How to Exchange or Join Health Plans without Meeting Waiting Periods?

 

 

How to Change or Join Health Plans Without Meeting Waiting Periods

First, you might have seen better conditions with another health insurance provider, or you might simply want to switch plans within the same provider. Whatever the situation, I'm sure you don't want to go through that waiting period again.

But don't worry! However, on some occasions it may not be necessary, in which case you just need to ask for it. portability of need.

However, do you want to know more about what it is, how, and when to apply? Keep reading.

Portability of Deficiencies

This way, if you're trying to sign up for a new health plan with the same provider or a different provider, you can request Portability of Waiting Periods. This way, you won't have to go through the waiting period again and can enjoy the services and benefits immediately.

However, this is a right of all beneficiaries of health plans with contracts from 02/01/1999, regardless of the type of plan contract.

Still, there are two other types of portability of deficiencies:

Special Portability

If an operator is leaving the market, whether due to cancellation of its registration or bankruptcy, you definitely have the right to request Special Portability, regardless of the type of health plan and the date of signing the contract.

In other words, this process is determined by ANS and must occur within 60 days after the date of publication of the Operational Resolution.

Extraordinary portability

Extraordinary portability occurs when, for some exceptional reason, the beneficiary has no other options, such as when the available plans on the market are insufficient or incompatible with the original plan. In these situations, the only time limit for switching providers is 60 days.

How to request portability of deficiencies?

• Constantly check whether you meet the requirements necessary to transfer your deficiencies.
• Consult the ANS Health Insurance Guide to identify your original plan and check which health plans are compatible with yours for portability purposes. deficiencies.
• After choosing the new plan you want to join, go to the operator with the required documentation and request the membership proposal.
• Please allow up to 10 days for the carrier to review your request. If you do not receive a response within this timeframe, the grace period portability proposal will be considered accepted.
• Once the process is complete, contact your original plan provider to inform them that you have exercised the grace period portability and request plan cancellation within 5 days of the new plan's start date. If you fail to comply with this deadline, the receiving provider may require you to fulfill grace periods on the new plan.

Requirements for portability

However, to carry out the portability, the following requirements must be met, otherwise, it will not be possible:

• The current plan must have been contracted after January 1, 1999 or have been adapted to the Health Insurance Law (Law No. 9,656/98);
• The contract must be active, that is, the current plan cannot be canceled;
• The beneficiary must be up to date with monthly payments;
• The beneficiary must comply with the minimum period of service in the plan. If this is the first time they transfer, they must have been in the original plan for two years, or three years if they have completed Temporary Partial Coverage (CPT) for a Pre-Existing Illness or Injury. In the case of a second time they transfer, the required period of service is at least one year, or two years if they transferred to the current plan with coverage not provided by the previous plan.
• The target plan must be priced in line with your current plan.

Compatible plans

One of the requirements for carrying out the waiting period portability is that the new plan must be compatible.

Therefore, the monthly fee must be within the price range of the old plan.

These price ranges are set by the National Supplementary Health Agency (ANS). To check which plans are compatible with yours, visit the ANS website.

Documents required to carry out the portability of deficiencies

The documents you will need to carry out the portability of your waiting period are:

• Proof of payment of the last 3 monthly payments or the last 3 invoices, if the plan is post-paid, OR a statement from the operator of the original plan (provided within 10 days) or from the contractor stating that the beneficiary is up to date with the monthly payments;
• Proof of period of permanence: signed membership proposal OR signed contract OR declaration from the original plan operator (provided within 10 days) or from the current plan contractor;
• Compatibility report between the origin and destination plans, valid for 5 days from the date of issuance of the protocol, OR protocol number, both issued by the ANS website;
• If the target plan is a group plan, proof of eligibility to join the plan. For individual entrepreneurs, proof of eligibility for a business plan.

Migration

Migration is when a health plan contracted before 01/01/1999 is exchanged for another health plan, sold by the same operator, which is already in accordance with Law No. 9,656 of 1998. 

Switching or Joining Health Plans

Therefore, the beneficiary has the right to change to a new health plan, regulated by Law No. 9,656 of 1998, without a new waiting period to be met.

However, this is only permitted for individual, family, and collective membership plans. To do this, you must follow these steps:

• Check if you have an unregulated plan, contracted before January 2, 1999;
• Consult the ANS website to identify health plans from your provider that are compatible with your plan for Migration purposes;
• Go to your health plan provider, taking the plan report in a compatible format with you, and request a Migration proposal;
• The Migration proposal must indicate the new health plan contract.
• It comes into effect on the date of signature, among other mandatory information.

Migration requirements

• The price range of the destination plan must be equal to or lower than the source plan, according to the date of signature of the membership proposal;
• If the Migration is carried out by the entire collective contract group linked to a legal entity, exemption from waiting periods will be guaranteed for new procedures within the same healthcare segment, without the need for plan compatibility through the ANS Health Insurance Guide;
• Migration cannot be done for plans that have been canceled or have been suspended for sale.

Adaptation

Adapted plans are those contracted up to 01/01/1999, but have some of their characteristics modified and adapted to Law No. 9,656/1998.

However, what happens is a modification to the beneficiary's contract, causing the beneficiary to pay up to 20,59% more for the health plan.

Switching or Joining Health Plans

To carry out the adaptation process, the beneficiary holding the individual or family plan or the contracting legal entity must negotiate directly with the operator.

Fulfillment of the waiting period for joining collective plans

For example, a corporate collective plan with more than 30 beneficiaries or a collective membership plan.

Additionally, some plans with fewer than 30 beneficiaries waive the waiting period. However, this is usually specified in the contract. Just make sure there's a clear clause, especially one that waives the waiting period, and that it's not just misleading advertising.

Other important information

• THE portability of deficiencies It is a right guaranteed to beneficiaries individually, and it is not necessary for all members of the contract or family group to exercise portability simultaneously.
• The monthly fee to check compatibility refers to the amount paid by the beneficiary carrying out the consultation and not the total amount for the family group.
• Plans from operators in the process of canceling registration or leaving the market cannot receive beneficiaries through portability of waiting periods.
• There can be no additional or specific charge to the beneficiary for exercising portability and there can be no price discrimination of plans due to the use of the waiting period portability rule.