Readjustment of health plans: understand how the charge will be – 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. The readjustment must be applied by the operators on the anniversary date of the contract, that is, in the month of contracting the services.

In the case of contracts with an anniversary in May, June and July, retroactive charging for these months will be authorized. The readjustment does not involve collective plans, be they corporate or by adhesion.

According to the agency, beneficiaries of individual and family plans should pay attention to payment slips.

The agency’s guidance is for customers to observe whether the percentage applied is equal to or less than that defined by the ANS (9.63%) and whether the charge with the readjustment is being made from the month of the anniversary of the contract, which is the month in which the document was signed.

To find out the anniversary date, you need to check the month in which it was signed in the contract. Below, see an example of application of the 9.63% readjustment.

How should the readjustment of the individual or family plan be?

Current tuition: hypothetical amount of BRL 100
Plan anniversary month: May

May.2023
Situation: the customer received the bill in May without the readjustment yet
Amount charged: BRL 100 (previous monthly fee)

Jun.2023
Situation: the customer received the bill in June without the readjustment
Amount charged: BRL 100 (previous monthly fee)

Jul.2023
Situation: the customer will receive the bill in July with the monthly fee readjusted and the value retroactive to May
Amount charged: BRL 109.63 (adjusted monthly fee) + BRL 9.63 (retroactive to May) = BRL 119.26 (total)

Aug.2023
Situation: the customer will receive the bill in August with the monthly fee adjusted and the value retroactive to June
Amount charged: BRL 109.63 (adjusted monthly fee) + BRL 9.63 (retroactive to June) = BRL 119.26 (total)

Sep.2023
Situation: the customer will receive the bill in September with the adjusted monthly fee
Amount charged: BRL 109.63 (adjusted monthly fee)

According to the agency, operators can apply a readjustment of less than 9.63%, but are prohibited from charging an increase above that threshold.

The ANS states that the measure affects individual and family plans that were contracted from January 1999 or that were adapted to Law No. 9656/98.

In absolute terms, the measure covers around 8 million beneficiaries, according to the agency.

This public is the minority of the market. It represents approximately 16% of the 50.6 million consumers of health care plans in Brazil. The biggest slice of the is that of the collective plans.

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

How to switch plans?

If the consumer understands that the health plan is not providing adequate care or needs to pay for a more affordable agreement, it is possible to opt for portability of shortages to another operator, according to the agency.

To find out about the options available in the market for contracting or exchanging via portability of grace periods, the interested party can make comparisons by consulting the ANS website. The portal also informs about requirements for carrying out the portability of shortages.

In case of doubt, consumers can contact ANS through different service channels.

They are the following: electronic form, call center for the hearing impaired (0800 021 2105), existing agency centers in 12 cities in the country (Monday to Friday, from 8:30 am to 4:30 pm, except national holidays) and Dial ANS (0800 701 9656), whose telephone service is free, from Monday to Friday, from 8:00 am to 8:00 pm, except on national holidays.