What are the Types of Health Insurance Contracts?

What are the Types of Health Insurance Contracts?

According to the National Supplementary Health Agency (ANS), more than 47 million people have health insurance plans. However, there are different types of plans, and it's important to understand how each one works before signing up for this service.

Therefore, we've created this content to help you understand the characteristics of the different types of health plans available on the market and the differences between them. Keep reading to learn more!

How important is it to have a health plan?

With prevention and a better quality of life in mind, it's important that people have access to healthcare whenever they need it. Furthermore, although the Unified Health System (SUS) is one of the best public health systems in the world and serves as an example for many countries, it cannot meet the full needs of the Brazilian population.

It is in this context that private healthcare becomes necessary to better manage your health at all stages of life, whenever you need it. After all, life expectancy is increasing.

We can compare the importance of a health plan to car insurance. You purchase the service as a preventative measure, to use when needed.

What types of health insurance plans are available?

Individual or family health plan

This type of plan is the most focused on your particular needs, as the coverage of services and assistance will be according to each user's profile.

The membership type is open, meaning anyone can sign up for and join the individual or family health plan. This means it can be for just one person or for the entire family.

Furthermore, the contracting and collection of monthly fees are done directly with the health plan operator or through a broker and the waiting period is common to all plans, complying with the maximum limits determined by the ANS.

Regarding the termination of the contract, it will occur in the event of fraud or non-payment for 60 consecutive days or more in the last 12 months.

Collective health plan by adhesion

The group health plan by membership can only be purchased by legal entities that are members of unions, councils, professional associations, or professional associations. Therefore, membership requires affiliation with the aforementioned labor organizations, but, depending on the contracted plan, may allow the inclusion of dependents.

The contracting and negotiation of the plan are handled by these entities or through a benefits administrator, but the monthly fees are entirely the responsibility of the plan holder, as with an individual plan. The difference is that, because many beneficiaries join together, the costs are much lower.

The waiting period will follow the same procedure as an individual plan, except for those who join the plan within 30 days of the contract's conclusion or anniversary.

Regarding contract termination, the operator may terminate the contract as long as it is provided for in the contract and applies to all members. However, in cases of fraud, loss of ties with the legal entity, or non-payment, the beneficiary may be individually excluded.

Corporate collective health plan

The corporate group health plan is aimed at legal entities, that is, entrepreneurs, unions or associations that want to offer quality health care to employees and collaborators of a given company.

Therefore, coverage for services and assistance will be based on the average employee profile of that company, and to join, you must have an employment or statutory relationship. However, some contracts allow the inclusion of dependents up to the third degree of kinship with the policyholder.

In this case, the company is responsible for hiring and collecting monthly fees, which usually deducts directly from payroll and may cover part of the expenses. Furthermore, the waiting period only applies when there are fewer than 30 beneficiaries. For more than that, waiting periods are waived.

Regarding the termination of the contract, it occurs in the same way as in the collective health plan by adhesion.

Which plan modality is best?

In fact, this isn't a question with a clear answer. This is because health insurance plan contracting modalities were designed precisely to meet the different needs of beneficiaries.

Learn more about health plans in our posts.