How Will The Health Plan Readjust In 2021?

 Anderson Fernandes  December 04, 2020  No comments

ANS suspends health plan adjustments for 120 days in 2020.

The term will start in September / 2020 and can be valid for annual adjustments and for changing the age range, additionally to exclusively dental plans.

National Supplementary Health Agency (ANS) suspended, for 120 days, contract adjustments for all kinds of health plans (individual / family and collective - by adhesion and business). The term will start in September and can be valid for annual readjustments and for changing the age range of medical and exclusively care plans. The announcement was made last Friday (21).

According to the ANS, there'll be a later assessment and incorporation of impacts, also because the thanks to reset the adjustments to take care of the balance of health plan contracts.

Understand the measure

Individual / family plans

The maximum percentage of adjustment to be applied to individual / family plans is defined and announced by ANS between the months of May and July. This year, there was no disclosure of percentage, therefore, the regulator didn't authorize the appliance of readjustment for a person contract with an anniversary beginning in May 2020. Accordingly, there'll be no announcement, nor readjustment authorization for these plans in 2020.

Collective plans with but 30 beneficiaries (business and by membership)

To define the readjustment of those contracts, the operators must take in one group all their collective contracts with but 30 beneficiaries to use an equivalent percentage of readjustment. Accordingly, the readjustments for these portfolios within the period from September to December 2020 are suspended.

Readjustment of collective plans with 30 or more beneficiaries (business and by membership)

readjustments of portfolios with 30 or more beneficiaries are defined after free negotiation between the contracting legal entity and therefore the contracted benefits operator or administrator. The justification for the proposed percentage must be substantiated by the operator and its calculations made available for conference.

According to the measure, readjustments for these portfolios are suspended from September to December 2020. within the case of plans with 30 or more lives, the contracting legal entity may choose to not have the readjustment suspended, if it's in their interest, and must inform the choice to the operator.

But, how is it in 2021?

Readjustment of health plans - Recomposition 2021

1 - What sorts of adjustments were suspended within the period from September to December 2020?

The suspension was applied to the readjustment thanks to cost changes (annual readjustment) and to the worth change thanks to a change within the age bracket that occurred in 2020 in healthcare plans for medical and hospital assistance. 

2 - What sort of health plans were covered by the suspension of the appliance of the adjustments within the period from September to December 2020?

The measure was applied to medical-hospital plans contracted from 01/01/1999 or adapted to Law No. 9,656 / 98, additionally to individual / family plans that had a Term of Commitment signed to define the readjustment index. 

3 - Which contracts didn't have the suspension of the appliance of the adjustments within the period from September to December 2020?

Non-regulated plans (those contracted before 12/31/1998 and not adapted to the Health Plans Law - apart from individual / family plans that had a Term of Commitment signed, whose adjustments depend upon express authorization from ANS, and people whose contracts provide the adjustment authorized by ANS); 

Exclusively dental plans; 

Corporate collective agreements with 30 or more lives which don't belong to groupings of contracts provided for in RN 309/12 that had already negotiated and applied their adjustment until 08/31/2020 or contracts during which the contracting legal entity chose to not have the adjustment suspended. In these cases, ANS sought to respect the negotiations already administered between the 2 legal entities - contracting and contracted -, ensuring legal stability and preserving the contracts effective.

Postpay plans. 

4 - From when and the way will the resetting of the suspended adjustments be made? 

Contracts that had readjustments suspended between the months of September and December 2020 may have the recomposition applied as of January 2021. the quantity due should be diluted in 12 monthly installments of equal value. 

5 - what's the utmost percentage of readjustment defined for individual or family plans and which can be charged from January 2021?

The maximum percentage of readjustment of individual or family plans contracted since January 1999 or adapted to Law No. 9,656 / 98 was set at 8.14%. The index is valid for the amount from May 2020 to April 2021, with the gathering ranging from January 2021, along side the restoration of suspended adjustments. 

It should be noted that the share of adjustment authorized for the amount from May 2020 to April 2021 observed the variation in health care expenses between 2018 and 2019, the amount before the pandemic which, therefore, didn't show a discount within the use of health services. the consequences of the reduction are going to be seen within the adjustment for 2021. 

6 - what's the share defined for individual non-regulated plans, which have a Term of Commitment signed?

For these cases (for four operators), the utmost readjustment rates which will be applied as of January 2021 are as follows:

Amil: 8.56%

Bradesco: 9.26%

Sulamérica: 9.26%

Itauseg: 9.26% 

7 - Can the resetting of the readjustments accumulate the values ​​related to the readjustment thanks to cost variations and by variation by age group? 

Yes, there are cases during which the share charge associated with the recomposition of the worth variation thanks to a change within the age bracket and therefore the percentage associated with the recomposition of the adjustment thanks to cost variation may coincide. within the case of variation thanks to age changes, there are 10 age groups and therefore the suspension period varies between one and 4 months. within the case of annual readjustments thanks to cost variations, the suspension period can vary from one month, within the case of contracts with an anniversary in December 2020, to eight months, within the case of individual contracts which had an anniversary in May 2020. 

8 - What information should the slips contain to tell consumers about the rebuild as of January 2021?

Billets should contain the subsequent information for consumers:

the monthly fee

the amount of the portion associated with the recomposition

the information of which parcel is (example: parcel x / 12) 

9 - How is that the adjustment percentage calculated for individual plans?

The calculation methodology is defined in Normative Resolution No. 441/2018 and combines the variation of assistance expenses with the Broad Consumer price level (IPCA) - removing from the latter the item Health Plan. This model is predicated directly on the segment of individual plans and features a component that establishes an efficiency factor for operators, avoiding an automatic transfer of costs.  

10 - Are operators required to follow the readjustment index defined by ANS for brand spanking new plans contracted by individuals?

Yes, authorized operators must observe the share defined by ANS as a ceiling for the readjustment of individual or family medical-hospital plans contracted after January 1, 1999 or adapted to Law No. 9,656 / 98. Thus, they can't apply a better percentage than authorized, but they're liberal to adopt rates less than that disclosed by ANS, or maybe to take care of their monthly fees without adjustment.  

11 - and the way does the adjustment of collective plans work? 

The readjustment of collective plans is calculated supported free negotiation between operators and corporations, foundations, associations, etc. For corporate and adherence contracts with up to 29 lives, ANS established the grouping of collective contracts for the aim of calculating and applying the adjustment - the so-called risk pool (RN 309/2012). This measure aims to dilute the danger of those contracts, offering greater balance within the calculation of the adjustment.

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