Procon is suing maladaptive re-adaptation health plans

Procon is suing maladaptive re-adaptation health plans

São Paulo’s Procon has filed a public civil lawsuit against five health plans to block offensive annual adjustments and require clear information to consumers.

The companies targeted by Procon Actions are Amil Assistência Médica Internacional, Bradesco Insurance, Notre Dame Intermédica Saúde, South American Health Insurance Corporation, and Qualicorp Benefits Manager.

According to Procon-SP, companies have applied annual adjustments to group plans without adequate transparency or information about technical rationale. The entity also argues that the percentages applied for readjustment of group plans were much higher than those applied for individual plans.

In the procedure, Procon-SP requires companies to provide effective information for up to 30 days on the impact of the percentage of confirmed losses in 2020 on collective plan adjustments that have been or will be implemented in 2021. The entity also wants companies to display the average of the adjustments. Annual reports applied in the past three years to corporate and membership collective health plans, the manner in which they were negotiated and how consumers were informed of these modifications.

The lawsuit also requires that in the event that health funds do not provide such information to the court, they are subject to a daily fine, and if found guilty, they must pay R $ 10 million in collective moral damage. All.

“There was no transparency on the part of the companies in applying these amendments and the operators have a duty to explain them. We are going to justice until they provide this information,” defends Fernando Kibes, CEO of Procon-SP.

Firms are the champions of complaints

In January of this year, Procon-SP registered 962 consumer complaints against re-adjusting health plans, which largely relate to annual adjustments to group plans. The five companies mentioned in the lawsuit are the champion of the complaints.

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Procon informed the health plans, but considered that the answers they provided were not sufficient. The companies were also fined by Procon-SP, based on consumer protection law.

Additionally, Procon also states that healthcare operators were unable to justify increases in individual lawsuits by consumers, which resulted in their victory in court.

What do the health plans say

As for UOL, Qualicorp confirmed in a note that it is responsible for benefits and that modifications are determined by the operators. However, the company said it is “seeking to negotiate the smallest amendment and offering alternatives so that its customers can maintain access to high-quality health plans.”

“A recent survey by the National Association of Benefits Managers (ANAB) indicates that the savings between the amount required by operators for annual settlement and the amount actually charged to benefit managers’ clients was R $ 6 billion in the past eight years the text says.

The company also wrote that it learned of the suit in the press, “so it is ignorant of its terms and cannot comment on it.”

The other companies mentioned before have also been contacted TwitterHowever, the case has not yet been commented.

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