Things About Health Plan That No One Ever Talks To You

Today you can not have the quality of life without a health plan to call your own. If abroad, even with some of the best public health systems in the world, projects have a fundamental complementary role, imagine in Brazil with all the scrapping of SUS.

However, as much as we talk about it, there are several things we do not often hear about health insurance. Now look at 10 of them and pay more attention to your rights.

1 – When the expenses of the companion are guaranteed by law

The law requires that the health plan cover the costs of caregivers of patients under the age of 18 and over 60 and persons with disabilities, in addition to urgency and emergency care.

2 – What is a health insurance plan Reference

Operators are required by law to offer a referral health plan, which includes outpatient and hospital medical coverage. There is coverage of consultations, exams, and delivery, with accommodation in the ward in case of hospitalization. There is, however, no dental care coverage.

3 – Plan cannot charge a membership fee

According to Procon-SP, the collection of membership fees is irregular. The operator can only charge the monthly payment.

4 – Operator may require medical expertise

It is the operator’s right to require medical knowledge. The cost, however, must be covered by the operator itself in the sale of the health plan.

5 – the Family business plan cannot be canceled

Business plans can be canceled by the operator or by the customer at any time. For this, it is enough that the collective agreement has at least one year of validity. The breach must be notified to the other party 60 days in advance. Otherwise, the fine is R $ 80 thousand.

However, the STJ opened case law to a family that had contracted the business health plan through MEI (CNPJ). The Court understood that, in practice, the health plan operated as a family plan. In this way, the family does not have the same bargaining power as a company.

The individual or family plans can only be canceled by the operator in case of fraud or delay of more than 60 days in payment.

6 – The Business plan will have portability of grace

Beginning in June 2019, the rules of need for clients who want to change their health plan or operator will also include beneficiaries of collective health plans.

The portability of shortcomings began in 2009, only for recipients of individual or family plans. Subsequently, it was extended to the collective plans for membership, and after that, the special portability of needs for special situations arose, for reasons beyond the control of the beneficiary.

Today, business plans represent almost 70% of the market and have the same coverage of other plans.

7 – Lying to the health plan is a crime

Health plan contracts are based on the risk of each contractor and also on the good faith of the consumer. Therefore, lying to the health plan is a crime, provided for in article 171 of the Brazilian Penal Code. The penalty is 1 to 5 years imprisonment.

Thus, hiding or failing to report diseases and medical conditions, therefore, can be framed as a crime of stellation, even if the disease has already been cured.

8 – Plan can be maintained after dismissal without just cause

Whoever is dismissed from work without just cause is entitled to keep the health plan. You can stay on the plan for a third of the time you were a beneficiary for the company, once the minimum limits of 6 months and maximum of 2 years have been respected.

9 – Retirees can keep the health plan for as long as they wish

Retirees who have had more than ten years of contribution to the business health plan can keep it for as long as they want. For periods of less than ten years, one year of coverage is valid for every one year of contribution.

10 – Disabled or elderly cannot be prevented from contracting a health plan

The operator can not make it difficult or refuse to make a health plan under any circumstances, whether for reasons of age or health. Everyone must have equal access to the programs, according to the law.