Health plans: Procon fee clarification after increases of up to 80%

Receive tickets from health insurance With extremely high adjustments it is the new concern of families who are under pressure from the general rise in prices for basic products and services. Consumers have complained about Procon-SP against the Qualicorp and the Unimed Central National (CNU) Due to shipping with an 80% re-adjusted value.

The Consumer Protection Agency wants companies to provide a spreadsheet identifying which provinces experienced this increase and the number of people affected. It also requested clarification on the ratio of administrative cost to medical hospital cost for all plans sold.

In addition, the agency has decided that Qualicorp will indicate which other operators, in addition to Central Nacional Unimed, will implement the disputed amendment. The deadline set by Procon-SP to receive the information expired on Monday, 2. The companies requested an extension of the date to the 11th and were granted.

These clients’ contracts are of a group-by-membership type, a health plan category with no adjustment limit set by the National Supplemental Health Agency (ANS)—the agency only sets rates for individual and family plans.

When operators stopped offering new individual plans to escape the ANS’ control of the mod, families migrated to group membership plans. These are plans that are contracted by entities, unions and associations. Customers are people who demonstrate a relationship with these entities.

There are also so-called “false group” business plans for a few groups of people (often just two or three). To hire them, it is necessary to have a CNPJ, but in general, the beneficiaries are part of the same family (father, mother and son, for example) without being able to get a better deal.

“There are 9.2 million people with membership plans, including Secret Membership, where the same broker tells the consumer to join a fake entity,” says Mario Schaeffer, a professor at the University of São Paulo Medical School and a blogger. from stadium.

“In the spurious groups, there are more than 5 million people in contracts with less than 30 lives. A group of 14 million people receive much higher adjustments than those practiced in individual plans (with 8.9 million beneficiaries,” he says.

In a note, Qualicorp stated that “the relevant CNU client portfolio readjustments were one-time and represented approximately 0.5% of Qualicorp’s total clients, and covered a small portion of users for a no longer commercial contract. The average CNU portfolio re-adjustments this year have ranged from 6% to 12%. Qualicorp offers alternatives so that its customers can maintain access to high-quality health plans and are available for further clarifications”

Also on a note, Central Nacional Unimed (CNU) stated that it “does not enter into direct contracts with beneficiaries, as it works exclusively with corporate contracts, with benefit managers being the authors of the monthly fee. Thus, Qualicorp is responsible for managing the health plan with its clients, including CNU also informs that it is taking appropriate action with respect to the publication published by Qualicorp, which erroneously leads to the understanding that the modification has been applied by the operator. The cooperative also states that it will provide all clarifications requested by Procon-SP within the legal term and ensure its compliance For all the rules of the National Supplementary Health Agency (ANS)”.