Readjustment of collective health plans weighs on the consumer’s pocket: ‘amount above my budget’

Unlike the individual and family health planswhose readjustment has not yet been passed on by the National Supplementary Health Agency (ANS), customers of collective plans already feel the weight of the increase for 2022.

In Ceara, the rates reach 16%, according to customer reports. The main operators of health plans did not disclose the average increase already applied this year.

Collective health plans, whether corporate or by membership, have a different model for passing on the increase in costs of operators. Annually, the ANS sets an adjustment ceiling for individual and family plans, but there is no limit for charging in collective plans.

In the case of plans with more than 30 lives, the annual adjustment is defined in the contract, with room for negotiation between the contracting company and the operator.

In the case of plans for up to 29 lives, as is the case with most subscription contracts, all contracts from the same operator must receive the same percentage of annual adjustment. The objective is to reduce risk by spreading costs.

According to ANS, in December 2021 there were 966,637 contracts of collective health plans in Ceará.

weighing in the pocket

Project analyst Letícia Almeida, 25, hired a collective membership plan at the end of 2020. At the time, it was the best cost benefit she found compared to individual plans.

Subtitle: Project assistant Letícia Almeida was startled by the increase

Photograph: Kid Junior

“I did some research on the individual plan and my individual plan was around R$ 470. When I did the research for the adhesion group, they gave me the amount of R$ 250 plus the union fee, in the end it was around R$ 280 and R$ 290”, he recalls.

In the first year, the adjustment made the monthly fee rise around R$ 50. But, according to Letícia, the last increase weighed on her pocket.

Initially, the operator suggested a readjustment of 19%, which was reduced to 16% after negotiations with the union. Even so, today the account commits around 25% of her income, which makes her think of alternatives to reduce the impact.

The initial value already weighed on income, and now with the readjustment it has an impact because we have to make some choices, I have to choose between [pagar] an account and continue with the plan. The percentage is too high to increase from one year to the next.”

Letícia Almeida

project analyst and collective plan client

In the case of Gardênia Nunes, a 40-year-old credit recoverer, the cost of health insurance increased by more than 38% between 2020 and 2022. Despite the high monthly amount, she sees no other alternative: the main thing is her health and that of their two children included in the plan.

“It was a value well above my budget, but because of the need I need to continue with the plan. It is very difficult for the moment we are living. I started working last year, my husband pays and he really had to fit into the budget,” she says.

Attention when hiring

The lawyer with an MBA in medical law and legal protection applied to health, Nycolle Araújo Soares, explains that collective plans may even be cheaper than individual plans at the time of hiring, but the client must keep in mind the unpredictability of readjustments.

This is because health plans calculate the adjustment on top of what was spent in the previous year. As there is no ceiling established by the ANS, this value can weigh on the consumer’s pocket.

There are several groups so there is an analysis of both the costs in general and the accounting of this cost of use. That is, in groups where high-cost treatments, treatments and prolonged hospitalizations were made available, the readjustment will be greater. There is a formula that is used, but it is often difficult for the consumer to understand”.

Nycolle Araújo Soares

lawyer with an MBA in medical law and legal protection applied to health

According to the expert, the pandemic has made the risk higher, due to the greater number of hospitalizations. This invariably reaches the consumer.

“Entering the individual plan may have a higher cost, but the readjustment is more predictable. In the collective, entry is cheaper, but the readjustment is outside the sphere of consumer decision”, he relates.

Nycolle points out that the consumer can question the readjustment, asking the ANS to recalculate it. Ultimately, the judiciary can be called upon.

Rules for readjustment

According to the ANS Collective Plan Readjustment Panel, the average national readjustment for plans with up to 29 lives was 9.84% in 2021. The lowest readjustment was for plans over 5,000 lives, which rose 4.88% in year.

In a note, the ANS highlighted three rules for the readjustment of collective health plans:

  • Mandatory communication of the applied index and information on the payment slip and invoice;
  • Periodicity of readjustment and impossibility of price discrimination and readjustments between beneficiaries of the same contract and product;
  • Mandatory availability to the contracting legal entity of the readjustment calculation memory and methodology used at least 30 days in advance of the scheduled date for the readjustment application.

According to the regulatory agency, “consumers can formally request the benefit administrator or operator for the calculation memory and the methodology used, which have a maximum period of 10 days for supply”.

ANS emphasizes that it is open to complaints from consumers through the Dial ANS (0800 701 9656), through the call center for the hearing impaired (0800 021 2105) and through the electronic form Fale Conosco at the Customer Service Center, available at agency website.

Readjustment in Ceará

In a note, Unimed Fortaleza stated that it follows the ANS rules for the readjustment of collective plans and reinforced that in plans over 30 lives, what counts for the increase is free negotiation.

“It is also important to clarify that Unimed Fortaleza observes good practices of respect for the customer”, he pointed out.

Searched for by the report, Hapvida preferred to position itself through the Brazilian Association of Health Plans (Abramge). In a note, the association reported that the average readjustment of collective health plans was 5.55% according to ANS data until May 2021.

“According to the IBGE, the variation accumulated in the last 12 months (data from February 2022) of health plans was -0.41%”, he defends.

THE Northeast diary he also sought advice from Amil, who did not return until the report was published.

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