Clipping of news on Brazilian Culture, Law and Citizenship
06/26/2013
This article was translated by an automatic translation system, and was therefore not reviewed by people.
Aline Leal
Brazil Agency reporter
Brasilia - Research released today (25) by the Brazilian Institute of Consumer Defense (IDEC) shows that between 2005 and 2013 there were increases of up to 538.27% in group health plans. A survey by the lawyer Idec, Joana Cruz, considered judgments of actions contesting the adjustments.
According Idec, operators are restricting the supply of individual plans and encouraging the sale of collective agreements, since they do not have a ceiling value for the adjustment indexes regulated by the National Health Agency (ANS).
For Joan, the ANS is remiss for not determine a maximum adjustment to group health plans, which are hired by a legal entity to provide assistance to persons working as employees and union members. The regulator determines only a roof for adjustment of individual plans.
The research identified an average increase of 82.21% in contracts collective plans analyzed, meanwhile the ceiling to increase authorized by the National Health Agency (ANS) for individual plans in 2012 was 7.93%.
Among the decisions on research cleared in 82% of cases the judges thought that the adjustment imposed by the health plan was abusive. In one third of these, was determined applying the same index set by the NSA for individual plans. "This lawlessness [unfairly increase] is detected and corrected by the judiciary," said the lawyer.
"The NSA can both as to interfere with the adjustment, the consumer's right to not have an overly burdensome requirement applied and have clear and adequate information. We understand that it is a regulatory failure ANS does not set a ceiling percentage adjustment for collective contract ", said the lawyer
According to ANS, the rate of readjustment of collectives is determined from the negotiation between the contracting entity and the operator of a health plan. Because they are both corporate entities would be at the same level to discuss the most appropriate way. The index should be reported to the NSA within 30 days after the price increase. The regulator notes that additional rules and operations for group plans are the same as those of individual plans.
According to the NSA, the 48 million consumers of health plans, 77% of customers are group plans, 37 million people. Among these, the majority of contracts, 85% (31 million) are contracts that are between two to 30 recipients, called the false collective Idec.
This type of contract, as well as other groups, do not have an adjustment ceiling determined by ANS and may be terminated by the operator at any time after the first year. Individual plans, the false collectives have the grace to be fulfilled by the beneficiaries, the group plans do not have.
According to the National Federation of Health Insurance (FenaSaúde), collective plans are adjusted in accordance with the contract, through free and transparent negotiation between employer companies or associations contracting health plans and health insurance companies.
According to the organization, for the calculation of the adjustment, the operators take into account the evolution of expenditure on health care - appointments, tests, therapies, hospitalizations, medical fees, among other items. She argues that the adjustment should cover the variation of these costs, in order to ensure the financial stability and sustainability of the operators Supplemental Health System.
As for the decrease in the supply of individual plans, the FenaSaúde says that given the economic stability, companies began to offer group health plans to their employees, which often extend to dependents of beneficiaries.
Editing: Fabio Massalli
Source: Agency Brazil
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This article was translated by an automatic translation system, and was therefore not reviewed by people.