At the beginning of February, the National Supplementary Health Agency (ANS) issued a ruling limiting the unilateral termination of health insurance contracts by operators in situations of default. The new rules may be viewed with concern by companies, considering the high number of frauds affecting the health insurance sector, generating a financial deficit of around R$30 billion in 2023 alone[1].
So how does NR 593/23 work? In short, it allows the plan provider to cancel contracts from the second month (consecutive or not) of default within a 12-month period. However, in order for this termination to take place, certain rules and prerequisites – which vary according to the type of contract, be it business, personal, family, among others – must be complied with, such as proof of official, formalized communication from the insurance company about the situation of default by no later than the 50th day of the occurrence.
There are also a series of deadlocks when it comes to breaking contracts, such as the impossibility of canceling the contract of people who are already in hospital, even if they meet the default criteria). Many of the measures are advantageous for the beneficiary, but can present complications in the overall picture of the provision of these services. This means that, for insurance companies, the new measure makes it more difficult to break fraudulent contracts, a challenge that was already severely affecting the sector before the resolution was implemented.
These changes come at the same time as the Legal Framework for Insurance is due to be sanctioned in December 2024.[2]. A broader package of regulatory measures that considerably alter the legislation in the area, establishing new rules on the timing of claims payments, changes to the risk assessment process, among other measures. The insurance market has received this package of laws with caution – and even some concern – fearing that the laws, intended to favor transparency for the end consumer, will hinder investigation processes in more complex claims and could result in higher costs being passed on in the products.
With the recent implementation of the new rule, it is still too early to assess its practical impact on the market. During the first year, it is hoped that more precise sampling and numerical analysis of these reflexes will emerge. The expectation is that these changes will not make the insurance segment more expensive, thus impacting the accessibility of insurance for customers and the profitability of operations for insurance companies.
Available in: https://www.jota.info/artigos/rn-593-23-da-ans-protecao-necessaria-contra-encerramento-de-contratos
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