The readjustment of individual health plans can hit a record and reach 16.3% this year, according to industry projections. The ANS (National Supplementary Health Agency) is responsible for determining the readjustment percentages of individual plans every year. The highest percentage authorized to date was 13.57% in 2016 (see previous readjustments below).
FenaSaúde (National Federation of Supplementary Health) projects that the increase is 16.3% this year. The entity says that the calculation considers the variation of assistance expenses, the variation by age group, the efficiency of the operator and the inflation of the period.
See the readjustments of the individual plans authorized by the ANS in recent years:
Impact of covid long influence
“The increase in various items, such as the price of medicines and medical supplies, the strong resumption of elective procedures, the impact of long-term covid treatments and the incorporation of new mandatory coverage to health plans, such as medicines and procedures, directly impact the readjustment”, says FenaSaúde in a note.
Abramge (Brazilian Association of Health Plans) also predicts an increase of 16.3%. In a note, it states that expenses in 2021 were higher than in 2020, because of the high occupancy rate of hospitals caused by the resumption of postponed care in 2020 and by the second wave of covid.
Global input inflation
“Other factors that had an impact were the global inflation of inputs (materials, equipment and medicines) and the exponential rise of the dollar, currency linked to most medical and hospital supplies used in Brazil”, says Abramge.
A report by BTG Pactual provides for a 15% readjustment. Last year, the adjustment was negative (-8.19%), which means that consumers had discounts on monthly fees.
Institute sees no reason for large increase
Matheus Falcão, an analyst at the Health program at Idec (Brazilian Institute for Consumer Protection), says that the institute has not found a strong economic reason to justify an increase in the magnitude projected by the sector. The readjustment can only be applied on the contract anniversary date after approval by the ANS.
“Inflation, which is actually higher, only represents 20% of the individual plans’ adjustment formula. Another important data is the loss ratio, in which there is no relevant increase for the application of the adjustment. There is no strong subsidy that makes that we expect such a high readjustment”, says Falcão.
For lawyer Rafael Robba, from the Vilhena Silva office, the great difficulty is the lack of transparency in the sector. “The ANS needs to present the data to show that there is a justification for such a high readjustment”, says Robba, who explains that the methodology for calculating the readjustments is based on the information that the health operators themselves send to the ANS, which makes that the sector is not very transparent.
User age makes it more expensive
The annual adjustment affects all consumers of the plans, but there is one more: the one by age group, which is applied to consumers according to age. The older you are, the higher the cost of the health plan.
There is discussion about changing the way the reset is applied to individual plans. The companies in the sector claim that the current calculation does not reflect the real price variation.
According to a report in the newspaper “O Globo”, the president of ANS, Paulo Roberto Rebello Filho, intends to place the issue of reviewing the readjustment as a priority on the agency’s regulatory agenda.
“I’m not saying that the increase will be free. But, if this is a point that hinders the offer in the market, the ANS has to be open to discussion”, said Rebello in an interview with the newspaper.
The ANS said, in a note, that there is no decision on the matter. “ It is important to note that these topics are on the ANS agenda and that there will be no change to the percentage of readjustment of individual plans that will be announced by the Agency for application in the period from May 2022 to April 2023″, said the agency.
Collective health plans on the market
Individual health plans are the minority in the market. In January of this year, there were 49 million health plan beneficiaries, with only 8.9 million having individual plans.
In collective health plans, operators determine the annual readjustment without defining a percentage by the ANS. The absence of regulation caused operators to stop offering individual plans, which have the maximum adjustment determined by the agency, to increase collective options.
“In the case of collective plans with 30 beneficiaries or more, these have an adjustment defined in the contract and established from the commercial relationship between the contracting company and the operator, in which there is room for negotiation between the parties. up to 29 beneficiaries, ANS establishes a specific rule for grouping contracts. In this way, all collective contracts with up to 29 lives from the same operator must receive the same percentage of annual adjustment”, says the ANS in a note.
Although there is no direct relationship, the experts consulted by the UOL say that the readjustments authorized by the ANS end up influencing the value of the collective price increase.
“Individual plans always end up being an indication of how much the collective adjustment should be. The values are always above what the ANS authorizes for individual plans. If we talk about a 15% to 20% increase for individual plans, we can imagine that the collectives should reach 30% or 40%”, says Robba.
According to data from the ANS, last year, the readjustment of collective plans with more than 30 customers was 5.55%, while individual plans fell by 8.19%. Collective plans with less than 29 customers had an average readjustment of 9.84%.
Falcão says that consumer protection agencies insist that collective plans would need a supervised readjustment, mainly because they serve most of the beneficiaries of health plans in Brazil. However, there is pressure from the industry for this not to happen.
“These are readjustments that are not based on good arguments. There is no bargaining power between those who hire the plan and the operator”, says Falcão.