What Is it a Membership Health Plan?

What is a Membership Health Plan?

Previously, health plans were only available for families or individuals. However, over time, other types of plans have been created to facilitate and improve access. One of these is the membership plan, which is similar in many ways to corporate plans.

However, you may not know how it works or still have some questions. Therefore, we've created this content to help you understand what it is, how it works, its advantages and disadvantages, and who can join a health plan by membership.

What is the membership health plan?

The membership health plan, also called a collective membership health plan, is a type of health plan that allows a group of people to have access to plans that are generally only available to companies.

But not just any group. In this modality, a professional or student association collectively contracts the health plan service, and thus, all those who are part of this entity are entitled to join the plan.

New members can only join through policies already open by an entity or professional category. Therefore, it is not possible to join individually, only collectively.

How does the collective health plan work by membership?

Membership is offered to a group of legal entities of a professional, sectoral or class nature that are linked to some type of entity, such as unions, councils and associations.

Therefore, firstly, a plan administrator becomes responsible for hiring and places all clients with common characteristics in the same portfolio.

In this way, this company will manage the entire plan and, therefore, represent the beneficiaries before the operators.

Once the individual joins the plan, they become the owner of their own plan. In other words, the group they belong to only serves as an intermediary, with the beneficiary being solely responsible for paying all monthly premiums.

What is the waiting period for the health plan by adhesion?

Generally, one of the biggest advantages of taking out a group plan is the reduced waiting periods.

In fact, some services can be used immediately after signing the contract, such as exams, consultations and hospitalizations.

However, when hiring, ask to be informed about the waiting period, especially for childbirth and in case of pre-existing conditions (if you already have a disease, such as myopia, there may be a waiting period for treatment).

However, it is common that in these last cases there is no reduction in the waiting period.

Adjustments by base date of adhesion plans

The health plan price is adjusted mid-year, shortly after the plan is announced by the providers. This means that, regardless of the term (1 month, 2 months, or 10 years), you'll already be paying a higher price in July due to the adjustment.

Therefore, because many people don't seek proper information on the subject, they end up being surprised by their monthly payment increase, even though they've only recently signed up. For example, they signed up for a plan in April for one price, but by July the price had already increased.

This often leads to legal action. Therefore, before purchasing a plan, it's important to ensure all these issues are clear and that you're aware of all deadlines and adjustments to avoid surprises.

What is the difference between a corporate health plan and a membership plan?

People often end up confusing the two types of plans, as they have very similar characteristics, such as operator options, co-participation and accommodation.

However, the main difference lies in who is responsible for hiring. In the case of the corporate plan, it is the company that hires the provider and includes the employees. In other words, beneficiaries have an employment relationship with the contracting company and, therefore, remain in the plan until they leave the company.

Regarding the membership plan, it is the entity that manages this process, and members have the option of joining or not, as they do not have any employment relationship.

Furthermore, the adjustment here also occurs differently. In the corporate plan, the adjustment occurs on the anniversary of the hire date, that is, 12 months after the contract.

What is the difference between an individual plan and a collective membership plan?

Individual plans differ from membership plans in many ways. The primary difference between them is the contract. While individual plans are contracted directly with the health plan provider, group membership plans are contracted through a benefits administrator, such as Qualicorp and Allcare.

Something that is non-existent in individual plans.

Finally, the adjustments are quite different between these modalities. In subscription plans, not only is the monetary adjustment made immediately after the announcement by the carriers (in May), but it is also calculated based on the policyholders' usage in the previous year (claims ratio).

In the individual plan, monetary correction only occurs after 12 months of the contract.

Who can sign up for a collective health plan?

Any individual who is linked to an association, union or professional body has the right to purchase a health plan through membership.

It is important to take into account all the advantages and disadvantages that this plan offers, especially regarding the promotional value that some operators offer, with discounts of up to 30% in relation to individual and family plans.

To sign up for a membership plan, you must be partnered with a benefits management company.

In Brazil, Qualicorp Administradora de Benefícios is the largest administrator of collective health plans by membership.

In this way, it works to make products viable, commercialize them and manage them for freelance professionals, public servants, professionals in commerce, industry and services, and students.

Collective health plans by adhesion are regulated by the National Supplementary Health Agency (ANS) and by Law No. 9,656/98, therefore they are completely safe.

The difference between this plan and other modalities is that the annual adjustment is determined based on negotiations between the health insurance company and the contracting entity.

However, based on the financial balance presented throughout the period evaluated.

Regarding other rules and operations, the same rules apply as for individual plans. For example, mandatory healthcare coverage, which refers to the services and procedures that must be offered by the health plan after contracting.

What is a Membership Health Plan?