Health plans: sanctioned the law that overturns the list of taxes and determines coverage outside the ANS list

Health plans: sanctioned the law that overturns the list of taxes and determines coverage outside the ANS list


The change, approved by Congress in August, was sanctioned this Wednesday by President Jair Bolsonaro, a candidate for re-election; companies in the sector opposed the new standard

President Jair Bolsonaro approved on Wednesday 21 the bill, approved by Congress in August, which obliges health plans to cover treatments that are outside the mandatory list of procedures provided by the National Agency for Supplemental Health (Agência Nacional de Saúde Suplementary).ANS), the so-called tax role. Brazil has approximately 49.6 million health insurance customers.





Health plans: sanctioned the law that overturns the list of taxes and determines coverage outside the ANS list

The law was vindicated by patient organizations, which saw the closed list as a threat to their rights. The plan operators, on the other hand, speak of risk to the financial balance of the firm with the change and are considering taking legal action.

Bolsonaro, a candidate for re-election, even contradicted the position of the ANS, in favor of the fiscal role. The Minister of Health, Marcelo Queiroga, had also criticized the proposal. The sanctioning event took place off the official agenda and, in a video recorded on the spot, the president, accompanied by First Lady Michelle, showed the sanctioned text.

The agency’s list contains “procedures deemed essential for the diagnosis, treatment and monitoring of diseases and health events” that the country’s medical care plans must offer. The mandatory procedures, on the other hand, vary according to the type of plan subscribed: outpatient, hospital – with or without obstetrics -, referral or dental. This list contains over 3,000 items.

In practice, experts say, the law just sanctioned once again considers the role “exemplary”. This means that the list of procedures covered by the plans contains some items, but operators must also encounter others that have the same purposes.

The standard specifies that the treatments or procedures prescribed by the doctor that are not included in the aforementioned list must have authorized coverage provided that: there is evidence of efficacy, in the light of the health sciences, based on scientific evidence and on a therapeutic plan; or there are recommendations from the National Commission for the Incorporation of Technologies into the Unified Health System (Conitec); o recommendation by at least one internationally renowned health technology assessment body, provided they are also approved for their citizens.

The project was presented to Congress after the Superior Court of Justice (STJ) decided in June that health plan operators would not be required to cover care not included in the tariff.

Rapporteur of the project of the exhaustive role in the Senate and candidate for re-election, Senator Romário (PL-RJ) celebrated the sanction. “It is a victory for life,” said the Carioca MP.

“With this decision, many beneficiaries of supplementary health plans have been affected by this insecurity about the possibility of interrupting their medical care, especially for those who are carriers of rare diseases or whose health problem would require several medical interventions”, reads a note issued by the Secretariat of Social Communication (Secom).

In a note, the National Federation of Complementary Health (FenaSaúde) regrets the sanction and says it is considering the possibility of resorting to justice. According to the body, which represents the companies, the law puts “Brazil against world best practices for evaluating the incorporation of medicines and health procedures, hinders the proper pricing of plans and undermines the predictability of treatment costs, which can cause an increase in monthly fees and mass expulsions of beneficiaries of supplementary care ”.

FenaSaúde also adds that, since April 2021, the care costs of private health plan operators and insurance companies have already exceeded the income obtained for consideration. With that, he says, there is an operating loss of R $ 9.2 billion over the past five quarters.

Required by the report after the sanction of the law, the Ministry of Health and the ANS have not yet taken a position. / FRANCIELLE OLIVEIRA COLLABORATE, SPECIAL FOR ESTADÃO

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Source: Terra

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