Clipping of news on Brazilian Culture, Law and Citizenship
11/11/2016
This article was translated by an automatic translation system, and was therefore not reviewed by people.
Transparent image
Purpose is to give greater clarity to the consumer and the operators throughout the process
Objective of the new resolution is to extinguish noises in the communication between beneficiary and operator - Archive
RIO - The National Agency for Supplementary Health (ANS) has announced that it will regulate requests for cancellation of the individual or family health plan contract, as well as the exclusion of beneficiaries of collective bargaining agreement or membership. To that end, it will publish, on Friday, Normative Resolution No. 412, whose objective is to extinguish possible noises in the communication between beneficiary and operator at the moment in which the consumer expresses his will to cancel the health plan or to exclude dependents.
The resolution, which will take effect within 180 calendar days from Friday, the date of its publication in the Official Gazette, applies only to so-called new plans. That is, those contracts entered into after January 1, 1999, or adapted to Law No. 9,656, dated June 3, 1998.
Director of Standards and Qualification of ANS Products, Karla Santa Cruz Coelho clarifies that the regulation will regulate the forms of unilateral termination of health plan contracts at the request of the beneficial owner, and aims to give the consumer greater clarity, security and predictability In the process of cancellation of health plan or exclusion of dependents by stipulating a specific rule for each type of hiring, defining responsibilities of the parties involved, obliging the operators to issue proof of science of the request for suspension, followed by proof of effective cancellation, in addition To determine the deadlines for delivery of such vouchers.
- With the standard, the beneficiary is guaranteed to have their request for cancellation of the plan or exclusion of dependents in a timely manner. We are making clear the service channels and the steps of the process, so that the consumer does not have any type of doubt at the time of requesting the cancellation. Similarly, operators must organize to follow the rite detailed in the standard, without creating obstacles to the beneficiary. With the edition of the standard, the ANS is organizing the operational process to give greater clarity to the consumer and also the operators, explained Karla in an interview with "Consumer Defense."
Fines for those who do not follow rules
The ANS director pointed out that operators who fail to comply with the rules set forth in the resolution will be subject to a fine of R $ 30 thousand. The director stresses, however, that the beneficiary must understand that, once the carrier becomes aware of the cancellation request, "the plan will be canceled".
Lawyer Ingrid Carcales, a specialist in health law, recalls that a few years ago, the consumer who did not want to keep the health plan, simply stopped paying and also to use the service. Two months later the operator canceled the product. Many consumers still do this, but end up having problems.
- Currently, it is imperative that you request the cancellation in writing and with confirmation of receipt. Otherwise, the consumer will be surprised by the collection of all outstanding monthly payments, even if you have not used the service. The new resolution, although very late, regulates precisely this theme. Many contracts do not even regulate how the request for cancellation by the consumer should be made, which will no longer be allowed as of the validity of the new resolution.
According to the lawyer, an interesting novelty applies to business contracts. Currently, the consumer who no longer wants to maintain the benefit must request the cancellation before the HR of the company in which he works. With the new resolution, he should first request the HR of the company and, if not answered in 30 days, may request cancellation directly with the health care provider, he comments.
Another novelty observed by Ingrid is the possibility of collecting a termination penalty by the health care provider, in case the consumer requests cancellation of the plan before the minimum validity of 12 months, which was only foreseen in collective agreements.
- This fine may be questioned by the consumer of individual products, as there is no provision in the law of health plans, and the ANS can not extend or limit the scope of the Law - says the expert.
Case-by-case procedures
At the individual or family level, cancellation of the contract may be requested by the holder, in the following ways: in person, at the operator's headquarters, at its regional offices or at the places indicated by it; Through telephone service provided by the operator; Or through the web page of the operator on the Internet - in this case, the operator must make available on its corporate portal access to the Information Portal of the Supplementary Health Beneficiary (PIN-SS), pursuant to RN No. 389, of November 26, 2015. Once the request for cancellation is made, the operator is obliged to provide immediate clarification on the consequences of the request, and must provide the beneficiary with proof of receipt of the request. From that moment on, the health plan will be canceled for the holder and his dependents, if any, or for one or more of his dependents, if the holder has only requested the exclusion of dependents.
