New rules of the health plan: what to do to pay the lowest prices? – New

What should you do to pay the lowest prices? Change the plan? Ensure a plan with the current rules while they do not change?

Consumers will have to make the calculations and badyze with great caution whether, in the account

published by ANS on June 28, the new regulation has 180 days to be applied by operators and will only be valid for new employees. . That is, who already has a plan today has the right to continue with the rules originally defined in his contract and to make a possible change only if he deems it necessary.

The new rules do not interfere either in plans that offer full coverage. Usage fees. They may continue to be sold normally by operators alongside the new coparticipation and franchise terms, although the offer of one of them is not mandatory.

"If the person already has a plan with co-participation, he will have to do research that will be less expensive, but with a 40% co-participation, the monthly reduction must be very expressive," said Alexandre Jubran, Jubran Galuzzi & Gonçalves Advogados, an office specializing in healthcare processes.

"For those who have a plan that does not require co-participation, the transition to certain options may become more expensive and have a plan

The co-participation is more expensive, but there are exemptions

Among the main changes promoted by the ANS, co-participation, a tool that transmits to the client part of the value of each procedure was set at 40% of the total value of the service.Under the current law There was no stipulated limit, but an understanding of ANS itself suggested a maximum transmission of 30% of each procedure, and may even make a fine for the operator who charged in addition.

that, similar to auto insurance, the agreement stipulates a minimum value from which it provides coverage.If the deductible, for example, is $ 100, the customer pays the full value procedures that have cost up to that amount. belongs to the operator.

On the other hand, the new rules also brought reliefs such as the creation of a list of over 250 procedures that will be exempted from any additional collection, which n & # 39; Currently not available and which includes treatments for chronic diseases (such as cancer and kidney failure) and some consultations with general practitioners (pediatrician, generalist and gynecologist)

More expensive procedures such as admission to emergency or hospitalization do not pay 40%, but a fixed amount (half-monthly or monthly plan, depending on the situation).

Do you have an individual plan?

• Collective business plans: hired and paid by companies to their employees
• Collective membership plans: hired directly by the user, but through an badociation or entity (such as unions, for example)
• individual plans: direct contract between the customer and the operator, with greater control of the ANS (as in the annual price adjustments) [19659017] will also be valid for all. In the case of business plans, however, the employer may increase the collection ceilings if agreed with the unions. As a result, the co-participation share of the employee can go from 40% to 60%.

  "If your plan is individual, do not go away," said Jubran. "They have virtually ceased to be marketed precisely because of the legal protections they have, and rarely have a co-participation."

  Who has full coverage should maintain an old plan

  For those who now have a full coverage plan, are included and there is no separate charge for use, it does not will be hardly a better option with the new changes, according to specialists in consumer law.

  Maria Feitosa, of Procon-SP, even suggests that consumers looking for a new diet take advantage of the next six months before the new rules come into effect to acquire the option with full coverage and ensure in the current rules. "If the person does not have a plan, it's worth doing this hiring now and always prioritize the plans without co-participation," he said.

  Who already has the full plan should try to maintain it as well. "If a person can afford a plan without co-participation, it's always the safest option, there are no surprises, no extra costs or others." worries, "he said

  . One of Procon's fears and other entities are that, with the expansion of options with frankness and co-participation, they end up no longer being offered, as this has happened with individual plans at the expense of the collective. However, there is no risk that this will happen. "It's a very different situation," said Marcos Novaes, chief economist for the entity. "If the plans without deductibles or co-participation were to give a loss all the time, then they would go away, but that's not the case, they will continue to be offered."

  The monthly coverage of a comprehensive coverage plan is usually more expensive Options with usage fees, but, according to Procon, at the tip of the pencil, may end up going out almost the same. Under the new rules, companies can charge additional monthly fees in franchises or coparties, which can generate an additional account equal to 12 monthly payments in the year, in addition to the fixed monthly fees themselves.

  has a monthly fee of R $ 500 and will pay R $ 500 per month of franchise or co-participation, she could instead pay a full coverage plan of R $ 1,000, "said Maria Feitosa. "If it's something the consumer can afford, he should keep that option."

  "The user will have to make this badessment," said President Abramge Reinaldo Scheibe. "If you are in good health and you use little, the account is one, if there is someone sick in the family, the account is another one, always keeping in mind." Mind you pay less. 19659010] For those who already pay coparticipation, it is worth badyzing new options

Plans that transfer to the recipient a form of payment for attendance are already today the majority in Brazil: in ten years, their participation was 22% to 52% For this group, the new rules will bring both benefits (such as the list of exemptions) and disadvantages (such as the relatively higher limit of co-participation) , and each person will have to know the number of contracts in the country. "For those who already have a plan that pays co-participation today, a cheaper product may appear and there will not necessarily be a worsening of the situation."

", said the lawyer Jubran, citing as an example the gratifications for the treatment of chronic diseases. "In this case, it is worth doing a market study to see if there will be a plan with coverage equivalent to what you already have, but at a lower cost. "

Maria Feitosa, of Procon-SP, to consult in private practice, at the doctor of your choice, who only uses the plan for emergencies and exams: "Generally, these are families who have greater purchasing power, but for this group, the new options may also be worthwhile."

"Partnership is already a widely used mechanism, we are not creating anything new clear, "Daniel Pereira, deputy director of the deve sectoral development at the ANS, declared UOL . "If the person is someone who uses the procedures too much, she will not hire an option with frankness or co-participation, she will see what is the best option depending on her use."

If you change a contract, you can pay more co-participation

If you already have a plan with co-participation or if you hire one for the next six months before the changes come into effect, you will retain the rules and values ​​initially contracted. This means that if the current agreement is 20% or 30% of the co-participation, it is the percentages that should be practiced, even if in the new products of the operator, the co-participations increase to 40%. %.

Copies of old contracts will only be changed into new rules if the client modifies the category of his plan that affects the usage charges, that is to say, he pbades from there. An option with full coverage to a co-participation or franchise even if in the same business and under the same owner.

In changes that affect only the coverage of the agreement – such as changing the size of the accredited network or migrating from one apartment to another, always within the same operator – the old ones percentages of co-participation are maintained. for those who have a plan without co-participation: the beneficiary will continue in this modality, according to the old rules, unless he decides to migrate to an option that includes the collection separately.

In any change or acquisition made before the new rules pbad However, the rules will still be valid.

If the business plan changes, you can also pay more

For those who are hired and who benefit from the health plan offered by the company, the decision to stay in the contract rules current or migrate to one of the new options will be that of the company, which can review each year, when the contracts expire.

To avoid change and avoid high co-ownership, the worker can budget and try to contract a plan for if and for the family, benefiting even the next six months before the new rules come into effect. choosing an offer that will always guarantee the current standards

But, as companies generally subsidize part or all of the monthly, in addition to being able to negotiate with operators of values ​​lower than those of the market, barely l & # 39; exchange will be worth it.