June 28, 2022
Individual health plans can be modified by more than 40%

Individual health plans can be modified by more than 40%

The National Supplementary Health Agency (ANS) has authorized readjustment of individual and family health plans by up to 15.5%, a record rate since 2000. However, the increase in monthly fees can exceed 40% for medical plan customers. This is because, in addition to the annual adjustment, operators are allowed to raise the monthly fee when there is an age group transition – the last possible increase is at age 59.

The calculation was made by a team of scientists led by Mario Schaefer, a professor at the University of São Paulo School of Medicine (USP) and blogger at stadium, and from Legia Bahia, a professor at the Federal University of Rio (UFRJ). The group relied on data from the ANS, which for the first time released the commercial values ​​of the agreements and operators. The survey was published on the Política & Saúde blog.

The average calculated on the basis of 3,500 plans, from 468 operators, indicates that price increases can be as high as 43.1% for those who “migrated” from the 54-58 age group to the age group 59 or older – this applies to customers who They turn 59 by April of next year. According to the rules of the ANS, there are ten age groups, the transmission of which entitles the operator to raise the price. For children and teens, the readjustment rate is 15.5%. For the other seven age groups, rates range from 25.3% (34 to 38 years old) to 43.1% (59 years and over).

For Schaeffer, the rates are “unacceptable,” particularly “in this time of economic stagnation and loss of purchasing power” of the population. “The elderly are financially expelled from complementary health services,” he says. “The person pays the plan their whole life and when they reach 59, more precisely, they can’t afford the costs anymore.”

Individual plans correspond to approximately 20% of all contracts signed with complementary health operators. Collective plans – contracted by associations, unions, corporations, etc. – can be negotiated directly and are not under the control of the ANS.

If all types of health plans (individual, group, etc.) are considered, the Lígia Bahia Group estimates about 6 million clients of transitional age, when the law authorizes an increase based on age. The Brazilian Association of Health Plans (Programs), in turn, argues that most CAP contracts do not provide for modification by this standard.

Schaeffer explains that the reallocation of values ​​for each age group is done “with relative flexibility”, which allows the operators themselves to determine which groups receive more or less adjustment. However, the rule states that the last range (59 years or older) cannot have a modulation six times greater than the first range (0-18 years old). It indicates that “the higher values ​​are usually the higher ranges”.

After the announcement by the American News Agency (ANS), the Minister of Health, Marcelo Quiroga, expressed himself on social media. According to him, changes are needed in the sector “such as increased transparency, efficiency and increased competition”. He also said that “the increases in monthly fees paid by Brazilians who contract with health insurance are not necessarily related to the quality of the service provided.” Already the boss Jair BolsonaroThis week’s candidate for re-election told host Sekera Jr that the increase was not “fair.”

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According to the National Federation of Complementary Health (FenaSaúde), which represents 15 operator and private insurance groups, affiliates have increased by 2.4 million clients since June 2020 and each one is “free to offer differentiated terms” to clients.

The entity also says that in the case of group plans, average adjustments last year were 9.84%, for plans up to 29 lives; and 5.55% for those with 30 lives or more. He says far above average rates “are the exception, not the rule”. He argues that the adjustment is “necessary to restore cost inequality. It also highlights a 24% increase in expenditures in 2021 — the year before there was a record drop in measures with the pandemic.

For Marcus Lovis, Abramge’s CEO, the 15.5% rise comes after the “negative” correction of the previous period and the true value will be 6% within two years. “In the economic panorama of Brazil, we can say that the plan has one of the smallest adjustments in history. When we ignore the claims, the remaining 14% is barely enough to pay taxes.”

The ANS says that “rapidly developing factors”, such as increased life expectancy, “are considered pressing issues”. In this scenario, he said, the adjustment resulting from the change of age group stipulated in the Sector Law is justified. “The composition of the age groups aims to spread the risk across a larger mass of users, providing a more balanced price for all beneficiaries.”