The cost of health insurance plans will increase nationwide. According to the ANS (National Supplementary Health Agency), the adjustment will have a fixed limit of 9.63%, and this value cannot be exceeded until April 2024.

Once decided, operators cannot apply monthly fee increases above the set percentage.

ANS has set a ceiling for adjustments across the country — Photo: Freepik/Disclosure/ND

According to the agency, the decision does not apply to collective plans, whether corporate or membership. This measure only applies to the monthly fee of individual and family contracts signed since January 1999. There are almost 8 million recipients, which corresponds to about 16% of the market for additional medical care.

Values ​​can only be changed from the anniversary of each contract. If the month of the anniversary of the contract is May, retroactive adjustments may be charged.

According to ANS, the current annual adjustment formula has been in place since 2019 and is mainly affected by changes in aid spending from the previous year.

In 2022, this deviation was 12.69% compared to 2021. It also takes into account the IPCA (Advanced Consumer Price Index), which measures inflation in a country.

Increase

In a note published on its official website, the Fenasaúde (National Complementary Health Federation), which represents the largest health plan operators in the country, assessed healthcare inflation, insecurity and regulatory instability, growing jurisprudence and a clear increase in fraud cases. among the main factors influencing the price change of health insurance plans.

“An annual adjustment is needed to reallocate costs and therefore to maintain the financial balance of the sector, which ended 2022 with an operating loss of 10.7 billion reais,” the organization said in a statement.

According to the R7 portal, ANS says that it is “incorrect” to compare indicators between inflation and bailout. This is because inflation only takes into account price changes, while health insurance plans take into account costs in general.

“Thus, the percentage calculated by ANS takes into account such aspects as changes in the prices of health goods and services, as well as changes in the frequency of use of medical services,” the ANS said in a statement.

However, Idec (National Consumer Protection Institute) refutes this thesis.

“The official ANS data does not support the companies’ version [de planos de saúde], because despite the historical increase in the use of plans in 2022, in practice this increase did not amount to a loss, since high interest rates guaranteed the return on financial investments of companies. If you add operating losses to financial profit, then last year the sector was at the level of “zero to zero,” says Idec.

“The figure approved by the regulator is almost 67% higher than the accumulated value of inflation in 2022 and once again pushes the consumer to address the management problems of sector operators,” notes Idec.

And who can’t afford it?

Lawyer Rafael Robba, specialist in health law at Vilhena Silva Advogados, gave an interview to the R7 portal and gave some advice.

If the adjustment directly affects the budget, it is proposed to negotiate with the operator. If a customer is unable to pay for a plan, they may attempt to downgrade or change to a plan with reduced portability.

“Many operators agree to a category change, but in this case, there is a reduction in the coverage of the health plan, as well as the accredited network,” Robba recalls.

“Changing a plan is more of a challenge because the few individual plan options on the market are very expensive and there are a number of restrictions,” he adds.