March 26, 2023
Shortcomings of health plans: understand what they are and what the deadlines are - Jornal Contábil

Shortcomings of health plans: understand what they are and what the deadlines are – Jornal Contábil

Contracting with a treatment plan It really is something that is beneficial to the health and quality of life of those who employ them. However, joining a health plan, or quoting a health plan for employment can ultimately generate many questions.

Among the most common doubts, perhaps one of the main ones that you or someone you know has is related to the term “deficiency”, since for a certain period you will not be able to enjoy some contracted benefits.

It is important to clarify that period lack It is something completely normal and practiced by all operators, so, when hiring a health plan, know that all operators will require this period.

How does the lack of health plans work?

First, it is necessary to clarify that the concept of grace period refers to a period within the contract period, during which some coverage of your plan is suspended, i.e. during this period you pay your monthly fee, but you cannot afford it. Take advantage of everything that is offered.

The need for a grace period has been foreseen to prevent the plan from being contracted, and after using a certain service, for example, a delivery, the insured ends up canceling the plan, causing a huge loss to the operators.

In this way, the plan sets deadlines by which the consumer can fully use all of the plan’s services, and the deadlines are usually as follows:

Surface maximum grace period
Urgency and emergency 24 hours
Simple consultations and exams 30 days
Other coverage (surgery, CT scan, MRI, etc.) 180 days
Birth 300 days
For pre-existing diseases or injuries 24 months

Points to pay attention to

An important issue is that health plan operators do not usually communicate that after a 24-hour grace period for urgent and emergency cases, the insured person is entitled to use the entire contracted coverage, necessary to restore health, including hospitalization in beds and intensive care units.

Another case related to a pregnant woman and fulfilling a deficiency. This is because, in the event of an emergency and an emergency, say, in the event of a premature birth, the plan must cover, yes, expenses related to the birth and care of the baby. This applies even to the postpartum intensive care unit.

If the operator refuses to cover, the pregnant woman is then entitled to a full refund of all amounts.

Finally, where a 24-month grace period exists for pre-existing conditions, this period can only be applied if the insured was fully aware of the diagnosis when contracting.