The speaker presents the PL for health plans; see what changes are suggested in the law

The proposal makes changes, among other things, to the rules on unilateral termination of contracts and on the adjustment of monthly fees

Federal MP Duarte Junior (PSB-MA) presented on Tuesday the 12th the bill that modifies the regulation of health plans in Brazil. The proposal makes changes in relation to the unilateral termination of contracts, the adjustment of monthly rates, among other points. The PL that intends to change the rules has been in the works in Congress for almost 20 years without reaching a result.

The bill is being worked through in the Chamber as a matter of urgency and is seen by consumer protection sectors as a window of opportunity to improve conditions for customers with health plans.

On the other hand, bodies representing integrative healthcare are working to avoid the implementation of rules that, according to the industry, could put health plans in difficulty. The speaker said he had spoken to the Speaker of the House, Arthur Lira (PP-AL), about bringing the issue to the plenary in the coming weeks, but did not set a date. Duarte said Lira is interested in starting the project soon.

Check for readjustment

The rapporteur proposes a rule for the readjustment of collective plans, which currently occurs at the discretion of the operators. Regardless of the size of the contracts, the National Agency for Complementary Healthcare (ANS) can intervene if an exorbitant adjustment occurs, exceeding the latest percentage authorized by the agency for individual plans. In this case, ANS will notify companies to question the percentage and may ultimately veto it.

The text also establishes a specific calculation model for the adjustment based on the size of the operators. For small businesses, with contracts of up to 99 lives (beneficiaries), the calculation must take into account all users to determine the percentage increase. The measure is a way to ensure that there are not very large adjustments for users of smaller plans.

According to the rapporteur, since the calculation of the value of a health plan is based on the rate of accidents, i.e. on the costs generated by the different users, forcing collective plans to consider a wider pool of people makes the readjustment fairer, as it reduces, among other things, the risk of default.

For large companies, i.e. with contracts exceeding 99 lives (beneficiaries), the balance can be freely established during negotiations between operators and contractors. Even so, if the percentage increase deviates from normal, the ANS can intervene.

Currently only individual plans have limited adjustments from the ANS. According to the ANS collective plan adjustment panel, last year the average adjustment rate in this modality was 11.64%. The value is a weighting of the different values ​​applied, but, individually, there are contracts whose increase has reached over 100%.

“It will not be up to the ANS to say a percentage, but rather to evaluate the reasons that gave rise to this adjustment. And in the case of an increase substantially higher than that of the individual plans, it will be up to the ANS to act to avoid any type of abusive adjustment and disproportionate. This result is the result of a lot of dialogue”, explained Duarte Junior.

Prohibition of unilateral termination

The report suggests that unilateral contract termination by businesses should be prohibited in any type of contract, individual or collective, except in cases of fraud or delay in monthly payments for 60 consecutive days.

The consumer must also be notified every 20 days of the delay and notified of the resolution by the 50th day of delay. In the previous rule the plan could be terminated in the event of a delay of 60 days – consecutive or not. It also provided that specific unilateral termination clauses could be included in collective agreements, which was used as a loophole by many companies.

“No one shall be prevented from participating in private health care plans because of their age, status as a person with a disability, serious or rare disease, or personal attributes, such as ethnicity, colour, status socioeconomic, family, nationality, sexual orientation, gender identity, religion, belief, ideological or political position,” the report reads.

According to Duarte Junior, companies have adopted “disproportionate” behavior towards consumers, which ends up leaving the relationship between user and operator unequal.

“The plan does this (terminate unilaterally) with the elderly, people with disabilities or those undergoing chemotherapy. It is a disproportionate thing. What we want to add is that there cannot be unilateral termination of the contract. It will only be possible to withdraw if the consumer is in debt. If it is overdue for 60 consecutive days, notify and remove the consumer (from the plan). If you pay on time and the delay is less than 60 days, there is no unilateral termination. The consumer pays for the plan for life, he pays not to use it, but when he needs it, (plan) it needs to work,” the deputy argued.

Rare Disease Fund

The text proposes the creation of a national fund made up of public and private resources to finance high-cost therapies aimed at treating rare diseases. The model, according to the speaker, will be regulated by the Ministry of Health.

“The vast majority of rare diseases have no cure, because there is no investment in in-depth research to ensure solutions, improve the quality of life and longevity of these people,” said the speaker.

Request for exams

Another point raised by the speaker is the possibility of covering laboratory tests requested by nutritionists, physiotherapists, speech therapists and occupational therapists. Duarte suggests that this coverage exists as long as these exams are necessary to evaluate how to treat patients based on their practice areas.

Single record

As Estadão stated, the rapporteur included in the text the provision of a single medical record to share data relating to visits and tests carried out by patients in the Unified Health System (SUS) and in the private network. According to the rapporteur, the measure is an attempt to ensure that there are no unnecessary expenses when the additional network makes the patient repeat tests already carried out in the SUS.

The proposal envisages that the ANS and the other bodies participating in the health inspection will participate in the construction of the platform, to assist the Ministry of Health in the process.

“We are in dialogue with the Ministry of Health and propose an update of the SUS law so that we can establish a single medical record. It is a way to ensure more sustainability, reduce unnecessary expenses and also curb criminal practices required for tests that the consumer sometimes he doesn’t need to do it,” explained Duarte Junior.

Source: Terra

Ben

Ben Stock is a lifestyle journalist and author at Gossipify. He writes about topics such as health, wellness, travel, food and home decor. He provides practical advice and inspiration to improve well-being, keeps readers up to date with latest lifestyle news and trends, known for his engaging writing style, in-depth analysis and unique perspectives.