Fecomercio policyholders complain about the suspension of their health plan in SP

A health plan that served FecomercioSP (Federation of Commerce of the State of São Paulo) insured persons was terminated on the 1st, and former beneficiaries complain about the termination. The agreement was signed between the federation and Bradesco Saúde, in addition to being managed by the operator Qualicorp.

In positioning sent to Sheet, Qualicorp did not inform the number of beneficiaries impacted by the termination of the contract or the reason for this. The company claims that health plans aimed at a small portion of customers are being replaced by new products and that the entity offers alternatives. Bradesco Saúde and Fecomercio did not comment.

The plan was a collective membership plan, says Rafael Robba, a lawyer specializing in the right to health at Vilhena Silva Advogados. He explains that these agreements are marketed to associations or unions and that they usually have an administrator who takes care of the plan – in this case, Qualicorp.

The ANS (National Supplementary Health Agency) recommends that, in collective membership plans, termination of the agreement may occur at the request of the companies that signed the contract. It is also necessary that the provisions for the termination of the agreement are provided for in the contract. For example, sometimes a 60-day notice is required stating that the plan will be terminated if this condition is present in the contract.

For Robba, the terms for these health plans could be stricter. He compares, for example, with the case of individual or family plans, which are more restricted to changes or interruptions. “The operator can only cancel an individual or family contract when the beneficiary defaults or commits fraud”, explains the lawyer.

In the case of the Fecomercio contract, former service users are now complaining about the end of the contract. Businessman Rubens Pimentel, 49, is one of them. He says that, in early January, he was informed by email of the discontinuation of the plan. He says he contacted Qualicorp and Bradesco, but initially both companies did not confirm the information.

When the change was confirmed, he says, Qualicorp did not clarify the reason for the end of the contract. “I keep imagining people who are hospitalized and end up on the street.”

In cases like this, Robba explains that there is the possibility of starting a lawsuit in court to prevent the suspension of the contract. “We have similar cases in which legal actions were necessary to prevent the termination of the contract, mainly of those people who are undergoing treatment or the elderly, who are unlikely to be accepted in other plans.”

The lawyer explains that these actions occur mainly when these two most vulnerable audiences realize that they will not be able to access another medical insurance without the grace period. In cases favorable to users, the plan is prevented from disqualifying the customer.

portability

When a collective plan is terminated, users are entitled to access another service without going through the grace period. To find a new health plan, ANS provides a system that helps in the search. In it, the person adds information about the finalized agreement, and a list of new compatible plans is generated.

Robba also says that some people opt for an insurance broker, but he points out that it is essential “to make sure that the contracting of the new plan is being carried out with portability of shortages”.

But there are scenarios where identifying a new agreement is not very easy. The ANS informs that, sometimes, the user cannot “find a new plan that meets his expectations”. Coverage or value, for example, may meet user expectations.

This is the case of Rubens Pimentel. He is already looking for alternatives to the finalized agreement, but he realized that he will either have to pay much more or he will have to settle for a worse health plan.