Project Projects Maximum Amendments to Group Health Plans – News

You Group health plans It will have a limit on monthly fee adjustments, as it currently does with individual and family agreements. The proposal is part of an alternative that must be submitted by the end of June to the House of Representatives, according to Rep. Duarte (PSB-MA), the project’s rapporteur who proposes changes to the health plans law.

The text also states that this type of plan is regulated by the ANS (National Complementary Health Agency).

The aim of ensuring regulation is to curb the practices that were occurring in many cities in the country. “We will prohibit unilateral termination of these contracts and limit readjustment of group health plans,” Duarte said, during a public hearing at the Consumer Protection Committee.

He was appointed rapporteur of the issue at the beginning of May, and is now awaiting the formation of a special committee by the Chamber’s board of directors. Duarte is expected to issue an opinion on just over 270 proposals being processed that indicate changes to existing legislation on health plans.

He also reported that the alternative would expect that consumer protection law would apply to self-management plans, which is the way a company or entity itself establishes and operates, on a non-profit basis, the health assistance program.

differences

On Monday, the ANS, a regulatory body linked to the Ministry of Health, authorized a readjustment of up to 9.63% in the value of individual and family health plans.

ANS explains that the readjustment index for individual or family plans is set by the agency, approved at a collective board meeting and estimated by the Ministry of Finance.

“The percentage is the maximum readjustment. Operators may apply lower rates, but are prohibited from applying rates higher than those set by ANS for individual or family plans,” the regulatory agency says in a note.

Group plans with 30 or more beneficiaries have a specific modification in the contract and are established based on the business relationship between the contracting company and the operator, where there is room for negotiation between the parties.

service

“The consumer does not know the concept of the STJ (Supreme Court of Justice), according to which this contract today is not for consumption and, therefore, Procon cannot be sued today. This has led to an increase in the judiciary in search of a guaranteed service,” Duarte said.

According to the decision, the new law should also authorize the request for examinations to be carried out by other specialists, such as nutritionists and physiotherapists, for example, and ensure the supervision of service providers.

Which increases the cost [das operadoras de planos de saúde] It is not the number of tests and procedures, but the demand for tests that does not exist, which is not used by the consumer. “We will work to reduce this through increased inspection,” he concluded.

supports

The Health Program Coordinator of the Brazilian Institute for Consumer Defense (Idec), Ana Carolina Navarrete, supported the idea of ​​regulating group plans.

This is what solves the shortage of individual plans. If you leave most of the market unregulated or with very little regulation, compared to the individual plan, which is more regulated and better regulated, then obviously the market escapes to where it is less regulated, and then we have a lower supply of individual plans,” he noted.

ANS Executive Director Paulo Roberto Rebelo Filho reported that the agency already has an advanced study on organizing group plans.

“We have evolved in regulation, which has brought more transparency to what is communicated to the beneficiary, that is, more clarity to the contract regarding the indicators and indicators that the operator notes when these values ​​are conveyed to the beneficiary,” he said.