The National Supplementary Health Agency (ANS) opened on July 21, the Public Consultation 99, to receive criticism and suggestions regarding the proposed Normative Resolution that changes the process of updating the List of Health Procedures and Events and revokes RN no. 470/2021 and RN no. 474/2021. 

The proposal aims to comply with Law No. 14,307/2022, which defines new rules on the process of updating the List and the composition and functioning of the Commission for Updating the List of Procedures and Events in Supplementary Health (Cosaúde).  

The deadline for sending contributions is 45 calendar days, ending on September 3rd. Those interested in participating can click here to access the information. 

The documents related to the proposal are available in full during the consultation period on the ANS website: www.gov.br/ans, in "Access to information", in the item "Social Participation“, in the subitem “Public Consultations” . 

What should your health insurance provider cover? Check the ANS Procedures List

Health plan operators must follow the standards defined by the National Supplementary Health Agency (ANS) so that there is regularity and act in accordance with federal laws.

Coverage ROL are procedures that healthcare providers are required to cover, according to each type of healthcare plan.

These procedures are defined in the ANS list, separated by plan types, and your healthcare provider must always follow it. 

They are: Outpatient, hospital with or without obstetrics, reference and dental.

Continue reading until the end to learn more about which procedures your healthcare provider should cover.

Types of plans and coverage

Hospital

The types of health plans that must contain hospital coverage are those that include obstetrics, hospital without obstetrics and the reference plan.

These points of the plan must be observed and recorded in the contract with your client so that there is clarity in what they are contracting, as there are other types of plans that do not have hospital coverage, but only outpatient coverage.

Outpatient

In outpatient plans, your healthcare provider must only cover exams, consultations with doctors in offices or clinics, and treatments that do not require hospitalization.

Orthotics and prosthetics

For orthoses that require a surgical procedure to be placed or removed, coverage is mandatory when you are a client with a hospital plan.

However, in its article 10, the same Law allows the exclusion of coverage for the supply of orthoses and prostheses not linked to the surgical procedure (or non-implantable), such as glasses, orthopedic vests, limb replacement prostheses.

The prostheses are installed in the ANS reference plan, and that according to the art 10 of law 9656 – 1998, requires coverage because it is a device that totally or partially replaces a limb, organ or tissue.

Exams

ANS has a valid and mandatory list of exams for health plans to comply with, in plans contracted since January 2, 1999.

Make sure that both outpatient and other types of procedures are approved by the system of partner hospitals, clinics, laboratories and offices so that the plan contracter has an excellent experience using the health plan.

For old plans, operators must follow the LAW 9,656 of 1998, in art 35, where we talk about adaptation as agreed between the parties.

(…) all contracts concluded as of its validity, ensuring consumers with previous contracts, as well as those with contracts signed between September 2, 1998 and January 1, 1999, the possibility of opting to adapt to the system provided for in this Law. (…) Without prejudice to art. 35-E, the adaptation of the contracts referred to in this article must be formalized in a specific term, signed by the contracting parties, in accordance with the standards to be defined by the ANS. (…)

How can technology help?

For your healthcare provider to be one of the best, it is important that it has quality hospitals and healthcare professionals, and that they clearly fulfill their rights and duties towards the patient and their provider. 

We invite you to discover the SAUDI, a system designed to maintain the “financial health” of Supplementary Health Plan Operators. Used by the largest healthcare providers in Brazil, it is today the most complete and integrable medical audit system.

SAUDI automates the entire process, from requesting authorization for medical procedures from the network of providers, to their respective release for payment. 

SAUDI's objective is for health plan operators to become healthier and achieve better results through better management of their healthcare costs.

The results are surprising in the first few months of use! And the best part, it has ZERO implementation cost.

Contact us and learn how our customized solutions can deliver significant results in a short space of time!