Minor health insurance increases 10% and weighs for MEIs and small business owners

Small collective health plans, which serve up to 29 people, had a much greater increase than other plans this year, according to data from the ANS (National Agency for Supplementary Health). The increase was 9.84%, while collective plans with more than 30 people rose 5.55% and individual plans, in fact, were even cheaper, with a drop of 8.19%.

The smaller plans cater mainly to small business owners and workers registered as MEI (micro-entrepreneur Individual). The discrepancy between the adjustments shows that a resolution by the agency created precisely to smooth the increase in plans with up to 29 lives has had no effect.

The rules for readjustments are different depending on the type of plan. While individuals have a maximum increase determined by the ANS, collectives are free to set prices, without agency action. In this case, the negotiation is carried out directly between operators and customers, both in the case of large plans and small ones.

Experts heard by UOL claim that the lack of limit for the readjustment harms consumers, especially those with smaller plans, as they have little negotiating power with operators. The association of health plans says that the formula for calculating the readjustment is provided for in the contract and that the high results from the increase in the costs of medical procedures.

Resolution seeks to contain adjustments

The bill that defines how much the adjustment of collective health plans will be includes the accident rate, that is, what was spent on medical procedures and what was paid by beneficiaries in monthly fees, explains Melissa Kanda, a lawyer specializing in medical law and health .

In the case of larger plans, with more than 30 lives, this account is made in each contract, annually.

Now imagine a plan of a small company, in which an employee took covid-19 and was hospitalized for a long time. By this rule, the contract would have a very high loss ratio, because few people would share a very large expense.
Melissa Kanda, lawyer

An ANS resolution, published in 2012, sought to minimize this problem. By standard, the same operator must group the contracts of all health plans with up to 29 people, and then calculate the adjustment. That is, the account considers the expenses of all these plans together, not each one individually. Thus, costs are diluted, and the trend is for the increase to be smaller.

ANS says that it inspects whether the grouping of contracts is being carried out and, if it finds any irregularities, it can apply a fine of R$ 45 thousand for each breach of the rule.

Small go up more than big ones

Even so, the readjustments of small plans in recent years have been greater than those of large ones, according to ANS data, available since 2016.

Average increases in collective health plans:

  • 2021:
    • Up to 29 lives: 9.84%
    • 30 lives or more: 5.55%
  • 2020:
    • Up to 29 lives: 11.15%
    • 30 lives or more: 7.10%
  • 2019:
    • Up to 29 lives: 13.5%
    • 30 lives or more: 9.99%
  • 2018:
    • Up to 29 lives: 15.64%
    • 30 lives or more: 11.33%
  • 2017:
    • Up to 29 lives: 16.86%
    • 30 lives or more: 13.86%
  • 2016:
    • Up to 29 lives: 16.94%
    • 30 lives or more: 15.05%

Source: ANS Collective Plan Adjustments Panel

Lack of protection, experts say

For Rafael Robba, a lawyer specializing in the Right to Health at Vilhena Silva Advogados, the numbers show that the resolution “is not working”.

If, even with the resolution, the people who have these small collective plans are having higher adjustments than the plans linked to large companies, it is a sign that these people are not receiving the protection they should.
Rafael Robba, lawyer

He cites as harmed, for example, families that open legal entities just to hire the health plan, since the rules of the individual plan are more restrictive. The practice is not illegal but, according to the ANS rule, people registered as MEI need to prove that they have had economic activity for at least six months to be able to hire a collective health plan.

Marina Paullelli, a lawyer specializing in health plans at Idec (Brazilian Institute for Consumer Protection), says that the readjustments “are abusive” and that the ANS needs to exercise a more effective regulation of collective plans.

A consumer who is MEI and hires a small-size collective plan does not have any bargaining power with the operator to negotiate the adjustment. The ANS should regulate these increases in the same way as it does with individual plans, even more so because they are 80% of the plans.
Marina Paullelli, from Idec

According to Flávia Bahia, professor of law at FGV (Getúlio Vargas Foundation), regulation needs to be readjusted for collective health plans, with “detailed” audits carried out on spreadsheets.

It is a matter of equity, as the health plan is related to life itself. I don’t see irregularities [nos reajustes], but the need for greater attention from ANS in relation to these contracts, which are collective but have very low bargaining power.
Flávia Bahia, professor at FGV

ANS interference could reduce the offer of plans, says association

Renato Casarotti, president of Abramge (Brazilian Association of Health Plans), says that the readjustments are high, but not abusive or improper.

An abusive readjustment is one that is not justified, an excessive charge. The readjustment of the plans is not abusive, but it is high when compared to other sectors because inflation in the health area is high.
Renato Casarotti, from Abramge

Casarotti agrees that smaller group plan clients have no bargaining power. According to him, however, the formula for calculating the adjustment is provided for in the contract since joining, and should be taken into account by customers when purchasing a plan.

It’s a rule that’s in the contract. What we can discuss is how to bring more transparency to this. When choosing a plan, the customer should look not only at the service network or the price, but also at how the plan is readjusted. And operators could take advantage of this when selling the product.
Renato Casarotti, from Abramge

About the discrepancy between the readjustments of individual and collective plans, Casarotti affirms that it is not possible to compare the two cases, since the calculation methodologies are different.

For individual plans, the account made by ANS considers the variation in costs and the number of beneficiaries across the country, regardless of the operator. As the maximum readjustment value established by the agency is an average, some plans should have larger readjustments, if their costs were considered, and others, smaller.

Casarotti says that this mechanism ended up making many individual health plans unfeasible, as the readjustments did not cover all costs. Therefore, the offer of individual plans with a wider coverage network decreased. According to him, this is what can happen if the readjustment of smaller collective plans is also determined by the ANS.

This solution looks very attractive, but in fact it will end up restricting the offer. What will happen is that only those who work in a company with more than 30 people will have health insurance.
Renato Casarotti, from Abramge

FenaSaúde says the increase is less than the medical inflation

In a statement, FenaSaúde (National Federation of Supplementary Health) stated that the model established by the ANS for collective plans with up to 29 lives has “guaranteed that the readjustments are, historically, lower than medical inflation”.

The entity also said that the increases applied in 2021 for collective plans, in general, are “among the lowest ever applied by operators at least since 2013”.

ANS does not manifest

O UOL sought the ANS, but received no response until the publication of this text.