ANS announces readjustment of up to 9.63% in individual health plans: see the impact on your pocket
Individual and family health plans may experience an increase of up to 9.63% in 2023. This amount represents the maximum increase limit that can be applied during the period from May of this year to April 2024.
The readjustment will be in effect from the month of May - Photo Reproduction / Internet
A National Supplementary Health Agency (ANS) announced this Monday morning (12) a new readjustment in individual health plans, which can reach up to 9.63%. The lives of more than 8.9 million Brazilians who have this type of plan across the country will be directly affected by this decision, which is equivalent to 17.5% of the 50.6 million consumers of health care plans in Brazil . Therefore, it is crucial to understand what the financial impact will be for consumers once the value has been established and approved during an agency directors meeting.
Readjustment
The change will come into force from next month effective April 30, 2024. The calculation of the maximum percentage is carried out using the Annual Variation Index of Assistance Expenses (IVDA) and the accumulated inflation in the last year. The final value of the health plan is impacted by factors such as inflation, the increase or decrease in the frequency of use of the health plan and the costs of medical services and supplies, such as medical products and equipment.
The percentage of 9.63% is the maximum rate allowed for this type of plan in this period, but operators can choose to apply lower rates. Compared to 2022, this year's readjustment was lower than established. Last year, the plans suffered the biggest increase in 22 years, with a percentage of 15.5%. This readjustment rule applies exclusively for individual and family plans. As for collective and business health plans, operators have autonomy to define prices and adjustments, without the need for ANS authorization.
May and June adjusted tuition fees will be billed in July and August, respectively, along with the planned adjustments for those months. It is important to highlight that the calculation takes into account differences in value. In the last 12 months, Brazil presented an accumulated inflation of 3.94% until May, based on IPCA. This means that the maximum readjustment index is more than double the inflation registered during a year.
The readjustment applies to medical and hospital plans that were contracted from January 1999 or that were adapted to Law nº 9.656/98. It is important to point out that the increase in the cost of health plans is implemented by the operators when one year has passed since the signing of the contract.
What it means to the consumer
According to the ANS, the readjustment is necessary to ensure the sector's sustainability and maintain the quality of services offered by health plan operators. However, for consumers, the readjustment can represent a significant increase in the amount of the monthly health plan. Therefore, it is important to carefully analyze each option and compare the prices and services offered by different operators. In addition, it is possible to negotiate with the operator to obtain a discount on the monthly fee or change the plan to one that is more suited to your consumption profile. The annual readjustment must be communicated to the consumer by the operator.
It is also important to remember that, for consumers who already have a health plan contract with a fixed amount, the readjustment cannot be applied. In this case, the operator must justify the increase in costs before applying any change in the monthly fee. If the operator exceeds the authorized percentage, it is recommended that the consumer seek the ANS. The initial procedure consists of asking the operator for clarification. If the company does not solve the problem, the consumer must contact the ANS.
It is possible to establish communication through the numbers 0800 701 9656 and 0800 021 2105 (for people). If the consumer perceives an excessive increase, he has the right to contest the readjustment. The first step is to require the operator to justify the increase. If the company does not provide an adequate explanation, the consumer must seek help from the ANS, consumer protection bodies, such as Procon, and, if necessary, even resort to Justice.
Health insurance
According to the ANS report, released in December 2022, the health care plan sector accounted for a total of 50,493,061 users, of which 8.9 million correspond to family or individual plans. ANS provides a guide on its website that allows consumers to search for all health plans available in the country. In addition, ANS offers several channels to receive complaints related to irregularities and difficulties in service.
ANS disk: 0800 701 9656
Contact Us: www.gov.br/ans
Call Center for the Hearing Impaired: 0800 021 2105
Finally, you need to be aware of your rights as a consumer of health plans. ANS makes available on its website a list of guidelines and information on the rights and duties of consumers, as well as a service channel for denouncements and complaints.
