Arbitrary modifications to group and group health plans

Several decisions across the country show that it is possible to review collective and commercial health plan contracts in order to apply, as a maximum, the amendments approved by the National Health Agency (ANS). Another possibility that is still unknown to many consumers is to search for a refund of the updated amount related to the last 3 plus years. This position reinforces the understanding that group and corporate health plans can be equated with individual and family plans, especially since they have exactly the same goal: ensuring coverage for people, regardless of the form of the contract.

Increasingly, the market has reduced the offer of individual and family plans. This is because plans of this type are subject to all ANS regulations, which is not the case with group and corporate plans. To make matters worse, the latter can be canceled at any time, unlike individual and family plans, which can only be canceled due to non-payment or fraud. In general, group and corporate plans are subject to adjustments much higher than the percentage established by the ANS. Abuse cases can and should be dealt with in the judiciary.

This year, the ANS specified that family and individual health plans will have an adjustment for the period from May 2022 to April 2023 by up to 15.5%. This was the highest adjustment rate the agency had ever organized since its inception. But collective and commercial plans do not even have a ceiling for readjustment and what is observed are exactly larger modifications of up to 30%.

It is important for the consumer to understand that often, when joining a group plan or a business plan, in the beginning, their monthly fee can be very beneficial, as it is less than the family or individual fee. However, over the years, it can be a huge trap, because, as mentioned earlier, there is no ANS-regulated ceiling for annual adaptations of collective and commercial plans, leaving the consumer at the mercy of operators’ health excesses.

The consumer should know that this annual adjustment applies to all contracts, regardless of the age of the consumer. Thus, it can be experienced by all customers, including the elderly. In this way, it is very important for consumers to know their rights and, in the event of abuse, to seek to guarantee them, so that justice can be served, because collective and commercial schemes, unfortunately, provide less protection for the insured. These are the fastest growing plans in the country. Don’t fall into this kind of trap!

* Marina Basile is an attorney and health law pioneer in Bahia, specializing in Civil and Hospital Medicine Law, MBA in Management and Business Law, Certified in Privacy and Data Protection, in Compliance and Best Practices. His office is one of the few in Brazil that is actually in Metaverso.