The ANS sets forth rules for notifying health plan defaulters

The National Agency for Supplementary Health (ANS) has specified that notification of users of defaulting health plans, which may lead to contract cancellation, can be done by electronic means, such as email, cell phone messages and applications.

On Friday (29), the regulatory body issued new rules on how notification should be sent. The standard was published on the 20th The official diary of the federation (Standard Resolution No. 593/2023) and is effective as of 1/4/2024.

ANS Director of Standards and Product Qualification, Alexander Fioranelli, said the new standard modernizes beneficiary communication due to default. “Publishing this regulation fills some of the gaps that existed and updates the regulation, as it brings electronic means that facilitate communication, whether for the beneficiary or the operator.”

Reporting methods

According to the new standard, operators of health plans must report defaults by electronic means and use beneficiary registration data, which the contracting party has communicated to the operator.

Among the possible electronic means, ANS lists email with digital certificate and read confirmation; Text messaging to mobile phones; Messaging in a mobile device application that allows the exchange of encrypted messages; And a recorded phone call with data confirmation by the interlocutor.

However, a notification sent via SMS or mobile application will only be valid if the user responds confirming that he or she is aware of it.

The Air Navigation System (ANS) also allows communication with the consumer in the above formats, for example by letter or through the operator's representative or agent, with proof of receipt of the notification signed by the contracting party.

for whom

The new regulations will apply to contracts signed after January 1, 1999 and to those adapted to Law 9656/1998.

It is valid for those who have not paid the monthly fees for individual or family health plans, for individual entrepreneurs who contract a group business plan or for those who pay the monthly fees for a group plan directly to the operator.

Disqualification of the beneficiary or unilateral suspension or termination of the contract due to non-payment will only be possible if there are at least two unpaid monthly payments, consecutive or not, within a 12-month period.

notice

The Operator must notify the User by the fiftieth (50th) day of default, as a prerequisite for excluding the beneficiary from the plan or suspending or even unilaterally terminating the contract at the initiative of the Operator, due to non-payment.

If the notification is made after the fiftieth day, it will be considered valid if the operator guarantees a period of ten days, counted from the notification, to settle the debt. However, the operator must prove that the consumer was notified of the default, with the relevant date of notification.

The text of the notice must contain information that is fully understood by the consumer: the number of days in default, and an indication of the months of delinquency; Forms and deadline for paying the debt and thus settling the contract; As well as health plan communications to clarify doubts.

In cases where the operator is unable to notify the consumer, the rule specifies that the plan cannot be canceled until ten days after the last attempt to contact the beneficiary. The operator must prove that notification was made by all permissible means.