[ad_1]
When he decided to contract a health plan for his son, retired Navy officer Jorge Gonçalves de Lima, 65, did not doubt and chose a less expensive collective health plan than individual offers. . Eight years later, however, George regrets. He considers the annual readjustments in the monthly plan as "unfair" and feels deceived by not understanding how the calculation of the new rates works.
– I and many people are running for the collective plan by membership because it is implied that we will receive service a little lower and therefore we will pay less. But readjustments are lower for individual plans, which ultimately benefits those who agree to pay more and sacrifice who wants to pay less.
The last two years, the adjustment of health insurance plans has become the main complaint received by Idec According to the institute, is the lack of transparency and regulation as to the quality of products and services. The main reason for this dissatisfaction, according to the institute, is the lack of transparency and regulation of the consumer.
In the case of individual and family contracts, the maximum annual adjustment is defined by the ANS (National Agency for Health Insurance) – set at 10% in 2018 ] after litigation . But in the case of corporate membership and business plans, the decision is made by the operators, through negotiations with the directors and without any limit of values.
Another important difference between the two types of plans is that in the case of ANS prohibits operators from unilaterally canceling the contract, says Ana Carolina Navarrete, a health researcher at Idec. Already in the group plans, in addition to determining the rise in prices, operators can cancel the contract after the first year of service, which can happen, for example, when there is no price. 39, agreement concerning readjustment
– The recommendation is so that the person prefers the individual plan because he is more protected. The group plan is cheaper at first, but the person ends up losing that initial benefit in the first or second adjustment applied.
The health plan that Jorge pays to his 32-year-old son Gabriel has been readjusted to 14.91% for the period from July 2018 to June 2019, reaching R $ 362.81. The service is provided by Unimed-Rio and administered by Qualicorp. Since the beginning of the agreement, in October 2010, when the monthly cost was 120.62 reais, the cumulative readjustment is 200%.
By way of comparison, the eight readjustments announced by ANS since 2011 for the individual plans point to a cumulative increase of 123%. If the same limit was applied to the group plans, Jorge would pay from July the monthly payment of 269.97 reais, not the current amount of 362.81 reais, a difference of 1114 reais after 12 months.
The military on the reserve are asking for a lack of information to understand the calculation of readjustments.
– They are two weights and two measures. Operators may even [reajustar o plano por conta própria] but this is not certain, because everything is a health insurance, whether it is individual or collective by membership.
Fair increase?
Although more protected, contracts individuals and families are a minority on the market. Of the 47.3 million private plans, 9.1 million are in this category, or 19% of the total, according to ANS. For individual plans, the ANS limited readjustment to 10% increase (38%), According to R7
Recipients Sulamérica's plan concluded by the São Paulo Engineers Union through Qualicorp's official Brazilian Inflation (IPCA) for the "Health and Personal Care" sector, between May 2017 and April this year, was 5%. , According to the Brazilian Institute of Geography and Statistics (IBGE).
The absence of specific economic parameters for the sector, as an index of inflation defined by the SNA itself (which does not exist), exacerbates the consumer, according to Navarrete.
– There is currently no one and allow you to measure what is a fair rebalancing. The IPCA serves as a provisional index in the absence of an index of the ANS itself.
An alternative to challenging values is to bring the claim to justice. An investigation conducted by Idec in court decisions in 10 states and the STJ (Superior Court of Justice) between 2013 and 2017 revealed that 75% of readjustments were banned by the judiciary. All cases, however, have been surveyed by larger companies.
– This happened among the major legal entities.
According to Abramge (Brazilian Association of Health Plans), "medical inflation reflects a partial replacement of medical and hospital costs and"
"In recent years, social spending has often increased more than revenues , representing about 85% of what operators have collected with the monthly fees of beneficiaries., without taking into account administrative, operational, commercial and fiscal costs, "the badociation said, in a note sent to the report. [19659020] The CEO of ANS, Leandro Fonseca, said R7 that not only the cost but also the frequency of use, given an overall context of "aging of the population ", which makes the plans more
– This adjustment largely follows the variation in hospital medical costs in the sector.Health inflation is higher than inflation in several sectors of the economy. & # 39; economy, not only in Brazil.
The lack of regulation of the collective plans ends up being transferred to the individual contracts, explains the researcher of Idec, since the ANS uses as parameter the average readjustment of the collective plans (rejection of the maximum and minimum values) to set the ceiling for increasing individual agreements. To achieve the final percentage of readjustment, the agency also incorporates an estimate of the impact on operators after updating the list of mandatory procedures.
– We do not perceive this as a good mechanism. There is no clarity if this information is appropriate or not. ANS uses information from an unregulated (collective) sector to define the values of a regulated (individual) sector.
Idec got an injunction last week in the Federal Court of São Paulo that limited the increase of individual plans to 5.72% – in the context of an action involving the methodology of readjustment of the NSAs – but the decision was annulled by TRF3 (Federal Regional Court of the 3rd Region).
Reached by R7 Unimed-Rio states that the readjustment of "group health insurance by membership is calculated by the badysis of the financial index (HSMV) and the loss of contract, and applied according to the negotiation between the contracting parties. "
Qualicorp states that" the responsibility for the definition and application of the annual adjustment is exclusive to the health plan operators, within the contractual and legal limits. "
that" the adjustments applied to the plans of the company are in accordance with the rules established by the ANS and the agreements concluded between the parties. "
* Gabriela Lisboa collaborated
Source link
