Having health insurance in Brazil is difficult, because of the cost. Those who have a plan face two types of readjustment. The first is annual, which affects all contracts once a year, and the second is by age and the client’s aging is applied.
The expectation of the sector is that the individual plans have readjustment of 16% this year. But what to do if the increase weighs too much on your pocket? experts heard by UOL say there are some alternatives before giving up of private assistance.
Negotiate with the operator
Matheus Falcão, an analyst at the Health program at Idec (Brazilian Institute for Consumer Protection), advises the client to ask the operator about the readjustment as soon as he notices a very strong increase in the price of the monthly fee.
“Consumers need to ask where the percentage of the adjustment came from and use the Consumer Defense Code in their favor, especially regarding the right to information. The attempt here is to make a bargain with the operator. We realize that in some cases it is possible to get discounts monthly fee in this conversation”, says Falcão.
The consumer will not always be able to negotiate. If this does not happen, the guideline is to file a complaint with consumer protection agencies, such as Procon.
If the situation is still not resolved, the next step is to file a lawsuit in court. Experts advise that the consumer does not fail to pay the health plan during the period, unless you have some authorization from the Court.
The law allows operators to suspend assistance after 60 days with arrears in individual plans.
“Individual plans can only be canceled due to default after 60 days, and the operator needs to communicate the consumer until the 50th day. In collective plans, there is no rule in the law, you need to see what is in the contract”, says Rafael Robba , lawyer of the Vilhena Silva office.
Changing health plan
Another alternative is portability of grace periods, which means that the consumer can switch health plans without any type of coverage restriction (grace period). Portability has a few rules:
- The current plan must have been contracted after January 1, 1999 or have been adapted to the Health Plans Law (Law nº 9.656/98)
- The contract must be active, i.e. the current plan cannot be canceled
- The beneficiary must be up to date with the monthly payment
- The beneficiary must meet the minimum period of permanence in the plan. In the first portability, it is two years in the original plan or three if you have completed temporary partial coverage for a pre-existing illness or injury. In the second portability, the required period of stay is at least 1 year or 2 years if you have made the portability to the current plan with coverage not provided for in the previous plan
- The target plan must be priced compatible with your current plan
The documents required for portability are proof of payment of the last three monthly payments, proof of stay period, compatibility report between plans (issued by the ANS Guide to Health Plans). If the destination plan is collective, you must present proof that you are able to join the plan.
An important point is that compatibility considers the initial price of contracting the plan, that is, it disregards the adjustments applied over time. This helps to increase the number of plans that can be supported when porting.
Although some operators make portability difficult for the elderly or those with a pre-existing disease, Robba says that this is a consumer right, as long as it meets all the requirements.
“It is important that the consumer is documented about any attempt to make the portability. If there is any refusal by the operator, you can open a claim in the ANS or in court”, says Robba.
The destination operator has up to 10 days to evaluate the portability request. The ANS guides the consumer to request the cancellation of the old plan within five days after the start of the new plan.
“If you do not request the cancellation within this period, you will be subject to the fulfillment of deficiencies in the new plan for non-compliance with the rules”, explains the ANS.