Panel SA: Health plan readjustment returns to the sector’s agenda

With the proximity of the release of the new calculation of the readjustment limit in the prices of individual health plans by the ANS (National Supplementary Health Agency), the matter returns to the operators’ table.

The re-discussion of the methodology for readjusting individual plans is on the ANS agenda. Today, the maximum percentage is defined annually by the regulatory agency, based on inflation and operators’ medical expenses.

The sector does not like the current model, which last year even led to a reduction in prices.

The operators defend that the readjustments of individual and family portfolios should be regulated by the market itself, as is the case today in collectives, which have the correction defined in the commercial relationship between the contracting party and the operator.

ANS states that it is important to encourage competition in the sector and encourage the sale of individual and family plans, with the aim of expanding the coverage options available in the market. Theoretically, the increase in supply would stimulate a natural reduction in prices.

According to the regulatory agency, the matter is being discussed, but there are still no decisions and, in case of possible changes, they will not interfere with the percentage that should be released soon, for the period between May 2022 and April 2023.

Last year, for the first time in history, operators had to apply a negative adjustment in individual and family health plans. The index was -8.19%, reflecting the reduction in system procedures and expenses in 2020.

Any change must suffer reactions from consumer protection entities. Fernando Capez, director of Procon-SP, says that companies in the sector need to increase transparency in disclosing cost information to consumers before talking about releasing readjustments.

“Procon-SP will hit that key. Either by federal law or by court order. Health insurance companies, first of all, need to publish a list of their expenses for the year. Many insurance companies are buying hospitals. a monopoly that will allow distortions. It almost creates a conflict of interest, making the care as cheap as possible in the hospital to create less damage for the company that will reimburse the hospital”, says Capez.

Joana Cunha with Andressa Motter and Ana Paula Branco