Procon-SP investigates corporate health plan contracts

NS Procon São Paulo has received accusations that health care providers are forcing consumers to open small businesses only to employ the business plan, which has no monthly adjustment limit, and an investigation has begun to investigate possible wrongdoing in the sector.

The suspicion is that health insurers only encourage the hiring of business plans or, in some cases, only offer that option to consumers, with the goal of making more profit from adjustments not regulated by the regulator.

Practically speaking, in the individual plan, the adjustment that the consumer will feel in his pocket will be a percentage regulated and supervised by the National Health Agency (ANS) – as opposed to what happens in contracting business plans, when the values ​​stipulated by the insurance companies themselves.

“Five days ago, the ANS gave a negative discount of more than 8% and lowered the values ​​of individual plans, but let the companies make the adjustments they see fit in the business plans. There was a business plan that increased by 40%, 60%, 100%,” says Fernando Kepez. , director of Procon Corporation in São Paulo.

He believes that many people may have been motivated to start a small business to join the business plan. “A group business plan cannot be drawn up if the company has not been active for more than six months. Procon claims that this is a simulation, a fraud, and that all companies with CNPJ created exclusively for health insurance that are inactive are immediately transferred from groups to individual” Keeps continues.

Psychiatrist Evelyn Rozenbaum went through this and filed the complaint at the agency. “I had a horrible experience. Out of nowhere they kicked me, I got a message saying ‘You’re out’, blowing. You tell her what attracted her to the proposal and that she didn’t realize that in the business plans, both parties could cancel the contract at any time – and that there was no set limit for modification.” To my surprise, when it came time to pay, there was an extra.”

The National Federation of Complementary Health (Fenasaúde) reports that health plans follow current legislation and rules set by the National Health Agency.

The Brazilian Association of Health Plans (Abramge) says that since 2017, the ANS has demonstrated the need for a document confirming the registration of individual entrepreneurs with the competent bodies of the organs and their regular registration in federal revenue for a period of at least 6 months. In addition, operators are required to check the contracting company’s documentation for the health plan annually, on the anniversary of the contract.