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ANS defendeu em reunião que operadoras tiveram redução de gastos em 2020

Health plan: the discount is valid from the anniversary of the contract – saving

Users of individual health plans will begin to feel discounts on premiums from the month of the anniversary of the contract with the operator. On Thursday (8), the National Supplementary Health Agency (ANS) decided that Annual Correction Index for Agreements For the period from May 2021 to April 2022 it will be -8.19%.

As a result, health plans that had their birthdays in May, for example, should receive the monthly fee in August at a discount of more than 8.19%, since the indicator should also be applied in the May, June and July installments of this year.

If your deal has an anniversary in October, for example, the discount will only be valid from that month onwards.

However, the modification does not reach all health plan users. It is only valid for individual or family medical hospital routes that were contracted as of January 1999 or adapted to Law No. 9656/98.

Currently, these types of contracts represent 17% (about 8 million) of total health plan beneficiaries, according to May 2021 data from the ANS.

How will it work?

In the example given by ANS, with the reduction of 8.19%, a person who paid a monthly fee of R$100 for his health plan would, from the month of the annual adjustment, R$91.81.

It is worth noting that the premiums containing the restatement of the pending adjustments from September to December 2020 – which should start to be collected from January of this year in fractional form – remain in effect and will be applied normally.

And if the ticket comes without a discount?

Listen to the lawyers R7 Save We recommend that the consumer wait a little before contacting the court, if the discount does not appear immediately.

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“Sometimes the system may take some time to adjust with the new values. So, it is worthwhile to wait a while before taking any legal action. The operators usually follow the APR for the character and I think users will not have any problems receiving discounts,” he said. says attorney Alexander Perth, who specializes in consumer law and health plans.

Perth suggests that consumers who will adjust my plan in August, for example, wait until September before showing up.

“If the opponent does not appear in the next month, it is worth contacting the operator, talking to the financial department, and if there is no solution, file a complaint with the ANS. The judge usually asks users if there is an attempt to negotiate before joining the court, it is better to start the process administratively.

Attorney Adriana Maia, who specializes in the right to health at Vilhena Silva Advogados, is also opposed to any legal action at this time.

She adds that although it is an unprecedented decision by the ANS, operators are unlikely to contest and question the annual index.

“ANS has a very improved methodology for arriving at the readjustment index. It would be difficult for an operator to question or seek a review in court.”

The discount opens a gap for group plans and work

Berthe and Adriana believe that the negative amendment created by the ANS opens the way for beneficiaries of collective and commercial plans to question the corrections applied to their contracts by operators.

Perth believes the status of the amendments will become more clear in the coming months. “Now is the time to sit down, and do the math to present the new accounts to the users. The thing is to wait and see what lies ahead.”

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Adriana remembers that if it was necessary to file a lawsuit, the user would have to go to the General Court, that is, he would not be able to rely on the JEC (Special Civil Court), formerly known as the Small Claims Court.

It should be noted that while individual plans, fixed by the ANS, suffered a correction of only 8.14%, Procon-SP set the monthly fee for corporate and group plans which suffered an increase of up to 150%, the percentage being considered abusive and unjustified .

The reduction was granted unanimously by ANS

The decision to make a negative adjustment in 2021 was voted on at a virtual meeting with ANS directors on Thursday (8). All five board members voted in favor of an 8.19% reduction in tuition fees.

According to the agency, there was Decreases from 82% to 74% in the use of medical services Not urgent by users in the past year, such as surgeries and exams, regarding preventive measures to reduce the effects of the Covid-19 pandemic.

With that said, health plan operators’ expenses also fell.