See alternatives to fit your pocket

It is difficult to obtain health insurance in Brazil due to the cost. Those with a plan face two types of readjustment. The first is annual, and affects all contracts once a year, The second is according to age and the aging of the client is applied.

The sector expects individual plans to be readjusted by 16% this year. But what to do if the excess burdens your pocket? Experts heard before UOL Say there are some alternatives before giving up of special assistance.

Negotiate with the operator

Mateus Falcao, an analyst with the health program at Idec (Brazilian Institute for Consumer Protection), advised the customer to ask the operator about the adjustment as soon as he notices a significant increase in the price of the monthly fee.

“Consumers need to ask about the source of the percentage adjustment and use consumer protection law to their advantage, particularly with regard to the right to information. The attempt here is to strike a deal with the operator. We understand that in some cases it is possible to obtain discounts with a monthly fee in This conversation,” says Falcao.

The consumer will not always be able to negotiate. If not, the guideline is to file a complaint with consumer protection agencies, such as Procon.

If the situation is not resolved, the next step is to file a lawsuit in court. Experts advise that the consumer does not fail to pay the health insurance plan during the period, unless you have a court authorization.

The law allows operators to suspend assistance after 60 days of individual plans having arrears.

“Individual plans can only be canceled due to default after 60 days, and the operator needs to communicate with the consumer until the 50th. In group plans, there is no rule in law, you need to know what is in the contract,” says Rafael Ropa, attorney for Vilhena’s office. Silva.

Change the health plan

Another alternative is the portability of grace periods, which means that a consumer can switch health plans without any type of coverage limitation (slack period). Portability has some rules:

• The current plan must have been contracted after January 1, 1999 or adapted to the Health Plans Act (Law No. 9.656/98)
• The contract must be active, that is, the existing plan cannot be canceled
• The beneficiary must be up to date with the monthly payment
• The beneficiary must meet the minimum working period in the plan. In the case of the first transfer, the term in the original plan is two or three years if you have completed temporary partial coverage for a pre-existing illness or injury. In the second transferability, the period of residence required is at least one year or two years if you have made transferability to the current plan with coverage not provided for in the previous plan
• The target plan should be priced in line with your current plan

Documents required for portability are proof of payment of the last three monthly payments, proof of period of stay, and a report on compatibility between plans (issued by ANS Guide to Health Plans). If the destination plan is group, you must provide evidence of your ability to join the plan.

An important point is that compatibility takes into account the initial contract price of the plan, that is, it ignores adjustments applied over time. This helps increase the number of plans that can be supported when relocating.

Although some operators make portability difficult for the elderly or those with pre-existing disease, Rupa says this is a consumer right, as long as it meets all requirements.

“It is important that the consumer is documented about any attempt to make a transfer. If there is any refusal by the operator, you can open a claim at the ANS or in court,” says Ropa.

The destination operator has up to 10 days to evaluate the transfer request. The ANS instructs the consumer to request the cancellation of the old plan within five days after the start of the new plan.

The ANS explains: “If you do not request cancellation within this period, you will be subject to fulfillment of deficiencies in the new plan for non-compliance with the rules.”