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Resolution published Thursday 28 in the Official Journal of the Union, which sets new rules for the terms of medical conventions. Health plan operators can charge clients up to 40% of the value of each procedure performed, according to a standard issued by the National Complementary Health Agency (NSA).
Changes in normative resolution 433 also include procedures for
In the co-ownership model, when the client pays a portion of the costs of care each time he uses the health plan, a practice used in countries like the United States United States of America. According to the ANS, this can not exceed the amount of the monthly fee (monthly limit) or 12 monthly payments in the year (annual limit). And in the franchise model is the percentage set in the contract, in which the operator has no liability for coverage.
In the latter case, there are two forms of application: the plan is not liable for expenses until the limit stipulated in the contract is reached or limited by the amount of the fee. access, setting the value of the deductible for each procedure. Thus, it is forbidden to use a differentiated co-participation due to an illness or pathology. The value adjustment can only be applied over a period of less than 12 months.
Joint ownership and franchise were already used, but without defined rules or limits. ANS only asked companies not to exceed the limit of 30% of the amount billed to customers by co-participation, which now drops to 40%. The new rules will come into effect in 180 days and will only apply to new contracts.
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