Find out now what a health plan covers and offers to patients

Find out now what a health plan covers and offers to Patients

Many people do not know what a health insurance cover and, therefore, has not hiring this type of service. But the truth is that they are the cheapest and safest way to ensure quality medical care when needed.

Still, it is natural to have doubts about hiring plans, since health services are so diverse and there is a plethora of toppings. In this post, you will find out what a health plan covers and what can be left out of it.

How does a health plan?

Before knowing about the coverage, it is important to understand how health plans operate. Even as it may seem strange to pay a monthly fee for a service that will be used in the future without knowing exactly how it works.

The truth is that the operation of the plans is much simpler than you think. It is based on the idea of ​​mutuality, in which several people come together around a common interest. All attended beneficiaries pay to receive services at different times and according to the amount paid.

That is, in order to have access to higher quality health, the beneficiaries contribute to a common fund that will be used when only one request. A person end up paying for the services offered to the other and vice versa.

Thus, by joining a plan, in fact, we are sticking to this fund shared use. Only to manage such a great value and ensure that the rights and needs of all are met, it is important to have someone prepared for it.

This is where the operators of health plans . They not only have the expertise to manage the plans, as they are also able to reconcile interests and needs.

To address these differences is that various categories of plans were created, different values, and different forms of relationship between the beneficiaries. Therefore, there are individual plans, family, collective, business and all forms of coverage.

What health insurance cover?

It is not easy to reconcile the interests of so many people. Therefore, it is necessary to have a large provider network , which are the hospitals, clinics, laboratories, clinics, doctors and other professionals affiliated to the plan and are able to perform the service through it.

To consult with a special agreement, the beneficiary can have access to much more affordable than private services. The amount is paid by the mutual fund and passed on to the professional or institution.

But the plan does not just cover queries. In fact, many people do not hire this service not understand the scope of it. Even with the differences between the basic and more complete packages, operators are required by law to ensure a minimum coverage.

The National Health Agency (ANS), the body responsible for overseeing the plans, states that the following services must be included:

  • unlimited number of medical consultations;
  • days of hospitalization and ICU;
  • consultations with other health professionals (speech therapists, nutritionists, physiotherapists, psychologists) during hospitalization or outpatient segmentation (according to specific rules);
  • laparoscopic surgery (less invasive) and intensity modulated radiotherapy for tumors of the head and neck;
  • collection bags to ostomy patients;
  • prosthetics and orthotics in surgical cases;
  • immunobiological medicaments for the treatment of ambulatory;
  • accompanying guarantee for patients under 18 and over 60;
  • surgery in cases of morbid obesity, as long as medically indicated;
  • small and preventive dental surgical procedures (when included in the medical plan, or isolated dental plan).

Only in hospital levels, it is also mandatory to carry out special procedures such as blood therapy, parenteral and enteral nutrition, hemodialysis, chemotherapy and radiotherapy.

Operators are required to accept people who have injuries and preexisting conditions. However, the plans may offer coverage Partial Temporary (CPT) for a maximum of 24 months. This condition must be declared by the recipient immediately on accession, subject to legal penalties if this is not done.

Diseases such as AIDS and cancer can be treated as pre-existing conditions, but coverage is required within the selected level to the plane (with or without hospitalization).

The ANS provides a space for consultation of all services covered by health insurance, mandatory or not. You can view them here .

What is not covered by the plans?

Not always the operators are required to cover a given service. This is especially true in non-emergency situations, in elective procedures (when a person chooses to undergo a certain procedure) or in special cases. Thus, in general, are not covered:

  • providing orthotics (glasses, contact lenses, crutches and vests) and prostheses (of limbs, eyes etc.) unrelated to surgery;
  • slimming treatments and procedures for aesthetic purposes;
  • provision of household medicinal products except those related to the treatment of cancer;
  • rejuvenation treatments and procedures;
  • Experimental treatments and drugs not approved by the Health Surveillance Agency (Anvisa);
  • Clinical aesthetic or surgical procedures, such as in plastic surgery and application of Botox;
  • Artificial insemination;
  • some types of transplants, except the cornea and tissues (in the case of grafts, for example);
  • unethical treatment or not authorized by law (such as abortion).

A good deal of coverage of these procedures is the responsibility of each operator and the different levels of plans. So it is good to consult all the services offered before you sign a contract and they cater to what you need.

It is also critical to hire recognized and credible companies in the market. Operators must ensure compliance with the agreements, even if they stop working.

Before you join, consult an experienced and suitable broker and check what the health plan covers as well as all relevant legal implications. Having a plan can be decisive to ensure quality medical care when needed.

Now that you found out what a health plan covers, how about finding the right service for you? Contact us and learn about the benefits and advantages we offer to our members!

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