Health Plan: The Complete Guide for the Whole Family

Health Plan: The Complete Guide for the Whole Family

That health is a serious matter, no one discusses. However, it is quite common for people to be in doubt about the real need to hire a health plan or how to choose the most suitable for your needs.

After all, I really need to hire a health plan for children? You need me to do it even before birth? And in the case of the elderly, who should I take before signing the contract?

To address these and other questions, we developed a complete guide, so you will not go wrong in choosing the health plan best suited for you and your family.

Prepared? Then follow the reading!

Why is it important to have a health plan?

It is not uncommon that people have questions when hiring a health plan. After all, this is a monthly payment of commitment that may seem unnecessary when we are healthy. Think that way, however, is a big mistake. Understand why:

The public health system is not satisfactory

Unfortunately, the public health system can not provide the necessary support to citizens in most of the country.

Often, tests, surgeries and even simple queries take months to be scheduled – which can become particularly worrying in the case of children and elderly, who have the most fragile health.

Moreover, the delay in conducting surveys can make diagnosis difficult and compromising the treatment of diseases whose chance of cure is higher when detected early.

Another problem is the difficulty of getting beds in hospitals that provide quality care, especially in emergency cases – which can leave you or your loved ones subject to their own devices in a time when it is essential to have quick service and quality.

In smaller towns, the situation may be even worse, since not all have doctors from various specialties to meet the population that depends on the public health system.

So it is important to be protected against any eventuality, preventing you to be caught off guard and go through a great stress before an accident or sudden illness that primarily affects you or your loved ones.

You can plan better financially

When you hire a health plan for your family , you know exactly how much you spend monthly on this subject, which allows you to plan better financially .

Otherwise, you need to make a saving for any eventuality related to the health of their families and yet probably will not feel completely safe.

Some medical expenses – such as hospitalization in intensive care units (ICUs) – can consume in a few days, large sums of money and jeopardize their financial equilibrium and even your heritage.

The cost-benefit is very advantageous

Often people end up not hiring the health plan for believing they will only use it if necessary to sporadic consultation or for routine examinations.

However, one must take into account that, over a lifetime, people of all ages are subject to a number of situations in which rely on medical care is essential.

It can be a simple situation – like a fever or malaise – or more complex cases – such as accidents and the possibility of diagnosis of something more serious illness.

Having a health plan, the amount that would be spent on all these services just watered down over the months, which represents an excellent value for money.

The health plan for children

For children, have health insurance becomes even more important, since this age group small often need constant medical attention, either for routine illnesses – such as colds and sore throats – or by accidents at home or at school.

How it works

Normally, those responsible want to include the child in the health plan soon after birth. However, it is important that you know that the little ones are covered for the first examinations and generally to medical monitoring, done in the hospital where the delivery was performed during the first 30 days of life.

Nevertheless, it is important to pay attention to the deadlines and search on the newborn’s membership in advance to avoid any kind of unexpected. Generally, the adhesion of children to a health plan takes place in 3 ways:

Inclusion in a health plan existing

It happens when the child’s mother is already a user of a health plan and includes the child as a dependent. The rules of the National Health Agency (ANS), the accession of the infants born to the parents of the plan should be carried out in free way.

In such cases, if it is included up to a maximum of 30 days after his birth, the baby begins to enjoy the same mother’s needs. This means that if the mother has already fulfilled all the needs of your plan, your child will also be automatically exempt.

On the other hand, if the mother is subject to partial coverage, so will the newborn.

Inclusion in the new plan, made from the child’s birth

It happens when parents or guardians seek health provider from the child’s birth to the hiring of a unique plan for it.

Thus, the contract takes effect with the same procedure of any other, and the newborn will be like any person, subject to vesting periods and the other contractual provisions.

If your case, it is important to know that some operators, aware that children often have different needs care, marketing plans geared to that audience profiles.

So it is important to check if the health plan you are considering hiring offers this service.

inclusion of child during pregnancy

If the desire of those responsible, the health plan can also be hired from the moment in which the mother discovers pregnancy. In this case, although the membership is for the newborn, the mother will be covering throughout the prenatal, but only for this type of care.

