Projeto será debatido em audiência pública em janeiro de 2025
Por Paula Laboissière – Repórter da Agência Brasil
A Agência Nacional de Saúde Suplementar (ANS) apresentou esta semana o resultado de estudos sobre uma nova política de preços e reajustes para planos de saúde. O projeto será debatido em audiência pública agendada para janeiro de 2025 – se aprovado, a previsão é que entre em vigor a partir de janeiro de 2026.
As mudanças propostas, segundo a agência reguladora, abrangem quatro temas: reajuste de planos coletivos; mecanismos financeiros de regulação, como coparticipação e franquia; venda de planos online; e revisão técnica de preços de planos individuais/familiares. Confira a seguir as principais propostas:
Reajuste de planos coletivos
– Definição do tamanho do agrupamento: atualmente, os agrupamentos são compostos por contratos com até 29 beneficiários. Na nova proposta, esse universo será ampliado para mil vidas nos planos coletivos empresariais e para a totalidade dos planos coletivos por adesão, “com o objetivo de obter maior diluição do risco e, consequentemente, reajustes mais equilibrados”;
– Definição de parâmetros para cláusula de reajuste: não será permitida a acumulação de índices financeiro e por sinistralidade. A operadora, segundo a ANS, precisará adotar ou um ou outro. A agência também vai definir um percentual mínimo de 75% para sinistralidade para cálculo de reajuste. “O objetivo é dar ao consumidor maior transparência sobre o cálculo realizado para a definição do percentual”.
– Rescisão contratual: igualar a regra de rescisão de contratos coletivos à regra de rescisão de contratos coletivos de empresário individual. Com isso, o cancelamento poderá ser feito no aniversário do contrato e desde que o beneficiário seja avisado com, pelo menos, 60 dias de antecedência. “Assim, a rescisão passa a ser programada para que o contratante do plano tenha tempo hábil para encontrar uma nova opção”.
Coparticipação e franquia
– Definição do limite financeiro do fator moderador por procedimento: passa a valer o percentual máximo de 30% de coparticipação por procedimento;
– Definição dos limites financeiros mensal e anual: limite mensal de 30% do valor da mensalidade e limite anual 3,6 mensalidades;
– Definição dos procedimentos não elegíveis (sobre os quais não poderá haver incidência de fator moderador por realização): a ANS estabelece uma lista de procedimentos sobre os quais não serão cobrados coparticipação/franquia, principalmente aqueles relacionados a terapias crônicas, oncologia, hemodiálise e alguns exames preventivos.
Vendas online
– Avaliação de critérios de venda online: a proposta anterior previa a contratação eletrônica, em caráter facultativo. A mudança estabelece a obrigatoriedade da venda online para planos individuais/familiares, coletivos por adesão e empresariais firmados por empresário individual, “a fim de facilitar o acesso dos consumidores a diferentes opções de produtos, de forma rápida, e reduzir a seleção de risco”.
Planos individuais/familiares
A ANS informou que estuda metodologia para admissão das solicitações, cálculo e aplicação da revisão técnica. “A previsão é que um novo normativo seja elaborado e publicado em 2025, com os princípios sobre os critérios de elegibilidade para a solicitação e sobre as contrapartidas que as operadoras devem apresentar quando tiverem o pedido de revisão técnica deferido”.
Próximos passos
Em nota, a agência detalhou que, a partir dos resultados coletados, vai elaborar propostas de normativas que serão colocadas em consulta pública para obter contribuições da sociedade. A consulta pública ficará disponível por 45 dias, de 19 de dezembro de 2024 a 3 de fevereiro de 2025.
“Na sequência, a ANS irá promover audiências públicas nos dias 28 e 29 de janeiro de 2025, sendo um turno para cada tema, manhã e tarde, para contemplar os quatro assuntos propostos”, destacou. “Ao final desse processo, a agência seguirá com a aprovação das normativas junto à diretoria colegiada e com a posterior publicação das novas regras regulatórias.”
Foto: © Marcello Casal jr/ Agência Brasil
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