Clipping of news on Brazilian Culture, Law and Citizenship
02.12.2015
This article was translated by an automatic translation system, and was therefore not reviewed by people.
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In this mode, the consumer pays for each consultation, examination, hospitalization or other procedures that use. The monthly fee is usually lower, but you need to evaluate whether it is worthwhile for your case
Have you heard of health plans with co-participation or franchise, as they are also called? This is the mode in which the user pays, in addition to the monthly plan, a fee every time you pass a query or do an exam, for example.
As in traditional health plan, the co-participation offers the same coverage. Only that while the first is no need to individually pay the procedures used in the second, the consumer pays a part of the expense of operating the service provided.
This rate varies from one carrier to another, and can be charged by a fixed amount or a percentage, which is determined by the plan itself, as provided for in the contract. For example, a query can cost R $ 20 or 20% of the amount foreseen in the provider table.
According to the National Health Agency (ANS), the operator is only forbidden to charge the full amount of the procedure as well be hindering the consumer's access to health insurance.
Still, according to the rules of the ANS, the co-participation may not result in distortion of free consumer choice, for example: operators who place z mode only for accredited providers to plans and providers do not put to members of the network itself.
Contracts with co-participation are commonly offered in the business group plans (offered by the employer) but it can exist between individual / family and collective adhesion, which are those provided by association or union. In the case of collective, either with co-participation or not, tuition increases are not regulated by the ANS. However, in the case of co-participation in hospitalization, the values must be fixed and can not suffer indexing procedures or conditions.
For cheap not expensive out
As the consumer pays a fee for loose procedure, the monthly plans with co-participation tends to be cheaper than similar marketing plans. But a tip for those who want to hire this modality is to study if it really worth it, taking into account some user needs, such as the frequency of appointments and tests in the same month.
Attention to contract
Consumers who opt for hiring such plan should watch closely what has the service contract, especially regarding the transfer of values and adjustments.
The operator, in turn, must inform in a clear and properly document the table used as a basis for calculating the value of consultations, examinations etc. If it is changed for some reason, the user should be informed in advance.
In addition, the company must provide a channel that enables the monitoring of the plan of use through an extract, with the date of the procedure, the description of the service and the responsible provider.
If the carrier does not clarify any of the conditions of service and the consumer ends harmed by this, the guidance is to complain to the NSA, the city Procon and, ultimately, trigger Justice.
Source: Idec
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This article was translated by an automatic translation system, and was therefore not reviewed by people.