Clipping of news on Brazilian Culture, Law and Citizenship
17/08/2012
This article was translated by an automatic translation system, and was therefore not reviewed by people.
The National Health Agency (ANS) announced at this Thursday, August 16, 2012, the maximum rates to be applied to contracts for individual health insurance old - those concluded before the entry into force of Law no. 9656 / 98 - the five operators that have written agreements (CT) on adjustment clauses. The universe reached is less than 1% of beneficiaries with coverage of physician-hospital health care market in Brazil.
Medicines Group Amil International Healthcare and Golden Cross Health Care International were allowed to adjust their contracts approved by the same index visor ANS plans for individual and family members hired after Law No. 9.656/98, which corresponds to 7.93%. Have specialized in health insurance Sul America, Bradesco Saúde and Itauseg Saúde may apply a rate of up to 9.37%.
As in the case of the rule established for the individual and family plans contracted after the Law 9.656/98 (new plans), the lag of up to three months between the application of the adjustment and the anniversary month of the contract could generate chargeback to be diluted by same number of months. For example, if the contract anniversary is in July and the adjustment is applied in October 2012, will be allowed the collection of real value concerning the adjustment was not applied during July, August and September respectively in October, November and December.
Methodology
This year the Specialty health were assessed by a new methodology, which was based on the lowest frequency variations and / or unit cost per item of care (consultations, examinations, hospitalizations, etc..). The new methodology, which maintains the principles of the terms of commitments signed in December 2004 was approved at the meeting of the ANS Board of 15 August 2012 and allowed the adjustment calculated for the insurers, whose initial request was 15% , remain at 9.37%.
In the segment of group medicine, the data presented by one of the operators have not reached a level of certification to allow the comparison of efficiency criteria. Thus, the Board decided to apply the same percentage adjustment to the approved plans and individual family members hired after the Law 9.656/98 for 2012: 7.93%.
Historical
In 2004, the NSA questioned the adjustments applied by operators abusive Bradesco Saúde, Sul America, Itauseg, Amil and Golden Cross. By 2003, the Agency authorized the indices used by these companies, but a Direct Action of Unconstitutionality (ADIN), filed in that year the Supreme Court, the Agency withdrew the prerogative to authorize in advance the adjustment of contracts prior to the enactment of the law governing sector health plans.
All these operators have clauses in their contracts for an annual adjustment based on a range of medical and hospital costs (VCMH), which did not translate clearly the criteria used to define the indices. The Agency then proposed the signing of terms of appointment. Through these terms, five operators have pledged to correct the irregularities and began to submit adjustments to the regulation of the ANS. These agreements prevented consumers were forced to cope with increases that reached 80%.
It is worth noting that the term sheet is intended to protect and defend the interests of consumers. However, these operators have requested adjustments increasing, especially insurers, who do not sell more new individual and family plans. In this case, as there is no entry of new beneficiaries, of course there is a rise in spending, due to aging of the population served by these plans.
Thus, the NSA believes that the term of commitment is no longer fulfilling its original purpose, why has initiated studies on possible alternatives for future adjustments of these plans.
Consumers can ask questions by contacting the Dial ANS (0800 701 9656), the electronic form available on the website in the section Customer Service Center, or in person at one of 12 Centers of ANS in the main capitals of the country.
Source: ANS
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This article was translated by an automatic translation system, and was therefore not reviewed by people.