Is the health plan expensive? Find out what to do to change your agreement

The private health sector already has 49.1 million beneficiaries, according to data from the National Agency for Complementary Health (ANS). This shows, among other things, the insecurity of Brazilians when they are solely dependent on the SUS. Maintaining this medical care, however, has become a challenge for families, especially in a high-inflation scenario, with rising prices and declining purchasing power.

Moreover, the ANS forecast for the maximum readjustment index of 15.5% is the highest in the historical series.

In recent years, we have encountered a bold attitude additional health. This led to an increase in the hiring of products with their own and more accessible network, a change of operator and an even greater dependence on the public network.

In the health plan change movement, many people complain about the many barriers created by companies to change their product, especially when there is a chronic illness, a previous injury, a disability, or an old age.

+ READ ALSO: What to consider when choosing an agreement?

But any obstacle imposed by medical plans is illegal. The prevailing understanding of justice is that the 24-hour grace period is a requirement for calls that are considered urgent or emergency, with immediate life-threatening or irreparable injury to the patient. If the consumer has a serious illness, the required coverage limit is two years.

So when is it possible to change medical care without a grace period? You can change your plans at any time without having to meet new grace periods and 24-month Partial Temporary Coverage (CPT) if you meet the following requirements:

– The original plan must have been contracted from 1 January 1999 or must have complied with the Health Plans Act (Law 9,656 / 98);
– The current contract must be active;
– The beneficiary must have monthly payments on the day;
– The destination plan must be compatible with the current price;
– Beneficiary must meet the minimum duration of the plan (first portability: two years in the original plan or three years in CPT; second portability: one or two years in the original plan, if portability to the destination plan includes unforeseen coverage).

THE portability it is carried out individually by individuals. However, the exemption may apply to individual / family, group membership or even business plans.

After the portability request, the destination operator will have ten days to review the request. If the company does not respond within the maximum period, the acceptance must be automatic.

The source plan should not be canceled until the portability is effective. At the end of the process, the previous medical aid must be notified in order to be canceled until the fifth day after its entry into force.

+ ALSO READ: Other articles in the column “Your rights in health”

Another possibility of change is through the application of the ANS Regulatory Precedent No. 21, which obliges the agreement to take into account all the grace periods already fulfilled within the same operator.

Even if all the conditions are met, the consumer is not always able to exchange the agreement. In the face of obstacles, often the judiciary it becomes an alternative to intervening in abusive behavior by operators.