Clipping of news on Brazilian Culture, Law and Citizenship
24/04/2012
This article was translated by an automatic translation system, and was therefore not reviewed by people.
Intention is to dilute costs with a larger group and stop abusive adjustments
The National Health Agency (ANS) is looking at business plans with few beneficiaries. A camera technique studies the "risk pool" proposal that each carrier will meet in a single contract with all those up to 30 recipients. The intention is to spread the cost with a larger group and thus bar the adjustments considered abusive.
The method serves as a opening for the escape of carriers increases determined by ANS, which regulates only the increase of individual contracts. By offering business plans for families, the carrier waves with tuition more affordable, but after adjustments imposes high - these plans, it is negotiated between the parties. "The agency is concerned about the escape of the beneficiaries of the individual to the collective enterprise," said Rosana Neves, manager economic-financial and actuarial product of ANS.
In the business plan, calculating the adjustment is made based on loss ratio - the more the plan is used, the greater the increase. In large groups, the expenses are divided by more people. Already for small groups - there are collective plans for two people - it is impossible to afford the cost.
That's what happened to the businessman LC, which acquired a business plan for him, his parents (both over 80 years), his wife and son. He saw a monthly jump of R$ 4,900 to R$ 7,900 after the father's health deteriorate. "I was not able to pay. We were forced to seek a lawyer."
The ANS is studying a way to increase the mass of beneficiaries of the business plan to spread the costs. "The pool join the contracts with few lives and make a single calculation to adjust them. That is, consider the costs and revenues of all of them."
Cheap. To have a business plan, just that one family member is registered in the CNPJ - either because it acts as a legal entity or because it has a really small company, as a small shop. "When the broker offers the business plan, the recipient thinks it's worthwhile. In some cases, the monthly fee is 50% cheaper. A person deceives," said the lawyer Renata Vilhena Silva, Vilhena Silva office, specializing in health.
Besides the excessive increase in tuition, the beneficiary is likely to have health insurance canceled - these contracts have a clause allowing unilateral cancellation of the plan. "This kind of information is not passed on to whoever is doing the plan. The safest thing is to have a plan regulated by the ANS standards that prohibit the unilateral termination," says Renata.
For the Brazilian Association of Medical Group (Abramge), discussion of the risk pool "seems more an undue interference of ANS, a market of free bargaining, which can bring distortions and imbalances in the industry." The theme is still being discussed at the institution.
MMA to sell the plan, a broker filled out and signed documents in place of the relatives of the entrepreneur Angela Capobianco Rossi, owner of a restaurant in Sao Paulo. Nine people are beneficiaries - Angela, children, dependent children and two brothers, partners in the family business.
When his brother needed surgery, the carrier refused to pay it, claiming it was a pre-existing disease is not informed. "We never saw the completed sheets. They sell what they want. We would never have known if my brother had not gotten sick," says Fabiana dos Santos, 35, daughter of Angela.
Source: R7 News
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This article was translated by an automatic translation system, and was therefore not reviewed by people.