[ad_1]
The National Agency for Complementary Health (ANS) released Wednesday (27) in the Federal Official Gazette a decision authorizing operators to readjust individual and family health plans up to 10%. The resolution is retroactive to May 1 of this year and is valid until April 29, 2019.
Justice has limited the adjustment to 5.72% (percentage equivalent to inflation for the segment of health and personal care accumulated in 12 months up to May, measured by the number of people. IPCA) at the request of the Consumer Protection Institute (Idec). But the injunction was canceled 10 days later, allowing the official percentage of 10% now. In 2017, the percentage of correction defined was 13.55%.
The decision reached 8.1 million beneficiaries, accounting for 17% of the total 47.3 million consumers of health care plans in Brazil, according to ANS.
Understanding the fight in justice
Idec's action was based on a report by the Federal Audit Office (TCU) that pointed out "distortions, abuses and lack of transparency in the methodology used by ANS to calculate the maximum readjustment percentage of 9," he said. 1 million beneficiaries of individual plans, of the total of 47.4 million consumers of health care plans in Brazil. "
ANS uses the same methodology to calculate the maximum rate of adjustment of individual health plans since 2001, taking into account the average percentage of update applied by operators to collective plans with more than 30 users.
However, the TCU understood that the calculation is wrong because the readjustments of these collective plans are informed by the operators themselves at ANS and are "not even verified or validated adequately by the agency", according to Idec .
In the action, Idec also claimed that there was a distortion in another element that makes up the readjustment. According to the institute, the TCU has identified that since 2009, ANS has counted twice the cost impact that plans have with the mandatory update procedures when formulating the index.
ANS appealed the case, arguing that the methodology applied to the adjustment "is supported by international studies that legitimize all the percentages already authorized".
The agency also said that the calculation of the adjustments is done to reflect the cost impact of the new procedures, "constantly updated by the list of services and events in the field of health".
The court then decided in favor of the ANS and considered it a "mistake" to link the adjustment of the plans to the IPCA, noting that the cost variation of the plans should be taken into account. in the calculation.
"It is wrong to compare IBCA's expanded price index – IPCA, to allowable benefit indexes to health plans, as it is representative of prices, whereas it takes into account the cost variation, "he writes. Judge Neilton dos Santos.
At the time, Idec deplored in a note the decision "taken by considering only the arguments of companies without taking into account the very serious facts that Idec and consumer organizations denounce for years".
How the adjustment will be applied
The maximum allowed readjustment can only be applied by operators authorized by the ANS. The list can be found on the website of the agency.
The correction of the amounts can only be applied on the anniversary date of each contract, but the retroactive collection of the values is allowed in the months of difference between the request and the anniversary date.
For example, if the month of the contract anniversary is May and the July billing has already been generated, retroactive billing will be allowed. In this case, the monthly payments for the next three months (August, September and October) will be increased by the amounts relating to the retroactive fees for May, June and July.
For contracts with anniversary between the months of August 2018 and April 2019, there can be no retroactive fees.
The tickets must clearly indicate the rate of readjustment authorized by the NSA, the ANS official authorization number, the name, the code and the registration number of the plan, as well as the month planned to apply the next annual readjustment.
Industry data
There are 757 operators in the country of medical badistance plans, which have 18.4 thousand active plans and 47.3 million users. Of the total plans, almost one-third are individual (29.3%).
Among users, 9.1 million have individual and family health plans (19%), but the decision to allow adjustment up to 10% applies to plans contracted at from January 1999 or adapted to Law 9 656/98 and reached 8.1 million beneficiaries (17% of the total), according to ANS.
Source https://g1.globo.com/economia/noticia/ans-publica-resolucao-as-autoriza-reajuste-de-planos-de-saude-individual-em-ate-10.ghtml
[ad_2]
Source link
