Health plan forecasts: Operators must prepare for an increase in contract values offered to their beneficiaries. This is because analysts estimate that there will be a adjustment of up to 18% in May 2022.
This predicted increase is mainly due to a variation in assistance expenses with service to plan beneficiaries, considering variations by age group and operator efficiency.
Another factor taken into consideration is the IPCA, Broad Consumer Price Index, which takes into account the prices administered by contracts for the services and products offered.
This increase aims to attract operators that may have left the segment aside to reinvest in the sector, even with the risk of contracts having a higher value than usual, which could increase the monthly fee.
ANS may review the contract calculation model for 2023
Speaking of adjustments, the ANS, National Supplementary Health Agency, may review the calculation model for contracts offered by operators to individual beneficiaries in 2023.
The idea is that this segment becomes attractive again for operators that have left it aside in recent years.
Currently, around 20% of the market is made up of individual contracts, however, in the last year, the number of individual contracts reduced by 117 thousand people, while users of collective plans increased by approximately 1.5 million.
Decision on the new adjustment model will discuss all hypotheses involved
While for operators it is essential that the calculation methodology is reviewed so that the segment's costs are covered, for beneficiaries there is a risk that plans will have a relatively high monthly fee.
So that both sides can be understood, the topic will be discussed and the risks and benefits involved will be put on the table so that a decision can be reached on the matter.
Another issue raised is the generation of greater competitiveness between companies, if the new model is approved, highlighting the need for good internal management in operators.
Furthermore, hypotheses such as periodic reviews of beneficiary contracts, with additional adjustments; regional increases according to the characteristics of each location; and, furthermore, the definition of a readjustment band that would give room for increases up to a specific range are being discussed.
In the latter case, an increase above the defined percentage would require accountability to the ANS.
Read too: Find out how ANS standards affect health plan operators
Discover a solution adopted by the largest healthcare providers in Brazil
As new updates are released on the subject, we will bring all the information necessary for managing your operator here on our blog.
But you can now prepare your health plan provider for any future changes, especially those that impact your health. control of assistance costs It is medical bill audit.
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