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After two weeks of negotiations, the health plan operators decided not to sign the commitment deadline proposed by ANS (National Complementary Health Agency) on April 9.
The regulatory agency had proposed maintaining health care for delinquent beneficiaries during the new coronavirus.
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In exchange, ANS would release R $ 15 billion from a sector reserve fund to guarantee the continuity of medical services in the event of non-payment of monthly fees.
In a note, FenaSaúde (National Federation of Complementary Health), which represents 16 groups of insurance operators and private health care plans, reported that it “did everything possible”, but it was not possible “to make the proposal to use part of reserves and provisions held by associates to face exceptional situations such as the one we are experiencing. ”
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FenaSaúde said that he recognized “the dedication and commitment” of ANS “in the search for alternatives to reconcile the adequate maintenance of the solvency of the operators that operate in the sector with the demands of the pandemic caused by the new coronavirus.” However, he said that the proposal for the counterparts made it impossible to access the fund, which is formed with resources from the companies themselves.
According to FenaSaúde, the information disclosed by ANS gives the “false impression” that the R $ 15 billion would already be released for the immediate use of the operators.
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“Neither one nor the other. In reality, most of these amounts would not be ‘released’ for use by operators, but would only have allowed the management and movement of their collateral assets, with the need for their timely restoration, ”said the federation, in a note.
FenaSaúde stated that the fund made available by ANS will not be accessed and, therefore, it will not be possible to assume the commitment to maintain coverage of clients in default, at the risk of “triggering a liquidity crisis of inestimable proportions” in the entire complementary healthcare sector. The federation noted that there was no guidance in this regard from the representative entity, but rather an individual decision made by the operators.
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The federation also pointed out that, as a measure to contribute to the fight against the pandemic, a large part of the operators suspended for 90 days the readjustments in the monthly rates of the medical-hospital plans of individual, collective adherence and commercial contracts with up to 29 beneficiaries. The measure is valid from May 1.
ANS
In response to the operators’ decision, ANS issued a note stating that the purpose of the proposed commitment term is “to protect beneficiaries of health plans and health service providers, while providing greater liquidity to operators, promoting the balance of the sector that ANS regulates ”.
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The agency requested the participation “of all segments” to mitigate the “serious consequences” that the pandemic will have on people’s health and on the socioeconomic situation of the countries. He also pointed out that signing the term would release R $ 10 billion previously inaccessible and that would constitute the available capital for the companies.
“The signaling of those who choose not to sign the term of commitment, compared to counterparts who point to minimum guarantees for the consumer, converges with what the available numbers indicate: the operators, in their individualized evaluation, understand that they do not need to resort to reserves techniques to face the pandemic ”, affirmed the ANS.
ANS also reported that the legislation requires that the compensation offered in any ANS proposed commitment term be favorable to consumers, and not generate benefits only for operators.
