Shortage: How much How long does it take to be served when purchasing a health plan?

Waiting Period: Health Plan

When purchasing a health plan, one of the most important aspects to consider is the waiting period. This is the waiting period before you can benefit from the health plan's coverage.

First of all, for this reason, we're here to explain how long you need to wait to sign up for a health plan.

What is the waiting period for health plans?

Thus, health plans can establish their own grace periods; however, there is a maximum limit that is regulated by the National Supplementary Health Agency (ANS).

Therefore, according to the legislation, for new or adapted individual or family plans, contracted from January 2, 1999 or adapted to the law, the health plan operator may require the following deadlines:

In cases of urgency, personal accidents or complications during pregnancy, and emergency, immediate risk to life or irreparable injuries: 24 hours;

• Full-term births, except premature and emergency births: 300 days
• Pre-existing illnesses and injuries (when the person signed up for the health plan, they already knew they had them): 24 months
• Other situations: 180 days 

It's important to keep in mind that these time limits are the maximum that health plan providers can require of you. Therefore, you may be able to get a shorter waiting period than this, but never a longer one. If the provider offers a reduction in waiting periods, they require it to be in writing.

Pre-existing conditions

You may have had a medical condition before signing up for the health plan, which is what we call a pre-existing condition, such as myopia.

The first point in relation to this is that it must be informed before hiring on the health declaration form, otherwise this may be considered fraud and the operator may terminate the contract.

The second point is that for pre-existing illnesses and injuries, the beneficiary will have temporary partial coverage (CPT) until the two-year waiting period is completed.

In other words, during this period, treatment of these diseases may occur, respecting the other deficiencies.

However, for highly complex procedures, high-tech beds, such as ICU and ICU, and surgeries that are related to pre-existing diseases, it will be necessary to comply with the CPT.

Continuing our example of myopia, you must wait 2 years to undergo prescription surgery.

Health Insurance Lack for Legal Entities

Although the waiting period for collective plans uses the same table as for individual or family plans, the difference is that, depending on the number of people who joined the plan, there may be exemption from waiting periods.

Additionally, the company or union contracting the plan can negotiate with the operator to reduce rates.

What to do when there is no service available when you need it?

Hospitalization coverage

Let's assume you have a plan with ward accommodation, but when you are admitted, there is no bed available.

In this case, you don't need to pay for a single room; access will be at no additional cost. This applies to both our own and accredited establishments.

De-accreditation of doctors, hospitals, clinics and laboratories

It may happen that the professional or establishment you usually go to is de-accredited and, therefore, they no longer accept your health plan.

Time until You Can Be Served When Purchasing a Health Plan

If this happens, there is no problem with your health plan, as long as the health plan guarantees care for its beneficiaries at other medical professionals, hospitals, clinics, and laboratories.

Furthermore, all these changes must be communicated to the beneficiary and, if the operator reduces the number of hospitals available, it will need prior authorization from the ANS.

Scheduling appointments and exams

If when it comes to scheduling appointments and exams, the only place you can find is very far from your home.

You should check whether the plan guarantees healthcare coverage considering the municipalities and states contracted.

If they are not guaranteed at the contracted locations, this must be communicated to the ANS, which monitors the entire healthcare network of each health plan.