June 29, 2022
“I want to have a health plan, but I don’t have the money now. How do I plan to pay?” – Época Negócios

“I want to have a health plan, but I don’t have the money now. How do I plan to pay?” – Época Negócios

(Photo: Pexels)

The Federal Constitution guarantees all Brazilians the right to health, that is, all residents of the country have access to the services of the Unified Health System (SUS), whose role has been highly appreciated in times of epidemic and vaccination against COVID-19.

The alternatives will be special services that can reach astronomical values, especially in cases of surgical operations, hospitalization, or contracting the services of health and health insurance companies.

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To plan to pay for a health plan, the best thing, in this case, is to organize the finances to make the monthly payments fit into the budget.

The first step is to conduct an in-depth and detailed analysis of the monthly budget, determine the revenues and expenses, separate the fixed ones from the miscellaneous, preferably using a spreadsheet, software or personal financial planning application. With this it will be possible to assess how much surplus resources are available each month and how much of this amount can be allocated to pay the monthly fee for the plan.

Once the specific value is determined, the reader can begin to search for a health plan that meets their needs and, if possible, the needs of their family. There are many companies that provide this type of service and it is important to evaluate the quality, reputation, contractual terms and lack of access to the services provided by the provider.

Health plans provide services through their network of certified professionals, therefore, it is up to the reader to check whether this network meets their expectations and whether there are specialists, clinics, laboratories, hospitals and other services of sufficient quality and quantity in their city or region.

Health insurance in turn allows users to freely choose the professionals who will help them, pay for the service, and thus request a reimbursement. The monthly fee depends mainly on the coverage provided and the percentage of payment for the services.

Plans are broken down by types of coverage, such as outpatient, inpatient (with and without obstetrics), dental, and referral.

According to the ANS (National Agency for Complementary Health), outpatient plan coverage ensures the provision of health services that include medical consultations, exams, treatments, and other outpatient procedures. Emergency care is limited to the first 12 hours of care, and does not include procedures that are exclusive to hospital coverage.

Hospital coverage ensures that services are provided under a hospital inpatient system and may or may not include obstetrics, i.e. the inclusion of maternity care services in a particular unit must be contracted.

Reference plans are the most widely used, incorporating outpatient and hospital settings with obstetrics and nursing coverage.

Plans can also participate or not, that is, the user can only pay the monthly fee or also a percentage of the services used. The higher the coverage of the plan, the higher its cost. But are they really necessary? This is the assessment to be made: finding a balance between what is important to the user and the cost of the plan.

As for adjustments, these are of two types: annual, with a limit rate determined by the ANS and calculated on the anniversary of the contract; And because of a change in the age group, which occurs every five years, between 19 and 59 years for the user. It is important for the reader to review the price list for all age groups, not just your current age, to have a minimal expectation of future increases in the amount of tuition fees. On the ANS website there is a lot of information that users can refer to before and after purchasing the plan.

The reader should also consider whether they have access to any health plan operator associated with their trade union, union, or union, so-called group health plans. If this alternative is viable, it could represent lower costs and, eventually, access to premium services and reduced slack.

The most important thing is that the initiative takes place in a planned way, avoiding unpleasant surprises along the way. good luck!

* Adriana De Lucca is a Personal Financial Planner and holds a CFP® (Certified Financial Planner) certification, awarded by Planejar – the Brazilian Association of Financial Planners. Email: [email protected]

The answers reflect the author’s views, not those of ÉpocaNegócios.com or Planejar. The Website and Planejar are not responsible for the above information or for damages of any kind resulting from the use of such information.