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Health insurance operators refused to maintain health care services until June 30 to default on clients, as the National Complementary Health Agency (ANS) wanted. The objective of the measure would be to minimize the crisis in the health system during the covid-19 pandemic.
In return, the agreement proposed by the agency would release R $ 15 billion from a fund that retains R $ 54 billion from the operators themselves.
In a note, the National Federation of Supplementary Health (FenaSaúde), 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 the reserves and provisions held by associates to face exceptional situations such as the one we are experiencing. “
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.
“Neither one thing nor the other. In reality, most of these securities would not be ‘released’ for the use of operators, but would only have allowed the management and movement of their collateral assets, with the need for their restoration timely, “the federation said in a note.
FenaSaúde affirmed 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” throughout the 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.
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 term of commitment is “to protect beneficiaries of health plans and health service providers, while providing greater liquidity for operators, promoting the balance of the sector that ANS regulates. “
The agency called for the commitment “of all segments” to mitigate the “serious consequences” that the pandemic will have on people’s health and 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 the minimum of guarantees for the consumer, converges to what the available numbers indicate: in their individualized evaluation, the operators understand that they do not need to resort to technical reserves to face the pandemic, “said 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.
