Unimed cancels corporate health plans again – 07/31/2023 – Market

Unimed Nacional has again canceled contracts for collective health plans for small companies in recent weeks.

The measure is part of a wave of terminations that has been practiced by Unimed Nacional this year and takes place after the company signed a commitment at Alesp (Legislative Assembly of São Paulo) that it would reassess the cancellations of plans for patients undergoing treatment. , such as autism.

The promise was made during a hearing held by the assembly on June 27, when Unimed was summoned to provide clarification.

The advisory office of state deputy Andréa Werner (PSB), who is following the case, says that, since the hearing until this Friday (28), it has received eight new reports of contract cancellations, even after the signing of the commitment. There were also 15 complaints about the disqualification of clinics or hospitals. Between April and May, the deputy had received about 190 complaints, most involving children with autism, cancer and epilepsy.

wanted by SheetUnimed Nacional states that the termination of contracts for the operator’s collective plan portfolios, of SME size or collective by adhesion, is regulated by the ANS (National Supplementary Health Agency) and respects the contractual conditions with prior communication to the contracting parties.

In a note, the National Unimed also says that, when there are treatments in activity, it has been dialoguing with the contractors “about the best way of conducting case by case”.

At the June hearing, Unimed representatives stated that, from January to May, 2,200 health plan contracts with companies were canceled by the operator, which covers 10,000 users, in a network that currently has around 2 million customers.

In May, the Public Ministry of São Paulo opened an inquiry to investigate cases of cancellation of Unimed Nacional.

According to lawyer Ana Lúcia Boaventura, specialist in medical law, the rule allows plans to make unilateral termination provided for in the contract, as long as they communicate to customers 60 days in advance, but the situation can be questioned and reversed in the Judiciary.

“At the time of hiring, generally, the possibility of termination is not clear to the contracting company and users. Patients can appeal, and the Judiciary has guaranteed access, but this generates wear and tear for those who are already vulnerable to the issue. of health”, says Boaventura.

The advance in contract suspensions takes place in the midst of a crisis in the supplementary health sector, which registers increases in accident rates and ended last year with an operating loss of R$ 11.5 billion, the highest in 20 years.

The ANS states that the practice of selecting risks by operators when hiring or excluding customers in any type of plan is prohibited. “No beneficiary can be prevented from acquiring a plan due to their health condition or age, nor can there be exclusion of customers by operators for these same reasons”, says the regulatory agency.

Also according to the ANS, “if there is termination of the collective plan contract (for whatever reason) and there is a beneficiary or dependent in hospital, the original operator must bear all the care until hospital discharge”. Procedures authorized during the term of the contract should also be covered by the operator, as they were requested when the beneficiary’s bond with the plan was still active, according to the agency.