Clipping of news on Brazilian Culture, Law and Citizenship
13/07/2012
This article was translated by an automatic translation system, and was therefore not reviewed by people.
Carriers have health plans suspended
The National Health Agency (ANS) has suspended the marketing of 268 health plans from 37 providers. These embedded on the criteria established by the NSA for the suspension of the products since they were repeat offenders in breach of Ruling No. 259, which determines the maximum periods of service for appointments, tests and surgeries.
Operators have been reported and products are prohibited to be sold from 07.13.2012 until the next quarterly review, which will be released in September.
Beneficiaries who have plans for which marketing is being suspended, your care will not be harmed. On the contrary, that the plan can be re-marketed, it is necessary an adaptation on the part of health care provider, the access of beneficiaries to the contracted network, which favors those already in the plan.
Consumers who want to hire a health plan can verify that the record of this product is a marketing plan with suspended by the NSA. This information can be accessed on the website of the ANS in: www.ans.gov.br, Health Plans and Operators, Contracting and plane change.
Fines and administrative measures for noncompliance with the standard
The operators of health plans that do not meet the deadlines set by the NSA are subject to fines of $ 80,000.00 or $ 100,000.00 for emergency situations and emergency. In cases of repeated noncompliance, operators may suffer administrative measures such as suspending the sale of all or part of their health plans and the enactment of the special technical direction, including the possibility of removal of its directors.
After trying to schedule the service with professionals and health facilities accredited by the plan and not achieve within the maximum time allowed, the recipient must contact the carrier's plan for an alternative to the requested service. In this contact, the consumer should not forget to write down the number of protocol, which will serve as proof of the request made.
If the carrier does not provide solution to the case, the beneficiary shall, taking in hand the protocol number, make a complaint to the NSA through a channel service: Dial ANS (0800 701 9656), Customer Service on the website Agency (www.ans.gov.br) or, in person, in one of 12 Centers of ANS in the main Brazilian capitals.
Here's a list of health plans whose marketing was prohibited by the NSA for new beneficiaries
Questions and answers
1) How the NSA will ensure that products are not marketed suspended?
The National Supplementary Health Agency, and take note of these complaints through the commercialization of society will monitor through its information systems. If it is found down the marketing plan, in addition to a fine of R$ 250,000.00 (two hundred and fifty thousand reais), the NSA may take other administrative measures in regulation as the establishment of technical supervision or removal of directors of operator .
2) The operator who has suspended plans for marketing new products you can register in NSA?
Yes, the operator can register new products in the ANS and these will be properly monitored with regard to ensuring the timeliness of care.
3) What happens if the operator in addition to these other plans were to be suspended for trading for the same reason?
All the operator plans are being followed regularly and continuously in relation to ensuring compliance with deadlines established by the NSA. It is expected that the need to meet these deadlines will stimulate the construction of networks suitable accredited to the operation of the private health care. If operators do not show improvement in its result, and the suspension of other products may be subject to technical supervision administrative measure, including the possibility of removal of their dirigintes.
4) The plan may drop back to be sold by the operator?
Yes No subsequent evaluation period, if the operator submits an improvement in its results when compared to the result of the previous period, you can return the product to be marketed.
5) What were the criteria for suspension for marketing of products?
He was taken into account the number of complaints related to the guarantee of care recipients and the average of the operator during the evaluation period. Operators who obtained a result above the cutoff point set from the data received from the industry, in each quarterly assessment, a score of 0-4. Those who presented the sum of 6 to 8 points in two subsequent periods of assessment, with the score of the second period equal to or greater than the score of the previous period, be prevented from marketing the products claimed.
Source: ANS
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This article was translated by an automatic translation system, and was therefore not reviewed by people.