The rapid Covid-19 test was included in the list of mandatory coverage by health plans. The resolution of the National Health Agency (ANS) was published in the “Official Gazette of the Union” (DOU) on January 20th. The measure came into effect immediately after publication in the DOU.

The inclusion of testing in the list of mandatory procedures was unanimously approved during an extraordinary virtual meeting between the organization's collegiate board on the 19th.

Health plans will not be required to pay for the test when the patient has tested positive for coronavirus up to 30 days ago or has contacted an infected person, but is asymptomatic. Children under two years of age will also not be included in coverage, as will those who wish to know the diagnosis to return to work or suspend the isolation period.

“Covid brings us restrictions and impacts on the entire population, both individual and collective. The pandemic imposes some situations and reflections on us. But, more than reflecting, we were urged to act”, said Paulo Rebello, president of ANS, during the meeting.

Understand the ANS decision

The ANS decision follows the same position issued the day before and also unanimously, by the Commission for Updating the List of Procedures and Events in Supplementary Health (Cosaúde). During this afternoon's meeting, the agency's directors also stressed that the change was driven by the “increase in the number of cases” and “new pressure on the health system, including diagnoses”, which required a “reassessment of processes ”.

Covid-19 rapid test – see how it will work: 

The test must be requested by a doctor and is valid for symptomatic patients, between the 1st and 7th day since the onset of symptoms, when one of the Group I criteria and none of the Group II criteria is met:

Group I (inclusion criteria)

• Patients with Flu Syndrome:individual with an acute respiratory condition, characterized by at least two (2) of the following signs and symptoms: fever (even if reported), chills, sore throat, headache, cough, runny nose, olfactory disorders or taste disorders.
• In children:In addition to the previous items, nasal obstruction is also considered, in the absence of another specific diagnosis.
• In the elderly:specific worsening criteria should also be considered, such as fainting, mental confusion, excessive drowsiness, irritability and lack of appetite.
• Patients with Severe Acute Respiratory Syndrome (SARS):individual with flu-like syndrome who presents: respiratory discomfort, persistent pressure in the chest, oxygen saturation lower than 95% or bluish discoloration of the lips or face.
• In children: In addition to the previous symptoms, observe nasal flaring, cyanosis, intercostal insufficiency, dehydration and lack of appetite.

Group II (exclusion criteria)

• Asymptomatic contacts of a confirmed case;
• Individuals up to 24 months of age;
• Individuals who have performed, less than 30 days ago, an RT-PCR or rapid antigen detection test for SARS-CoV-2 whose result was positive;
• Individuals whose prescription is intended to track the disease, return to work, control cure or suspend isolation.

Control your healthcare provider’s costs

With this obligation becoming even more important, it becomes even more important to control the costs of your health plan provider. And an efficient way to do this is to implement a medical audit solution, which allows everything from authorization of procedures and OPMEs, including purchase, in addition to concurrent medical monitoring of the patient, to the provision of payment to service providers, all automatically, integrated, zero paper and with total transparency and greater accuracy, streamlining and simplifying financial management.

Not to mention the reduction in the aging of resources from disallowances subsequent to the closing of the jurisdiction, which can lead to a reduction in the mandatory value of technical reserves, with a consequent reduction in financial costs.

It is because of these details that SAUDI is the most awarded and used medical audit system in Brazil.

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