How to Cancel a Health Plan

How to Cancel a Health Plan

Surely subscribing to a service is much easier than canceling it, right? But no matter the reason, canceling a health plan must follow certain rules. This applies whether it's done by the beneficiary or the provider.

It may be due to customer dissatisfaction or fraud on the part of the beneficiary, the cancellation must comply with the Law, as well as the contract signed between the parties.

Therefore, both the application and proof of coverage will differ between plan types. To learn more about this topic, continue reading.

Individual or family plan

Cancellation at the consumer's request:

If your plan is individual or family, the cancellation request is made in person, by phone or even through the operator's website in the customer area.

Once the request is made, the operator must immediately clarify the consequences of the cancellation, in addition to providing proof that they received the order.

If you don't provide it immediately, you have a maximum deadline of 10 business days. From that moment on, the health plan will be canceled.

If you request something over the phone, you may not receive the document. In this case, resubmit the request and provide written proof of the request.

Attention! Until you request cancellation, monthly fees will be charged, and if payment is not made, the operator may protest the bill and include the consumer's name in a credit bureau.

Furthermore, the National Supplementary Health Agency (ANS) authorizes the charging of a fine for cancellation before 12 months of the plan's validity, if this has been established in the contract.

But this requirement is abusive and the consumer may challenge it in court.

Cancellation by the health insurance company

The operator may only cancel your health plan in cases of fraud or non-payment of monthly fees after 60 days (consecutive or accumulated) of delay within the one-year validity period of the contract.

In addition, the operator must send a letter within the 50th day of delay informing the beneficiary about this delay and the possibility of canceling the health plan.

Collective business plan

Cancellation at the beneficiary's request

If you have a business planTo cancel, simply request it from the Human Resources department. The company will have 30 days to inform the operator of the beneficiary's exclusion.

If the deadline is not met, the beneficiary can contact the provider directly, which must cancel the plan immediately and provide proof of receipt. From that moment, the plan will be canceled.

Cancellation at the request of the contracting company

The company can request the exclusion of just one beneficiary or the cancellation of the entire contract. However, to do so, it is necessary to follow the term and cancellation rules set forth in the contract.

Most operators establish in their contracts the obligation to provide 60 days' prior notice and payment of a fine, if this occurs before the end of the term.

Cancellation by the health insurance company

As with individual or family plans, the provider can only cancel the contract in the event of fraud or non-payment of monthly fees. Furthermore, if the beneficiary ceases to be a partner or employee of the company, the provider can also cancel the contract.

Collective plan by adhesion

Cancellation at the consumer's request

For those who hired collective membership plans, the cancellation request must be made to the health plan operator, the health plan administrator or the legal entity that is the contracting party for the health plan.

However, it's best to do so with the carrier or administrator. Upon request, the carrier must provide written proof of cancellation within 10 business days.

Cancellation by the health insurance company

Both the operator and the administrator may cancel the health plan contract if the beneficiary does not lose their eligibility status, that is, no longer belongs to the professional category or union.

Furthermore, in cases of fraud on the part of the beneficiary or the contracting company or non-payment of monthly fees (in most cases after a delay of 30 consecutive days), the operator may also cancel the plan.

Operators' duty when requesting cancellation of any type of plan

After receiving the request, the operator or benefits administrator must clearly and accurately provide the information listed below: 

• Possible need to comply with new grace periods and Temporary Partial Coverage, if you are joining a new plan;
• Immediate loss of remission;
• Completion of new health declaration;
• Suspension of coverage for High Complexity Procedures (PAC), high-tech beds and surgical procedures;
• The request to cancel the contract or exclude a beneficiary has immediate effect and is irrevocable, as soon as the operator or benefits administrator is aware of it;
• Overdue monthly fees and/or any co-payments due for the use of services provided prior to the request for cancellation or exclusion from the health plan are the responsibility of the beneficiary; 
• Expenses arising from any use of services by beneficiaries after the date of request for cancellation or exclusion from the health plan, including in cases of urgency or emergency, will be the responsibility of the beneficiary;
• The exclusion of the beneficiary holder of the individual or family contract does not terminate the contract, and dependents already registered are guaranteed the right to maintain the same contractual conditions, assuming the resulting obligations; 
• Exclusion of the beneficiary holder of the collective agreement business or by adhesion will observe the contractual provisions regarding the exclusion or not of dependents.

The operator's attendant must provide all this information at the time of the request, whether in person, by telephone, website or on the receipt of the cancellation request.

Furthermore, within 10 days of receiving the request, the operator must provide proof of the effective cancellation of the contract or termination of the beneficiary, containing any service charges made by the operator or administrator. benefits.