If a woman prefers to take advantage of the full coverage, it is necessary to hire a health plan in his name than that done to the child. It is also important to consider that if the contract is concluded before delivery, the inclusion procedure should be performed normally.

This means that, as in other cases, those responsible for the child have the obligation to inform the health plan about the birth of the child, which will enjoy the benefits of hiring.

Tips for choosing the health plan for your child

When choosing the health plan most suitable for your child, it is important to take some precautions to ensure that small have the best possible care. Find out what they are:

Check the provider network closely

When choosing a health plan for small, it is important to pay attention to the accredited network offered by the operator.

After all, it is impossible to predict which medical specialty the child may need. So it is important to hire a plan with a wide network of accredited in various specialties.

Before signing the contract, it is always a good idea to check references with the doctors who are already accustomed to meet the child. Check, for example, if the pediatrician with which he makes routine visits goes by the plan you are considering hiring and, if not, look for indications of doctors who are part of the network.

It is also important to check whether the urgency and emergency service locations are near your residence or child’s school. Remember that children fall and get hurt easily, and need to move to the other side of town in a situation like this can be impractical.

Finally, be sure to check whether the hospitals accredited network has ala child and a good structure for the care of the small.

Assess the scope of coverage

If you often travel with children, it is extremely important to check if the health plan you are considering hiring has municipal, regional or national coverage.

Often, it is common to feel tempted to hire the plan with the provider that offers the cheapest service . However, this can mean extra expenses, especially if you need some emergency service and emergency during a trip to another state, for example, and have a limited coverage plan.

Stay tuned to the type of plan chosen

With regard to the forms of payment, health plans can be divided into with or without co-participation.

In 1 case, the fees are usually cheaper. But beyond that, you need to pay an extra amount, stipulated in the contract, every time you need to use the services.

Already in the plans without co-participation, you only pay the monthly fee and do not have to pay anything to make use of the accredited network.

When you hire a health plan for children, we must weigh this decision as well, since small, to have the immune system still in training, often need more medical services than adults.

Also, you need a financial reserve available for such occasions. So it is important to place the tip of the pencil is the savings you make when hiring a plane with co-participation pays off by the amount of times you need to use the services.

The health insurance for adults

Before you start researching the health plans best suited for you and your family, it is important to understand the hiring modalities available. Know more:

How it works

In general, health plans are divided into four categories, which relate to coverage options. Understand what they are and choose the one that best meets your needs and those of your family:

outpatient

In this type of contract, the user has the right to emergency care and medical emergency within 12 hours, appointments and tests that can be performed in clinics and outpatient clinics.

This type of plan, however, does not cover costs of hospitalization and, if necessary, they should be paid by the user.

Hospital without obstetrics

In this type of hiring happens the opposite, ie, the contractor is entitled to full coverage in case of hospitalization – including ICU – no maximum daily. However, appointments and tests outside the hospital stay must be paid by the user.

This mode also covers emergency care or emergency that lead to a hospital or if they are essential to the preservation of life. more complex procedures such as radiotherapy and chemotherapy, are also covered during hospitalization.

Stay tuned to the fact that, as the name implies, any expenditure related to prenatal and childbirth are not covered by such a plan.

Hospital with obstetrics

Works the same way as above, with the difference also include coverage of any examination, consultation or procedure related to prenatal and delivery care.

This type of plan also provides assistance to the newborn for 30 days and the possibility of inclusion of the child as a dependent with the same mother’s needs.

Reference

One of the methods employed by most users, this type of health plan provides coverage of hospital and outpatient plans in one contract.

In practice, this means that the beneficiary is covered for consultations, exams and hospitalizations related or not to the delivery, unlimited daily, in addition to emergency care and emergency.

