After all, how does portability work in health insurance?

After all, how does portability in health insurance work?

At some point you ever feel tempted to change your health plan, but gave up because they did not want to  meet the needs  again? But know that you can migrate to a more advantageous contract or plan without the need.

The portability in health insurance is a consumer right. To enjoy this benefit, however, you must meet some minimum requirements determined by the National Health Agency (ANS).

You want to better understand how this works? So enjoy today’s post to take your questions!

After all, what is portability in health insurance?

It is the possibility of hiring a new health plan , whether individual, family  or collective  adhesion, within the same or another carrier without meeting again grace periods or temporary partial coverage (CPT). That is, the contractor has immediate access to consultations, tests, hospitalizations and any other procedures provided for in the contract.

Portability is available to health plans contracted from January 2, 1999. For this to be possible, it is necessary to observe some rules, although simple,  often raise doubts  among consumers. The first is having served the needs in their original plan.

Moreover, to achieve portability for the first time, the user must have the health plan for at least two years – or three if it was framed in temporary partial coverage in their original plan. From the second time you use the portability, you must be in the plan just a year ago.

Another important rule concerns the contractual period in which the user can take advantage of this benefit. You must request the portability within 120 days from the contract’s anniversary month.

Failing to do so, requests will only take place the following year, also within 120 days from the contract birthday. So it is important to pay attention to the time if you’re thinking about changing health plan.

Although it meets all of these requirements, as determined by the ANS, the transfer of grace happen only when the target plan is a price range equal to or less than the original plan.

If you still are not sure whether you can perform the portability of your current contract to another of your choice, ANS offers on its official website a  flat compatibility simulator .

What types of portability?

The portability of health plans without lack of compliance can happen in two situations:

Normal portability

Is that what happens when voluntarily, the consumer decides to switch health plans, whether of the same or another operator, since it considers mandatory requirements.

special portability

In this case, regardless of the type of health plan or contract signing date, there is a need of change contract for reasons beyond the will of the user, such as:

  • when the operator’s registration is canceled by the NSA or when it is in bankruptcy;
  • at the time of resignation, dismissal (both without cause) or even retirement for the beneficiary of the maintenance period guaranteed by law;
  • when one of the dependents lose the link with the contract not be able to stick to the plan or if he dies.

In most cases, when the consumer has a plan governed by the old rules (ie, when his contract was signed before January 1, 1999), you can perform two types of contractual changes. Find out what they are:

Migration

It happens when the consumer enters into a new contract with the same provider. In this case, since the new plan is compatible with the above, the Bank may not require compliance with new grace period.

Adaptation

It occurs when there is need to change the established contract for expansion of minimum coverage required by the NSA. The covers that existed are maintained (as long as not contrary to the current rule of health plans) and there can be no requirement to comply with new needs.

Besides these, there are two other situations where the beneficiary of a health plan is free to meet needs. Look:

Join in corporate health plan

It happens when you join a business collective level (ie, one who is  hired by an institution for its employees ) within 30 days after the conclusion of the contract or its relationship with the company.

Admission to the collective level of adhesion

In this case, you sign the contract of a collective health plan membership (the one hired by a union or professional association to its tied) within 30 days after signing the contract by the institution.

You also gets free from the obligation to comply lack adhere to the contract’s birthday, since his relationship with the entity has happened after that date and the adhesion proposal is formalized within 30 days after.

How can I achieve portability without fulfilling the shortage?

To make the portability of your health plan, the first step is to check that you meet the prerequisites for obtaining the benefit.

Once this is done, see the ANS site to see what other health plans are compatible with yours. Once chosen, contact the chosen operator and ask for a membership proposal.

When you sign the document, be sure to submit copies of payment receipts for the last three months and a document proving that you joined the health plan two years ago – or three if you have fulfilled the temporary partial coverage – as a copy of the signed contract, the proposed accession or declaration of the origin of health insurance.

If the target plane is collective for membership, you must also provide a link with proof of the contracting entity. The operator’s response to which you want to migrate must take place within 20 days after signing the proposal.

If not, it is considered that there was accepted without reservations. Therefore, the ideal is that you contact again with the health plan to request the membership card and clarify any doubts.

His new contract will become effective 10 days after acceptance. Either way, your new operator needs to contact the old health plan to confirm the start date.

Regardless, to avoid any future complications, it is strongly recommended that, at the end of the process, you contact your old provider to warn her about the portability and the effective date of the new contract, which will also be the closing date the previous plan.

We like to understand how portability works in health plans? So be sure to follow us on  FacebookInstagram  and  LinkedIn  to continue monitoring other date information and tips!

 

Spread the love

Advertisement

No comments.

Leave a Reply