Main Questions About Health Insurance

Main Questions About Health Insurance

To help our readers, we've selected the main questions about health insurance.

How do you know if your chosen health plan and the company providing this service are reliable?

To find out if you can trust your provider, simply request the provider's and plan's registration number from the ANS (National Supplementary Health Agency). By accessing the ANS website, you can check:

• Operator data and plans;
• Monitoring of service guarantee;
• Operator performance through the ANS Qualification Program;
• Complaints index;
• Accreditation of operators;
• Operators whose registration was cancelled;
• Payment of operators together with reimbursement to the SUS;
• Caesarean section rate.

With this data, you'll be able to assess the main questions about whether or not you can trust the company you're considering hiring.

Is my health plan required to cover all the care I need?

The health plan is only required to make the minimum coverageThis means that it must offer consultations, exams and treatments established by the ANS according to each type of plan (outpatient, hospital with or without obstetrics, reference or dental).

However, if the contract mentions any service that is not included in the ANS list, the operator is obliged to cover it.

How does emergency care work?

Urgent and emergency care will vary depending on the type of plan you choose. They will work as follows:

Plan type	Urgency	Emergency
Outpatient plan	Care limited to the first 12 hours in the outpatient clinic.	Care limited to the first 12 hours in the outpatient clinic.
Hospital Plan	Personal accidents: comprehensive care	Waiting period fulfilled (maximum of 180 days): full care. Waiting period to be fulfilled (after 24 hours): limited to the first 12 hours, in an outpatient clinic.

Therefore, under outpatient plans, if you need to be hospitalized for even less than 12 hours, you won't be eligible for this through your health plan. In this case, you can choose between being transported to a SUS facility that has availability to continue treatment or paying the costs yourself.

However, for urgent/emergency dental care, you must have a dental plan. These services can be provided with full coverage 24 hours after your contract begins.

What influences the price of a health plan?

Plan prices are determined by the services offered. In other words, the greater the coverage, the higher the monthly fee.

Therefore, plans that only include consultations and exams tend to be cheaper than those that also include childbirth, hospitalization, or dental care. Furthermore, a regional plan is generally cheaper than a plan that offers nationwide coverage.

Another factor that makes all the difference in pricing is the customer's age. The older the customer, the higher the monthly fee. This is because they're more likely to need to use the provider's services more frequently.

How are health plan monthly payments adjusted?

According to the ANS, individual or family health plans can be adjusted in two ways:

• Annual adjustment, defined by ANS, on the contract anniversary date;
• Adjustment for change of age group: at 19 years of age and then every 5 years until reaching 59 years of age.

Therefore, it is important that you ask the operator for the monthly payment amounts for all age groups, so that you can have a forecast (remembering that it is not the final amount, after all there is an annual adjustment).

How much does a health plan cost? Why is one plan cheaper than another?

It may be that the operator or broker is selling you a corporate plan, after all, there are collective plans for 3 or more lives.

In these cases, the problem lies in the adjustment. This is because the provider can increase the price without the ANS's intervention, as it only sets the adjustment percentage for individual or family plans.

In other words, the initial price may be cheap, but when it comes time to adjust the price, the operator may act in bad faith and increase the price abruptly.

To avoid falling into a trap, remember that the monthly fee is closely linked to the services available, the coverage area, and your age. Also, compare prices with others; this can help you get an idea.

Can the operator make any demands on me when I purchase a plan?

One of the requirements of health plan providers is the declaration of illnesses or health problems. You can receive care from a doctor recommended by the provider at no cost, or from one of your own choosing, but in this case, you will be responsible for the costs.

Additionally, a medical examination may be requested, also paid for by the provider. So pay close attention when signing up, as the provider cannot charge any membership fees. The only amount charged is the monthly fee.

If I have a medical condition, can the operator refuse to sell me the plan?

Under no circumstances may the provider refuse to sell the plan. However, if you declare that you have a medical condition, two situations may occur:

• For up to two years, suspend the provision of certain procedures related to the disease you declared;
• Increase the monthly fee so that you are entitled to all services, including those related to this disease.

What should the operator give me when I sign up for a plan?

You will receive the following documents:

• Copy of the signed contract containing all conditions of use (monthly fee amount, adjustment methods and coverage to which you are entitled);
• List of all accredited or referenced healthcare professionals, hospitals, clinics and laboratories;
• Manual for guidance on contracting health plans;
• Contract reading guide.

However, if your plan is collective, a copy of the contract is not mandatory for all beneficiaries, but can be requested from the company that contracted the plan.

After I purchase a plan, can the operator cancel the contract we signed?

The operator can only cancel the contract in cases of fraud, that is, if you fail to declare that you have a disease or allow someone else to use your card.

Additionally, if you fail to pay your monthly fee for two months, whether consecutive or not, your contract may be canceled. In cases of default, the provider must notify you 10 days in advance of the cancellation.

How long after purchasing can I use the plan?

All plans have a grace period for using the services. Check with your provider to avoid any surprises when you need them.

Main Questions About Health Insurance

However, they generally work as follows:

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

Can I leave the plan at any time?

Of course you can, but if you stay for less than two years, you'll likely have to complete another grace period. So don't do anything rash.

I still have questions. Who can I talk to about health plans?

Here at Geniuzz, we have a wealth of content about health insurance. Check it out here and we'll help you answer your questions.

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Main Questions About Health Insurance