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The National Supplementary Health Agency (ANS) announced last week a new calculation method to define the annual adjustment index of individual and family health plans. The new IRPI is based on the variation of medical expenses of operators in individual schemes and in the general inflation of the economy, reflecting, according to the ANS, the "reality" of the segment
IRPI is based on the variation of the medical expenses of the operators
"It brings other benefits, such as the reduction of the delay between the period of calculation and the period of application of the readjustment and transfer of the average efficiency of operators to beneficiaries, resulting in a reduction of readjustment rate ", said the regulator.
The proposal was approved by the board of directors of the body on Tuesday, July 18 and published in The Daily The new method of calculation will take effect from next year and the next Annual adjustment may only be applied by operators as of the date
"This methodology is the result of studies conducted by the agency's technical staff over the course of eight Recent years.It has been discussed at length with industry and society.These collaborators collaborated through contributions during public hearings, meetings
The readjustment index authorized by ANS is applicable to medical and hospital care schemes contracted after 1 January 1999 or adapted to Law 9,656 / 98. According to the data of October, 8 million beneficiaries are currently in these conditions – about 17% of the number total of clients of health care plans in Brazil.
Understanding
The new model combines the Value of Assistance Expenditure Index (IVDA) with the General Consumer Price Index (CPPI). The first index reflects the change in expenditures with the beneficiaries of the health care plan, while the second is related to other types of costs, such as administrative expenses. In the formula, the IVDA will have a weight of 80% and the IPCA of 20%.
The IVDA formula comprises three elements: Variation of Assistance Expenses (VDA), Variation of Income by Age Group. Efficiency Gains Factor (FGE)
The VFE deducts the portion of the operators' income, which is already recomposed by the adjustments due to the change in age. On the other hand, the EGF is an index of efficiency calculated on the basis of the variation of the social charges, transferring to the consumers the average efficiency of the sector and avoiding a model of automatic transmission of the variation of the costs
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