Customer can change health plan if hospital is excluded – 08/14/2023 – Health

Health plan customers will be able to change operators before the minimum stay period when they are dissatisfied with the withdrawal from a hospital or the emergency service of the hospital network provider. The decision was taken this Monday (14) by the ANS (National Supplementary Health Agency).

Currently, the customer can only exchange the service of one company for another after meeting minimum deadlines that vary according to the situation. In the first portability, for example, the permanence is two years, but it can reach three years if the beneficiary has completed a two-year grace period to cover a pre-existing illness or injury.

If you have already carried out any portability before, the minimum period of stay required drops to one year, but can rise to two years if the current plan has coverage not provided for in the previous one.

With the move to hospital service exclusion cases, none of these deadlines will be required. But the customer will still be required to fulfill the coverage gaps he had in the previous plan in the new plan.

The new plan chosen by the beneficiary does not need to be in the same price range as the current one, as in other cases of grace portability.

The service’s regulatory agency also decided that, when withdrawing a hospital from the network, the operator must notify its customers individually. The communication must occur 30 days in advance of the end of the service provision.

The new rules will come into force 180 days after their publication in the Official Gazette of the Union. At ANS, the expectation is that the publication will take place this week.

Network reduction will depend on hospitalizations in the region

The reduction of the hospital network will also have a new rule. If the unit to be excluded is responsible for up to 80% of hospitalizations in its service region, the operator will not be able to remove the hospital from the network. Instead, you should replace it with a new one.

In the rule that is still in force, the hospital can be excluded, without replacement, if it does not register hospitalizations of plan beneficiaries within a 12-month period.

The replacement of the hospital must observe the hospital services and urgent and emergency care used in the last 12 months. The new establishment must offer the same services as the substitute provider.

The norm maintains the obligation for the substitute hospital to be located in the same municipality as the excluded one, except when there is no provider available. In this case, a hospital in another nearby municipality may be indicated.

For changes to the plan’s network that occur in the beneficiary’s municipality of residence, the operator will be obliged to make individual communication about any changes.

wanted by SheetFenaSaúde (National Supplementary Health Federation), representative of groups of health plan operators in the country, said it will evaluate the measure after the publication of the norm.