How to choose a health plan

How to choose a health plan

According to the 2019 National Health Survey by the Brazilian Institute of Geography and Statistics (IBGE), 281,000 people, or 59.7 million, have health insurance. But choosing a health plan isn't always easy, especially with so many options on the market.

However, it's possible to choose a good health plan that still fits your budget. Currently, providers offer excellent value-for-money options.

So, to help you, in this post we'll give you some tips on how to choose a health plan that's affordable for you and can also meet your needs.

Evaluate the operator's reputation

There's no point in considering all these points we'll discuss if the provider has a poor reputation. Whether you're looking at provider rankings on the ANS (National Supplementary Health Agency) website, Reclame Aqui, or Google reviews, check out what people are saying about the company's services.

You'll gain a better understanding of quality, monitor potential suspensions and bankruptcy proceedings, and see user experiences. This will help you decide which carrier to choose.

Choose the type of hiring

The second thing to consider when choosing a health plan is the type of coverage you're looking for. These could be:

Individual Plans

• Individual or Family
• You look for the operator to hire the plan
• Accession: Free
• Shortage: Yes
• Coverage: As per the contract and the List of Procedures
• Termination: Only in case of fraud and/or non-payment
• Billing: Directly to the consumer by the health plan operator

Collective Plans

In these cases, your company, professional association, or union contracts the plan for you. There are two types:

Collective by Adhesion

• Membership: Requires membership in a professional association or union
• Waiting period: Yes. Except for those who join the plan within 30 days of signing the contract or on the anniversary of the contract.
• Coverage: As per the contract and the List of Procedures
• Termination: Provided for in the contract and only valid for the contract as a whole
• Billing: Directly to the consumer by the contracting Legal Entity or by the Benefits Administrator.

Business Collective

• Membership: Requires a link with a legal entity through an employment or statutory relationship
• Waiting period: Yes. Except for contracts with 30 or more beneficiaries and for those who join the plan within 30 days of signing the contract or joining the company.
• Coverage: As per the contract and the List of Procedures
• Termination: Provided for in the contract and only valid for the contract as a whole
• Billing: Directly to the consumer by the contracting Legal Entity or by the Benefits Administrator.

The point here is that, generally, group plans, both membership and corporate, end up being more affordable. Furthermore, if you're an MEI (Individual Microentrepreneur), you fall into the corporate plan category, significantly reducing costs.

Define the scope of service

Health plans can cover different areas, either statewide or nationwide. Therefore, if you or a family member travels a lot, it's best to choose plans that cover the entire country, or at least the states you visit frequently. However, if you want something more affordable and travel isn't a regular occurrence, regional plans are the best option.

With this, the plans can be:

• National: serves the entire national territory
• State group: serves only some states
• State: is specific to a state
• Group of municipalities: serves some municipalities in one or more states
• Municipal: covers a single municipality

Pay close attention to the coverage

Coverage refers to the types of services you'll be entitled to when you sign up for a health plan. Therefore, it's important to be aware of the available coverage options.

The plans, regardless of the operator, basically work with the following types of coverage:

Obviously, the plan with the reference coverage is the best, but it's also the most expensive. Therefore, it's best to purchase at least outpatient and hospital coverage, but if you plan to have children, obstetrics becomes essential.

Choose accommodation

Accommodations refer to where you will stay if you are hospitalized. There are two types:

Shared accommodation: this is the ward, where there are 2 to 3 beds with people of the same sex, and one companion of the same sex is allowed.

Individual accommodation: individual rooms/apartments, with greater comfort and privacy, with one companion of any sex and age permitted.

Analyze the accredited network

Another tip, before choosing which plan you will sign up for, is to analyze the entire accredited network, that is, find out which hospitals, laboratories, clinics, and doctors will be able to treat you.

Therefore, it's up to you to evaluate whether the service providers you like and whether they're a reference in your city. After all, there's no point in having a broad network if it's not of high quality.

Therefore, choose plans that offer highly rated hospitals and healthcare professionals.

See what the grace period is

Health plans can establish grace periods for the release of services provided as follows:

• 24 hours for emergencies and urgencies;
• 180 days for other coverage;
• 300 days for full-term births (pregnancies over 37 weeks).

But be careful! If you already have a health insurance plan and want to switch, you can do so without having to complete a new waiting period. The ANS website explains how this works and the conditions for this to happen.

Read and complete the membership application carefully.

Do not sign before carefully reading the entire proposal, checking that all the document conditions fit with those you hired, and clarify all your doubts.

Additionally, you must complete a Health Declaration upon hiring. Therefore, be honest about your health status and, if necessary, seek medical advice.

Price

Finally, one of the most important points to consider is the cost of your health insurance premiums. After all, you might find the perfect plan, but it might not fit your budget.

Therefore, when evaluating the price, don't forget to take into account all the previous choices, as they directly affect the monthly fee.

Also, research and compare available plans; don't make a decision on impulse. Some carriers offer better conditions than others.

Don't forget the adjustments

All health plans, regardless of the provider, undergo annual adjustments and increases due to changes in age group (the older the person, the higher the cost of the plan).

The ANS publishes the annual adjustment percentage for individual and family plans. For group and corporate plans, adjustments are based on the provider's terms and conditions and agreements with employers.

So don't be alarmed to see your health plan costs increasing more and more.

Choosing a health plan isn't that difficult, is it?