What are health plans?

Health is one of the most important issues in any region of the world, and it would not be different in Brazil. A healthy individual can fully exercise their activities and have a good quality of life. On the contrary, a sick person has low productivity and reduced living standards. An entire population that is sick is something much more serious, turning what was once a simple health issue into a social problem.

Health care is a right of every citizen and a duty of the State set out in the Federal Constitution of Brazil. However, this guarantee cannot effectively meet the growing demand and, therefore, the State allows private companies to provide medical services to the population through Health Plans.

Through a contract, the individual or legal entity becomes enrolled in the plans offered by a certain company, having medical, hospital, outpatient and, in some cases, dental coverage. As of June 3, 1998, due to Law No. 9,656, health plans were obliged to create a standard package of services (known as “standard”), guaranteeing minimum coverage for members and, thus, reducing monthly fees. charged and greater number of adhesions.

Currently, Brazil has several health plans, many aimed at specific audiences such as the elderly and children.

About 28% of Brazilians have health insurance.

Index

Important issues to note

It is important that, before signing a contract with any health plan, consumers do research on which company best serves them. Read the guidelines imposed by the company, especially with regard to established prices, contract renewal and guaranteed service coverage. Pay attention to changes in health plan prices according to age group and pay attention to the monetary correction of monthly fees after 1 year of the contract has elapsed. Many companies correct the values ​​with rates higher than the year’s inflation.

Note the grace period, which is the period between signing the contract and actually using the services offered by the health plan. During this period, the consumer pays the monthly fees, but is not entitled to make appointments or undergo laboratory tests, for example. Currently, the grace periods are as follows:

– 24 hours for urgency and emergencies;
– 30 days for consultations and simple exams;
– 180 for special exams, surgeries and hospitalizations;
– 300 days for delivery;
– 24 months for pre-existing illnesses and/or injuries.

Stay tuned to see if the contracted health plan complies with these deadlines. It is prohibited for the plan to recount the grace period even if the consumer has already met the deadlines. The irregular requirement in the grace period recount occurs more frequently in the adaptation or renewal of the contract, payment delay or in the purchase of a successor plan.

Also observe the conditions imposed on the migration between plans and adaptation of a contract prior to 1998 to the new standard plans offered. According to the National Health Agency (ANS), the individual/family plan consumer signed before 1/2/1999 ask the operator for a contract adaptation proposal. In this case, the operator is obliged to offer it. The consumer can choose to accept the proposal or remain in the old plan. Adaptation conditions are usually beneficial, since, prior to 1998, health plans provided for limited coverage and the new law guarantees broader coverage of services. All proposals offered by operators are under the rules of law 9.656/98 and the Consumer Protection Code.

Types of health plans

Companies offer different types of health plans. See the definitions for each:

Individual or family contract

It is the one offered to individuals or entire families.

Collective contract

This type of contract is signed between legal entities (such as companies) and health plan operators to serve a certain group of people (such as employees). May or may not accept the inclusion of dependents (such as family members who do not work for the company). In this type of contract, there may still be 2 aspects:

– Corporate collective agreement: the beneficiary’s adhesion is automatic and mandatory;

– Collective agreement by adhesion In this case, adhesion is optional.

Read also: SUS and user rights

Jeanne Kenney
 | Website

I’m a stylist trainer, a content creator, and an entrepreneur passion. Virgo sign and Pisces ascendant, I move easily between my dreams, the crazy world I want, and my feet on the ground to carry out my projects.

Leave a Reply

Your email address will not be published. Required fields are marked *