Individual health plan will have readjustment of up to 9.63% – 06/12/2023 – Market

The ANS (National Supplementary Health Agency) approved this Monday (12) the maximum index of 9.63% for the annual readjustment of individual and family health plans in the country.

The increase ceiling is valid for the period from May 2023 to April 2024 and was announced at a meeting of the ANS collegiate board.

The annual readjustment is applied by the operators on the anniversary date of the contracts (month in which the services are contracted) and does not involve collective plans, whether corporate or membership plans.

The index came in below the range expected by the sector. Abramge (Brazilian Association of Health Plans) projected that the readjustment would be between 10% and 12%.

The new index is lower than that approved in 2022. Last year, ANS authorized a maximum annual readjustment of 15.5% for individual and family plans. It was the highest increase in the historical series with data since 2000.

The advance in 2022 came after the plans had a negative readjustment (-8.19%), for the first time, in 2021. The agency’s decision in 2021 was taken due to the drop in the use of supplementary health services and the consequent reduction in assistance expenses in 2020, the initial year of the Covid-19 pandemic.

BENEFICIARIES OF INDIVIDUAL HEALTH PLANS ARE 17.6% OF THE TOTAL

In April 2023, Brazil had a total of almost 50.6 million beneficiaries of health plans, according to data released by the ANS.

Of this contingent, 8.9 million were users of individual or family plans. The number is equivalent to 17.6% of the total – that is, the minority in the sector.

Meanwhile, beneficiaries of collective plans (business, membership or unidentified) reached 41.6 million. They represented 82.3% of the total.

The ANS annually approves the limit for individual and family plans. The percentage of revision of the collectives is determined from the negotiations of the operators themselves.

In April, Folha’s report showed that, among the collective membership plans, there were increases that reached almost 60%, which generated complaints from customers. At the time, sector representatives mentioned that the increases were necessary to ensure the balance of the system.

The sector came out of the health crisis with accounts in crisis, a situation that still persists. In 2022, there was an operating loss of BRL 11.5 billion. It was the worst result since the beginning of the historical series, in 2001.

UNDERSTAND THE CALCULATION

According to the ANS, the definition of the readjustment passed through the approval of the collegiate board of the agency and the appreciation of the Ministry of Finance.

The agency has been using a methodology that combines the variation in health care expenses with the IPCA (Extended Consumer Price Index) minus the health plan sub-item.

The calculation is based on the difference in assistance expenses per beneficiary of individual health plans from one year to the next.