ANS authorizes maximum readjustment of 15.5% in individual health plans | Economy

After an unprecedented negative adjustment last year, individual or family health plans could rise by up to 15.5% this year. The maximum percentage of readjustment that can be applied to monthly fees was set this Thursday (26) by the National Supplementary Health Agency (ANS). The decision should be published in the Official Gazette on Friday (27).

It is the highest percentage of readjustment ever approved by the agency. The highest until then had been 13.57% in 2016, according to data from the ANS historical series, started in 2000 (see the history of readjustments below).

The adjustment will be applied to medical-hospital plans with an anniversary in the period from May 2022 to April 2023, contracted from January 1999 or that were adapted to the new legislation (Law No. 9,656/98).

In 2021, a negative adjustment of -8.19% was determined in individual health plans due to the drop caused by the pandemic in the use of medical services, with the postponement of procedures such as surgeries and exams.

The annual adjustment is calculated based on changes in expenses with services to beneficiaries, intensity of use of plans by customers and inflation measured by the Broad Consumer Price Index (IPCA).

The Brazilian Association of Health Plans (Abramge) estimated that the percentage of readjustment would be “close to 15.8%”. Already the National Federation of Supplementary Health projected “adjustment of 15.7% in this cycle”.

“The increase in various items, such as the price of medicines and medical supplies, the strong resumption of elective procedures, the impact of long-term Covid treatments and the incorporation of new mandatory coverage to health plans, such as medicines and procedures, directly impact the readjustment”, says FenaSaúde.

According to Abramge, the resumption of calls postponed the previous year and the second wave of Covid-19, “much bigger than the first”, weighed on the cost of medical and hospital expenses in 2021.

“Other factors that had an impact were the global inflation of inputs (materials, equipment and medicines) and the exponential rise of the dollar, currency linked to a large part of the medical and hospital supplies used in Brazil”, highlighted the entity, adding that the health plans were the only regulated sector with a negative adjustment in 2021.

It is important to note that only the readjustment of individual health plans is defined by the ANS. In collective health plans (corporate or by membership), the increases are established directly by the operators.

When does the adjustment take effect?

After the calculation and definition of the index by the ANS, the readjustment will be applied by the operators from the anniversary date of the contract, that is, in the month of contracting the plan. The annual incidence base is from May to April of the following year.

This means that the maximum increase ceiling can be used as a reference until April 2023 .

Individual plans vs collective plans

Individual health plans are the minority in the market and the supply has decreased. In February this year, there were 49 million health plan beneficiaries in the country, against 47.6 million in February 2021. The number of individual plan customers fell from 9 million to 8.9 million, or 18.15% of the total.

In the collective plans, the readjustments are already taking place, since they do not depend on authorization from the ANS. In 2021, the average adjustment was 5.55% for contracts with 30 lives or more, and 9.84% for contracts with up to 29 lives, according to an ANS survey with data up to May last year.

Collective plans are usually sold with a lower monthly fee. Idec warns, however, that migrating from an individual plan to a collective one may not be advantageous over the years.

“The collective plan has less protection than the individual plan: one is the ceiling, which produces lower readjustments, and another is protection against unmotivated cancellation. In the individual plan, the operator can only cancel in case of fraud or non-payment”, he highlights. the institute coordinator.

ANS maintains a guide on its website, where consumers can search for all health plans sold in the country.

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