10 Frequently Asked Questions About Health Plans

10 Frequently Asked Questions About Health Plans

Who does not want to have an affordable health plan that  contemplates all the family  and count on close attention to home? At the time of researching the best option, however, is often arise some questions that end up confusing the contractor.

To help you understand the basic principles that cover this subject, brought here to answer the 10 most frequently asked questions about health plans. Follow!

1. What is the difference between health insurance and health plan?

Both are types of health plans, but there is a big difference between them: the way in which services and access are offered. The health plan must offer all its services for its own or third-party network, but the money back guarantee is not a certainty.

The health insurance, on the other hand, has a refund as a rule. He gives you indications of places to be serviced or refund you, but this type of plan can only be offered by an insurer that has a specialty area of ​​health.

2. What is grace?

This is one of the most frequently asked questions about health plans and a very common question. Grace period  is the period between signing the contract and the beginning of the services received.

The CPT, or temporary partial coverage, is a constraint for surgery, complex procedures and dependent beds largest technology to people who were already ill before the contract is signed.

By law, pre-existing conditions can generate a CPT up to 1 year. On the other hand, the maximum grace periods are smaller. See below:

  • emergency and urgent cases: 1 day;
  • delivery from the 37th week of pregnancy: 300 days;
  • other cases: 180 days.

3. What scope of contracted network?

It is important to learn about the plan’s coverage area that are hiring. If you do not travel a lot, it is advisable to take a regional plan, which would be cheaper. But if you work in another city, or travel frequently, a national plan may be right for you.

Information on accredited of your plan network is essential to meet the hospitals, laboratories and professionals who will meet you.

4. Who can apply for portability plan?

The portability, as well as the cell is the possibility of changing health plan operator without being charged new grace periods and CPT. One has to take advantage of the plan by two years until you can make the switch provider, and be with the timely payment. It is noteworthy that the new insurance must be compatible to the above and be in the same price range, or lower.

If portability has already been done ever, or the person had a pre-existing injury not reported in the first contract, the period will increase by one year. And only applies to plans contracted from January 1, 1999, or those who adapt to the law 9656 1998.

Before hiring a company, look for the provider’s registration number in the National Health Agency website and check the  performance , history and number of complaints the same.

5. There is deadline for portability?

Yes, portability should be requested after two years of the contract, between the first day of the plan the birthday month and the last business day of the next month. None of the operators, both the destination as the source, may require payment for portability.

6. What type of plan can hire?

There are two types of contract: the individual, hired by the consumer and his family; and the  collective , whose contracting company, union or association that has the consumer as affiliated. You should ask this question to your insurance agent to determine which plan is more advantageous for you.

Besides the type of plan, there are types of individual adjustment consisting of annual, regulated by the National Agency of Health, and also by age.

The collective level, on the other hand, has different types of adjustments: annual – which in this case is not regulated ANS penalty – by age group and by accident, which is more expensive as the services are most used.

7. At what time the patentee may request cancellation of your health plan?

For the current month is not charged, you should request the shutdown until the 15th of this month. If the request is made after that day, the month will be charged and an invoice will be generated after the shutdown. When asking for the shutdown of the beneficiary, all dependents will be automatically deleted.

8. The holder can hire different models plans for dependents?

No, the dependents are linked to the same plan holder. Thus, all the coverage is intended for the recipient is also extended to households.

9. How to include one or newborn foster child in the health plan?

Up to 30 days after delivery covered by the plan, the request for inclusion of the child must be done. Thus, grace periods and health declaration of completion will not be required. During the period between birth and the arrival of the ID card, the baby can be attended with the magnetic card of the mother.

Adopted children under 12 years may also be enrolled in the health plan as aggregates, no grace periods, as long as there is no disease, and the application is made within 30 days after adoption.

10. Younger plans entitle to any kind of service?

The minimum coverage available are regulated by law and are subject to determinations of ANS. However, this does not mean that the recipient can use all the procedures you need.

Operators are obliged to provide all procedures considered as assistance. If there is no coverage of any procedure, you can look for other types of plans in search of treatment you need, such as home care , including home care, air removal and even international attention.

The choice of the ideal health plan must take into consideration several factors, and a lot of research and study to hire the best option is needed. If you like to know the answer to frequently asked questions about health plans, share this post on social networks and pass the information along!


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