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The National Supplementary Health Agency (ANS) made a controversial decision by setting the permitted annual adjustment limit for individual and family health plans at 9.63% in 2023. Experts say that this decision could spark intense debate in the coming days, since in practice it could result in two increases for citizens this year.
The annual adjustment will be valid from May this year through April 2024, affecting only plans contracted after January 1999. This increase may be applied in each consumer’s birthday month, affecting approximately 8 million contracts according to official projections.
So, how will this adjustment affect workers? According to experts, citizens should pay close attention to their payment bill to know exactly how much they will have to pay and when the increases will be passed on. In some cases, retroactive payment will be required.
Although the charge for the increase is valid as of May, the decision was only made in June, which means that companies may apply the increases starting in July. However, in practice, citizens will have to pay the retroactive amount anyway.
To better illustrate the situation, let’s consider a citizen who pays R$ 100 per month for their health insurance plan. In this case, the sequence would be as follows:
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May – Pays R$ 100
June – Pays R$ 100
July – Pays R$ 109 (already including the adjustment) + R$ 9.63 retroactively for not having paid the increase in May
August – Pays R$ 109 (already including the adjustment) + R$ 9.63 retroactively for not having paid the increase in June
September – Pays R$ 109 (already including the adjustment)
“For contracts with anniversaries in May, June and July, retroactive charges for these months will be permitted,” the agency said in a statement.
“Following the announcement of the maximum adjustment cap, beneficiaries of individual and family health plans should pay close attention to their payment slips and check whether the percentage applied is equal to or lower than that defined by the ANS (9.63%) and whether the charge with the adjustment rate is being made starting in the contract anniversary month, which is the month in which the contract was signed,” the ANS added.
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“In recent years, our methodology has been challenged, and its faithful application has allowed us to observe a certain pattern of variation in expenses and mitigate the main effects of the pandemic seen in previous years,” said Alexandre Fioranelli, director of Product Standards and Qualification, in a statement.
Double Increase in Health Plan
According to the ANS, the adjustment due to an age-bracket change is valid for all types of health plans, including employer-sponsored group plans and association-based plans.
“This type of adjustment is provided for in industry legislation and is justified by the change in the profile of healthcare service use. […] If prices were established individually for each age group, younger people would have more attractive prices, while older people could face very high or unaffordable prices.”
In years when an age-group adjustment is possible, consumers may end up facing two increases. However, it is important to observe the rules, as there are limitations. ANS does not interfere with the adjustment amount, but if consumers feel harmed, it is important to contact the operator to understand what happened. As a last resort, they may seek to resolve the situation through legal action.
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It is also possible to file a complaint by calling Disque ANS (0800-7019656) or 0800-0212105 for people with hearing impairments, Monday to Friday, from 8 a.m. to 8 p.m., except on holidays.
