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The National Agency of Supplementary Health (ANS) announced Thursday (28) new rules that establish the collection of coparticipação and franchise in health plans. In accordance with Normative Resolution No. 433, patients must pay up to 40% in the event of a co-participation or deductible fee on the value of each intervention performed. The new rules will come into effect in 180 days and are only valid for new contracts.
With the co-participation: the consumer pays part of the procedure to the operator.
See terms of the plan:
- Regular plan: the consumer pays a fixed monthly fee, without having to pay any additional charges.
- Freely available: The consumer must have a deductible value in addition to the monthly fee if he is to conduct an examination or consultation that is not provided for in the contract.
The standard also establishes that the maximum amount to be paid by the co-participation can not exceed the amount corresponding to the consumer's own monthly payment (monthly limit) and / or 12 monthly payments in the year (annual limit ).
For example, if the recipient pays $ 100 per month, the monthly limit for the co-payment can not exceed $ 100. The beneficiary will then pay, in the month in which the co-participation took place, a maximum of 200 reais. In the case of the annual limit, the value of the partnership would be R $ 1,200. The use of differentiated coparticipation by disease or pathology is prohibited.
However, this plan may charge up to 40% per service This limit may be increased by 50% in the case of corporate health plans providing for such an increase through collective agreements or collective agreements, so that monthly and annual co-participation limits would be reduced to R $ 150 and R $ 1,500, respectively.] 19659011] If the established limit is exceeded, the costs of using the health plan will be fully covered by the plan. 39, operator, and it will be forbidden to charge supplements the following year.
In the case of visits to the emergency, the amount must be previously known to the beneficiary and can not be greater than 50% the value of the message.
The rules also provide for exemption from participation and deductible collection in more than 250 health procedures and events, including general practitioner consultations, preventive and prenatal examinations and chronic treatments. Currently, the mechanisms focus on any procedure. See below:
 "data-src =" https: //s2.glbimg .com / -snLLLdW_7Sa5rFfIR4TUZmqd7M (Photo: Reproduction / ANS) "title =" Procedures free from co-participation and franchise collection = / 0x0: 799×1184 / 984×0 / smart / filters: strip_icc () / i.s3.glbimg.com /v1/AUTH_59edd422c0c84a879bd37670ae4f538a/internal_photos/bs/2018/Y/0/agOud6Saqxo6ipIHbBAw/proces-isentos-2706.jpg "/> [19659016] YEARS </span> </p>
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<div clbad= "Procédures exemptes de coparticipation et de collecte de franchise")
According to ANS, in 10 years, the market share of Health plans with co-participation and deductible increased from 22% to 52% more than half of the approximately 48 million beneficiaries.
The rules on co-ownership and franchising are set out in an additional Health Council resolution 1998 and do not clearly specify the conditions, criteria and limits of the Implementation.
Another novelty is the possibility for health plan operators to offer discounts, bonuses or other benefits to those who maintain good health habits. The purpose, according to the new standard, is to encourage the conscious use of the procedures covered by the plans. However, this can not prevent the use of health services.
The measure should encourage recipients to join initiatives such as health promotion and disease prevention programs put in place by operators.
In franchised health care plans, the consumer pays a monthly fee that tends to be lower than other plans and is entitled to certain basic procedures. If you still need other consultations, exams or surgeries, you must pay out of pocket for the amount of the deductible provided in the contract. After using the full deductible, the health insurance plan must badume the expenses.
Under the new rules, there will be two types of deductibles:
- accumulated deductible deductible, in which the operator is not responsible for covering the accumulated badistance charges, in the 12-month period, from the signature or anniversary of
- Limited Franchise Access, in which the operator is not responsible for the coverage of the costs of badistance up to the amount specified in the contract, whenever the beneficiary accesses the accredited, referenced, cooperated network or, in contracts where there is a free choice, access to a health service provider outside the network of the # 39; operator.
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