Readjustment of individual health plans confuse the consumer. Understand when the tuition will drop

RIO – When will the health plan monthly fee be reduced? That’s what the commercial manager Carlos Eduardo Farkuh wants to know. Since the National Supplementary Health Agency (ANS) announced, in July, the negative adjustment of 8.19% for individual contracts, Farkuh is eagerly monitoring the delivery of invoices.

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— Paid R$ 2,226 until February. In March, the monthly fee rose to R$2,407. But when will it fall? Will I have to wait until 2022? I don’t understand this birthday story, is it mine, the one about the plan? – question.

Given the increase in registrations on issues related to adjustment, about 200 of them unfounded complaints about the delay in applying the index, tomorrow ANS launches an alert campaign on its website and on social networks, clarifying to users that the percentage is only applied in contract anniversary date. That is, the month he joined the health plan. In the case of Farkuh, the reduction in the ticket will only come in March 2022.

For Carlos Eduardo Farkuh, the tuition reduction will only come in 2022 Photo: Personal archive
For Carlos Eduardo Farkuh, the tuition reduction will only come in 2022 Photo: Personal archive

Weight in pocket:Readjustment of the collective plan is almost double the individual in 2020

— Among the people who complained that the index had not yet been applied, in many cases, the reason was the same: the contract anniversary month had not yet arrived. For this reason, we advise that beneficiaries check the contract or the bill itself the date of its inclusion – says the Director of Inspection of ANS, Maurício Nunes.

He still points out:

—If the entry date is October, for example, the application will be in the month of October 2021. If it is March, the adjustment will be applied in March 2022. If there is any doubt, the consumer can request information from their plan operator of health. If you cannot resolve it, you should contact ANS.

The -8.19% index disclosed by the ANS for individual or family health plan contracts must be applied by operators in the contract anniversary month, in the period between May 2021 and April 2022.

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At the Brazilian Institute for Consumer Protection (Idec), the number of complaints related to readjustments has grown 10% since the index was released by ANS. In addition to the date of application of the adjustment, the main issues are the recomposition of the index that was no longer applied to contracts in 2020 and how is the increase in collectives.

— We still see a lot of confusion about how the collection of retroactives is combined with the discounts of the 2021 readjustment, in the case of individuals. But nothing compares to the difficulty of those who have a collective plan and have not had any discount. The savings that operators made in 2021 are not being passed on to these consumers – says lawyer Ana Carolina Navarrete, coordinator of the Idec Health program.

Collective contracts do not have the readjustment percentage determined by ANS. According to a survey by Idec, in 2020 the increases applied to these contracts were almost double the rate for individual contracts.

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Understand how the readjustment works

  • Application. The negative adjustment of 8.19% disclosed by ANS is valid for individual and family plans and must be applied between May 2021 and April 2022, always on the anniversary month of contracting the plan.
  • Reset. There was no readjustment of individual and family plans in 2020. The rate of 8.14% started to be applied in January of this year. The difference between the amounts that were no longer charged last year was divided into 12 months, that is, until December.
  • Collectives. The index of these contracts is not determined by ANS. The agency, however, determines that, for contracts with up to 29 users, companies must make a pool of risk and apply the same readjustment to everyone with that profile. In other cases, the readjustment percentage is negotiated between the parties, without interference from the regulatory agency.
  • Where to complain. Dial ANS, 0800 701 9656; Contact Us, at gov.br/ans; or for the hearing impaired, 0800 021 2105