Health plans in Brazil are regulated, inspected and controlled by the National Supplementary Health Agency (ANS), which is linked to the Ministry of Health. ANS standards must be followed by all health plan operators, therefore, it is I always need to pay attention to your updates.

Many managers, doctors and health plan users are aware of the ANS, however, they do not know exactly how its operation affects the operators. With this in mind, we created this post to clarify this information. It will highlight the main points related to the standards, as well as changes planned for 2019.

Want to know more about the subject? So, just keep reading!

What are the main ANS standards for health plan operators?

Seeking to offer a quality service to the population, without excessively harming the functioning of health plan operators, ANS uses some rules that need to be followed by companies that offer medical insurance services.

Check out some points that are covered in the standards below.

Health plan coverage

The ANS determines which types of consultations, exams and the right or not to hospital admissions should be covered by the health plan. This list differs according to the type of plan chosen by the consumer (outpatient, hospital or reference).

Attendance deadline

ANS establishes maximum service deadlines that must be followed after the grace period stipulated in contract. A basic pediatrics, gynecology, obstetrics or general surgery consultation, for example, must be offered to the consumer within a maximum period of 7 working days.

Shortage

The lack of a plan is also regulated by the ANS. Urgent and emergency cases must be attended to within 24 hours of contracting the plan. Consultations and exams must last a maximum of 180 days, and full-term births must last 300 days.

Readjustment

The increase in monthly plan fees is one of the points regulated by the ANS. This increase differs depending on the type of plan chosen. Corporate ones can be more readjustable according to negotiations between the operator and the company that hires them, often taking into account their accident rate. The readjustment of individual plans is arbitrated by the ANS, according to criteria established by it.

Operator ranking

Each quarter, the ANS is based on 4 indicators to analyze performance of each health plan operator. They are: ensuring access to users, market sustainability, process management and regulation and quality and health care. From the results, the user and doctors can know whether the agreement is reliable to work with and to hire.

What are the changes to the standards from 2019?

For 2019, the ANS announced some changes to health plan standards, involving the readjustment of individual plans, portability and mandatory procedures.

The readjustment of individual health plans, until then, took into account the percentages applied in collective plans, which are decided by the operator itself, without having to follow an ANS limit. According to the new standard, these adjustments must be based on three components:

• the variation in assistance expenses;
• the variation in income by age group;
• the operator's efficiency calculation.

In addition to the adjustment, the list of mandatory procedures covered by health plans will also be revised. Finally, the other changes to the standard correspond to the issue of portability, which will allow:

• request portability between agreements at any time;
• request portability of the deficiency, including in collective corporate plans;
• change plans, using the grace period, in the event of a terminated collective agreement.

To the ANS standards aim to maintain the organization of this important health sector, which helps Brazilians to have a little more quality and peace of mind when they need medical care.

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