The National Supplementary Health Agency (ANS) set this Monday (12) the limit of 9.63% for the readjustment of individual and family health plans. The decision is valid for the period from May 2023 to April 2024. Operators cannot apply increases in monthly fees above the established percentage. The limit of 9.63% was endorsed by the Ministry of Finance and was unanimously approved at a collegiate board meeting of the ANS held this Monday morning. The decision does not apply to collective plans, whether corporate or membership. It focuses only on monthly fees for individual and family contracts signed from January 1999. There are almost 8 million beneficiaries, which corresponds to around 16% of the supplementary health market. The values can only be updated from the anniversary date of each contract. If the contract anniversary month is May, retroactive charging of the readjustment is possible. According to ANS, the current formula for calculating the annual readjustment has been applied since 2019, and is mainly influenced by the variation in assistance expenses from the previous year. In 2022, this variation was 12.69% compared to 2021. The Extended Consumer Price Index (IPCA) is also taken into account, which measures the country’s inflation. Based on the same formula, last year an adjustment of up to 15.5% was authorized. It was the highest percentage ever approved by the ANS, created to regulate the sector in 2000. The historic increase occurred one year after the unprecedented approval of a negative readjustment. In 2021, operators were forced to reduce monthly fees by at least 8.19%, as there was a general drop in demand for health services amid social isolation resulting from the covid-19 pandemic. Readjustment During the meeting that approved the limit of 9.63%, the CEO of ANS, Paulo Rebello, highlighted that each plan can have a specific readjustment, as long as it is equal to or less than the established maximum percentage. In April, when the agency released the sector’s economic and financial data, he had already told Agência Brasil that the results showed differences in performance according to the size of the operator. Large companies had the greatest negative results. “The readjustment percentages will depend on the situation of each operator”, he said at the time. In a note, the National Supplementary Health Federation (Fenasaúde), which represents the largest health plan operators in the country, assessed that health inflation, insecurity and regulatory instability, the growing judicialization and the significant increase in the occurrence of fraud are among the main factors that impact changes in health plan prices. “The annual readjustment is essential to recompose costs and, consequently, maintain the financial balance of the sector, which closed the year 2022 with R$ 10.7 billion in operating loss”, said the entity. According to Fenasaúde, the current formula generates indices that are detached from the real increase in costs by not taking into account parameters such as the loss ratio of the portfolios, the difference between business modalities, the regionalization of products and the speed of updating the list of procedures and mandatory coverage drugs. The entity also regretted the approval of Law 14,454/2022, amid the debate on the character of the ANS role that sets mandatory coverage. The legislation offered a response to the lack of definition that prevailed until then and that caused many cases to end up in court, generating contradictory sentences. Although Fenasaúde defended the exhaustive bias, so that exceptions to the list were not admitted, a different understanding prevailed. The law established two main criteria for the coverage of health procedures or treatments not included in the list: having their effectiveness proven on scientific bases and having approval from the National Commission for the Incorporation of Technologies in the Unified Health System (Conitec) or an evaluation body of health technologies that have international renown. For Fenasaúde, the change has an impact on the sector’s sustainability. The entity alleges that “weak and very subjective conditions were created to force plans to cover items outside the list”. Inflation The percentage set by the ANS is much higher than that of the IPCA, which accumulated 4.18% between May 2022 and April 2023. The non-governmental organization Brazilian Institute of Consumer Protection (Idec) released a note in which it considers that the authorized readjustment ” exceeds the bounds of reason”. According to the entity, official data indicate that there was no loss in 2022, as the negative operating result was offset by the profitability of financial investments by companies, driven by high interest rates. “The 9.63% index is almost 67% higher than the value of accumulated inflation in 2022 and once again pushes management problems of operators in the sector to the consumer”, said Idec. In 2022, the IPCA closed at 5.79%. Idec adds that consumer incomes do not grow at the same pace and regrets that more than 82% of the supplementary health market is made up of collective plans, which are not regulated by the ANS and can practice increases without any limitation. In seven of the last ten years, collective plans have applied, on average, an adjustment higher than the maximum allowed for individual and family plans. In a note, the agency argues that the comparison with the IPCA is not adequate. “Inflation indices measure the variation in prices of products and services. The readjustment indices for health plans are ‘cost indices’, as they measure the combined variation not only in prices, but also in the quantities consumed. In this way, the percentage calculated by the ANS considers aspects such as changes in the prices of health products and services, as well as changes in the frequency of use of health services”. Despite the ANS position, the note released by Fenasaúde brings a comparison of the indices. According to the entity, considering the last three years, the average of the readjustments authorized by the ANS is 5.64%, below the IPCA average of 6.79%. The period chosen by Fenasaúde, however, encompasses the year 2021, the only one in the last ten years where the ceiling set by the ANS was below inflation. If we consider the readjustment of the last five years, the average limit set for the readjustment of plans is 6.48% and the average IPCA is 5.68%. If the comparison involves the last ten years, the maximum percentage set by the ANS has an average of 9.27% against 6.11% of inflation.
Agência Brasil
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