Insurers suspend new student health plan subscriptions at RJ

Operators allege financial imbalance in student plans Photo: Tiago Queiroz/ Estadão

Unimed Rio, Golden Cross and SulAmérica suspend the sale of new health plans, mainly for students, in the state of Rio de Janeiro. The main reason is the reduced profitability of these contracts.

According to Unimed Rio, the decision is taken by several operators because of the difficulty of financial equilibrium of the policies, caused mainly by the frequent judicialization of the treatments. The cooperative also indicates that the suspension of sales begins from December 1, does not affect beneficiaries who are already part of the plan or cause an impact on its results. Unimed Nacional said the suspension is exclusive to the Rio de Janeiro unit.

Golden Cross, for its part, said it had temporarily suspended the sale of group membership plans for students through a business decision, without specifying details. The operator also specifies that the sale of plans linked to the National Federation of Students (FESN) and the Brazilian Association of Students (ABES) should be interrupted on November 20, but that all policyholders remain customers of the operator without no loss in presence.

Evaluation of marketed products is done periodically, says Abramge

In addition to student organizations, Golden Cross has contracts with other class entities covered by group plans, which will also see their sales halted in November. These are the Brazilian Association of Support for Commercial Workers (ABAEP), the Brazilian Association of Civil Servants (ABSP) and the Association of Liberal Professionals (ASPROLI).

Solicited, SulAmérica only says that it adopts the same position as the Brazilian Association of Health Plans (Abramge). The entity specifies, in turn and through a note, that the operators periodically evaluate each of the products sold, which may lead to their temporary or permanent suspension. “It is important to emphasize that the current beneficiaries will continue to receive all the necessary attention and care”, writes the association which represents the operators.

Firms allege ‘financial imbalance’ in customer portfolio

According to the FESN, one of the student organizations concerned, the reason for the suspension of new registrations was justified by Unimed Rio and Golden Cross, companies with which the entity had a partnership, due to the “price list much lower than the market, causing a financial imbalance in the portfolio”. Still according to the federation, the administrator Supermed, which acts as an intermediary between the insurers and the beneficiaries of group plans, also took the same position: that it was necessary to interrupt the sale of new contracts so as not to ensure the continuity of the portfolio of lives.

Insurance lawyer Erika Gleicher says the trend is that with the suspension of new subscriptions, the contract will die over time. “Historically young people haven’t been very interested in health insurance, they don’t see the point of it, so students usually only join when they need it. Hire, get surgery and leave. This is the big problem facing healthcare operators [com o público estudantil]“says the lawyer.

Until mid-2022, prices for the age group up to 23 ranged between R$224 and R$931 at Unimed Rio, and between R$260 and R$746 at Golden Gross. There are also options for students in other age groups, with the value of the most premium plans reaching R$4,397 at Unimed Rio and R$3,382 at Golden Cross in the highest age group (59 years and older).

Positioning of the ANS

According to the National Complementary Health Agency (ANS), subject to the termination conditions set out in the contract signed between the parties, the suspension of the collective agreement may be requested by the contracting legal entity or by the operator.

“If the operator terminates a group health plan contract, beneficiaries have the right to exchange the grace period portability plan (without shortfall or temporary partial coverage) for an individual or family health plan, company or collective by affiliation, to be exercised within 60 days of the loss of link with the operator”, indicates the ANS, in a note.

As an alternative for students in the state of Rio de Janeiro who do not yet have a health plan, it is possible to find other student entities that have valid collective membership contracts with other operators – such as the National Union of Students (UNE) and the União Brasileira dos Estudantes Secundaristas (UBES) – or migrate to an Individual or Family plan, which is usually more expensive, and therefore less beneficial for beneficiaries, according to Gleicher.

Another cheaper option, but still little explored, is for the student – ​​alone or with family or friends – to create a CNPJ, like the MEI, to be able to adhere to a business plan. Membership health plans for corporations are the most affordable, according to the lawyer.

This note was published on Broadcast on 10/25/2022 at 10:09 a.m.

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