In the case of a corporate collective plan, the beneficial owner may request the company in which he works, by any means, to exclude him or her from being dependent on the corporate collective health plan contract. The company must inform the operator, so that it can take the appropriate measures, within 30 days. If the company does not meet this deadline, the employee, beneficial owner, can request the exclusion directly to the operator, who will be responsible for providing the consumer with proof of receipt of the request - the plan being canceled from that moment.
Already in the collective plan for membership, the beneficial owner can request their exclusion or beneficiary dependent on a collective agreement for membership of the legal entity contracting the private health care plan. In this case, the request will be forwarded to the operator, for adoption of the appropriate measures - the cancellation will only take effect from its science. But the beneficiary can also communicate its intention to the benefits administrator (when the possibility appears in the contract signed between the contracting legal entity and the operator), or directly to the operator. In these two cases, after the receipt of the receipt of the request, the plan will be canceled immediately.
After receiving the request for the cancellation of the individual or family health plan contract, or for excluding beneficiaries in a corporate or collective collective plan by adhesion, the operator or benefit administrator shall inform, in a clear and precise manner, that, in a possible The consumer must comply with new periods of grace, in compliance with the provisions of item V of article 12 of Law 9,656 of June 3, 1998. It should also be clear that there will be loss of the right to portability of deficiencies , If this was not the reason for the cancellation request.
The operator or administrator must also inform that the possible entry into a new health plan may be included in the filing of a new health statement and, in the case of a pre-existing illness or injury (DLP), in compliance with Temporary Partial Coverage (CPT) An uninterrupted period of up to 24 months from the date of hiring or joining the new plan, suspension of High Complexity Procedures (PAC) coverage, high technology beds and surgical procedures. And that, in the immediate loss of the right of remission, when there is, the beneficiary will have to pay for the payment of a new health plan contract that he will contract.
The ANS also determined other information that should be made available by the attendant of the operator or benefit administrator at the moment of the request made in person or through the channels of these entities provided for in RN 395/16; Or be included in the receipt of the request for cancellation of the contract or exclusion of beneficiary, to be provided by the operator or administrator of benefits. Are they:
- Immediate effect and irrevocable character of the request of cancellation of the contract or exclusion of beneficiary, from the science of the operator or administrator of benefits;
- Overdue pecuniary compensation and / or possible copayments due to pre-payment or post-payment plans for the use of services performed prior to the request for cancellation or exclusion of the health plan are the responsibility of the beneficiary;
- Expenses arising from any use of services by beneficiaries after the date of request for cancellation or exclusion of the health plan, including in cases of urgency or emergency, will be at their own expense;
- The exclusion of the beneficial owner of the individual or family contract does not extinguish the contract, and the dependents already enrolled are guaranteed the right to maintain the same contractual conditions, with the assumption of the obligations arising;
- The exclusion of the beneficiary who is the holder of the collective bargaining agreement or by adhesion will observe the contractual provisions regarding the exclusion or not of the dependents, according to the provisions of item II of the single paragraph of article 18, RN 195, of July 14, 2009, Which provides for the classification and characteristics of private health care plans.
The regulatory agency also pointed out that, once the receipt of the cancellation or exclusion request has been provided, the operator or the benefit administrator must forward to the consumer, within ten working days, the proof of the effective cancellation of the contract or disconnection Of the beneficiary. Such proof must inform the possible charges of services by the operator or administrator of benefits. The request for cancellation of individual or family contracts does not exempt the beneficiary from the payment of a termination penalty, when foreseen in a contract, if the request occurs before the minimum validity of twelve months, observing the date of signature of the adhesion proposal.
Source: The Globe
To access the O Globo site, click here.
Our news is removed in full from our partners' websites. For this reason, we can not change the content of these even in cases of typos.
This article was translated by an automatic translation system, and was therefore not reviewed by people.