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Health plans refuse individual contracts with individuals

10/02/2013

This article was translated by an automatic translation system, and was therefore not reviewed by people.

 

 

 

 



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Most major health insurers in the country has left to sell individual plans . And ordinary citizens seeking the benefit is increasingly no option in the market .
The major health insurers leaving the country come to sell individual plans . And ordinary citizens seeking the benefit is increasingly no option in the market .
Flavia is dependent on the mother in a health plan for 16 years . When she became pregnant , failed to make an individual plan in the same service provider for the child also had assistance .
" I superpreocupada , I was nervous because it was missing a month, I did not expect this , my blood pressure went up because I tried to put it in terms that I 'm 97 and since I could not ," says Flavia Tinelli , engineer .
She was forced to resort to another company , smaller. And is paying dearly for that David was able to use the benefits .
"I decided to be paying two health plans for me so he could have one without grace ," says Flavia.
According to the National Federation of Health Insurance, which represents the largest health insurers in the country , the 17 groups of companies selling plans , only four still make individual contracts . The main reason , they admit , is profit .
" In individual plans , the adjustment is set by the government . If this adjustment falls short of the assessment of costs , those plans sold in the past are becoming deficient . No one should be forced to carry a wallet with underfunded plans , "explains José Cechin , director of FENASAÚDE .
Among the companies that recently canceled the sales of individual plans is the Golden Cross . The company passed the portfolio of individual plans for Unimed , which from Tuesday is responsible for 160,000 users . But some customers complain about not getting more appointments with doctors or they use the same hospitals .
Amil The group said it has asked the National Health Agency a change of the products offered , but not stopped selling individual plans . But when the consumer calls the network , finds that it is no longer possible to buy this kind of plan.
The National Health Agency sees no problem in the end the sale of individual plans . But he says the contracts already signed can not be broken .
" There is no legal obligation for marketing individual plans . There is a formal requirement of these operators to meet all those contractual obligations even when they choose to suspend the marketing of these products , "says Andrew Long , director of the National Health Insurance .
For the teacher Ligia Bahia , Institute for Studies in Public Health with fewer options the consumer will pay more .
"Companies are choosing , selling plans , marketing plans that suits them best . What are the plans that best suits them ? The plans are not regulated or in relation to or in relation to roofing prices " , says Ligia Bahia , a professor at UFRJ .
Ligia Bahia says , so to replace individual plans , some operators have begun offering so-called membership plan .
"It's a plan that he is single , but in reality it is presented as if it were collective. The ordinary citizen purchase this health plan for up to a relatively smaller and when it 's time for readjustment what happens ? Surprise . This adjustment , it is much higher , often much higher than the adjustment granted to the individual , "explains the professor .
The Office of Consumer Protection says the population is being harmed .
" The group plans they have a regulation that it is more contrary to consumer rights and more conducive to economic and financial interests of insurers and health plan providers . So the question of adjustments , the adjustments of these plans are very high because it has a value ceiling set by ANS contrary to what happens in individual plans , there is the possibility of unilateral cancellation by the provider of these collective plans , contrary to what happens in the plans individual , portability and vesting in group plans , she has a chance to happen more restricted than the individual and family plans , "said Joan Cruz , Institute of Consumer Protection .
The National Health Agency declared that it accepts the accusation that it is acting on behalf of insurers . And said he has been fighting in court against the marketing plans that violate the law .
Unimed already said it will maintain the same hospital network for clients individual plans of Golden Cross .
But that does not have the obligation to offer the same frame of physicians and laboratories.


Source : G1

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This article was translated by an automatic translation system, and was therefore not reviewed by people.

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