan users said they were unwilling to pay for possible tuition and procedure increases. This percentage highlighted the importance of having a health plan during a pandemic.

When it comes to using health plan services, the majority of beneficiaries turn to specialist consultations (69%), followed by examinations (13.3%) and emergencies (8.7%), according to the survey.

The data also showed that, despite a plan, 42% of beneficiaries use Integrated Health System (SUS) services. Among the uses of SUS, vaccine is the most cited, according to 49.3% of respondents. The demand is higher among the elderly and the population with lower purchasing power.

In the perception of the beneficiaries, the agility of the service is the most important factor in a health plan, which is indicated by 24.2%. Ease of authorization of procedures is second only to 15.4%, and the medical network included in the contract is 14.4%. The top five also include services (11.1%) and a network of professionals (10.9%).

Among the men surveyed, 51.5% acknowledge the importance of the plan, but are not willing to pay more for it. In terms of age, the percentage is higher among users between the ages of 40 and 49, 56.1% of those who are not willing to pay extra. Overall, only 20% of respondents are willing to pay more for health insurance.

Operators have already reported an increase

The average readjustment of the corporate collective plans in the service of micro-enterprises (MEI) and micro-enterprises (ME), among other businesses up to 29 lives, was 17.23%. Some operators have already reported the increase to their users.

“Our partners are working to guide consumers to make their own calculations and choose alternatives that are very close to their existing product and thus maintain a health plan that is so important to Brazilians. The COVID-19 pandemic raised the alert. that is even becoming a current concern, “said Alessandro Acayaba de Toledo, president of Anab and a lawyer specializing in health law.

Sami President and co-founder Dr. Vitor Asseituno says small adjustments are possible with controlled medical protocols and costs. “Our goal is not to readjust over inflation, because we don’t want the prices of the plans to be a barrier to people getting quality health care,” he says.

“If the consumer notices that the plan no longer fits his or her budget, after the readjustment, he or she may always have an alternative with the portability resource that allows him or her to change the plan or operator, including the grace periods already met.” highlighted Alessandro Toledo.

How is portability

According to the ANS, the portability of health plans is one of the rights of citizens who start using the benefit. In order to apply for a change, the plan must have been contracted since 1999 or be in accordance with the Health Insurance Act (the plan cannot be revoked). Payment must also be up to date.

The first portability can only be done when the person is at least two years old in the original plan. If you have completed partial temporary coverage for a previous injury, the requirement is three years of the original plan.

When making a new portability, the required period is at least one year. If the migrated plan has new coverage, the minimum time is two years.

Plans require a set of documents to send portability, such as a receipt for payments for the last three months or a signed statement of the operator of the regular situation and a signed membership proposal.

Another required document is the compatibility report of the origin and destination plans, provided by the ANS and the operators. If the plan is collective, it must prove that the person has the right to access it.

Response time is 10 days

The operator has 10 days to review the portability request. If no response is received within this period, the transition procedure will be considered valid. The beneficiary has five days to request the cancellation of the previous plan. Failure to do so will result in compliance with the requirements.

Portability is done by the operator or administrator of the destination health plan. The person must contact the company and request a change of plan, in addition to canceling the old one in the previous operator.

The portability of grace periods can be realized by allowing individuals to make changes without having to meet a period that pays for the service but cannot use it.

If you would like to be ported to a plan with new coverage not previously provided, you will have grace periods. According to the National Supplementary Health Agency’s Portability Portfolio, the needs are 24 hours for emergencies or emergencies, six months for hospitalization, outpatient and dental coverage, and 300 days for childbirth.

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