Tips to hire health insurance for adults

When researching health insurance for you and your family, it is important to consider some essentials. Be aware that some of them can influence considerably the amount of your monthly payment. Look:

Understand the main type of contract

The 1st step is to understand what the hiring modalities available in the market with regard to the form of accession. You can choose, for example, by an individual or family health plan.

In this mode, you sign the contract directly with the service provider and pays a monthly fee, which varies according to the chosen coverage and the number of dependents.

Already in the business plan, the contract is made by the company in which you work. If microenterprise and have a Tax ID, you can make hiring a business plan for you and your family on favorable terms.

Finally, you can also opt for the health plan membership, which is available for groups of people who are part of the same institution or professional association, or that have the same area of ​​expertise, such as lawyers, engineers and teachers.

Read the contract carefully before signing

It’s not unusual at all that in the rush to accept any condition that seems financially advantageous, the user closes deal without reading the contract carefully.

Although a lot of information contained in the document are usual, that is, common to most plans, it is important to thoroughly check whether the provider network, coverage and needs meet your needs and those of your family.

If any of the users of the health plan to make frequent use of any test or procedure, make sure it is actually covered and what is needed to be able to use it.

Often only when a loved one gets sick and needs medical support, users checking the clauses carefully and note that, unfortunately, left out some important coverage.

Know the procedures for appointments, tests and hospitalizations

Before buying, it is important that you know more deeply the operation in practice of the health plan. More than read the contract, you must know better how the operator behaves on a daily basis.

Find out, for example, on what are the procedures to make an appointment or make a simple test. Avoid very bureaucratic plans, complicating access even the most basic services.

Also check for tests and services which prior authorization is needed. In such cases, check that the required documentation and the procedure to be performed is reasonable and can be met in an emergency situation in which we naturally taken by great stress.

Understand well what the needs are

By hiring one health plan, both you and your family will go through a period in which, even if the contract has already been signed and the payment is already being done, you can not use the services offered. The situation that we term the name of grace.

Therefore, it is important to learn about the conditions offered by the service provider with regard to this matter to avoid misunderstandings.

In general, health plans often require 24 hours of need for emergency care, 300 days not to premature births, 24 months for pre-existing illnesses or injuries and 180 days for other cases.

However, these periods may vary from one health plan to another. When in doubt about whether the grace period required by the service provider is legal or not, see the site of the ANS , which determines the maximum limits to be met in every situation.

The health plan for the elderly

Hiring health plan for the elderly requires careful attention, since this stage of life the use of medical services usually increase. So it is important to make sure that the elderly will be fully met their needs at the time that need it most. And at a fair price.

How it works

The main question for anyone thinking of hiring a health plan for the elderly with regard to the values ​​that are charged, which tend to be higher just in a stage of life that yields usually decrease.

In addition to the annual adjustments, the health plans are subject to adjustments by changing the age groups predefined in the contract. This change in value in the monthly fee is applied to the initial age of each track, and the value will gradually increase over the years.

If you hire a health plan now, the adjustment for age can only happen until 59 years old. In practice, this means that there can be changes in the amount paid for that reason the complete 60, 70 or 80 years, for example.

If your plan was hired before January 1999, however, know that it is not illegal for the adjustment by age happens after that age. In such cases, the adjustment is governed by what is established by contract, and the amount can be increased to 80 years.

Tips to hire health plan for the elderly

Before buying, look at some tips that can help you make the right choice:

Check for supply of home services

In the case of the elderly, especially those of advanced age or with serious mobility problems, rely on a health plan that offers home service options can be extremely advantageous.

Make sure the chosen health has home health care plan, laboratories that collect samples at home and hospitalization home care , which guarantees service and professional structure in the user ‘s residence and replaces the admission to hospitals.

Check the reputation of the health plan

When you hire a health plan for the elderly , great care is. After all, they can not risk running out of coverage at the time they most need, is not it?

To prevent this from happening, it is important that you check the reputation of the health carrier you are considering hiring.

One of the best ways to check if the plan is reliable and has great potential to bring a lot of headaches in the future is to analyze his position in the ranking of Performance Evaluation of Operators Qualification Program.

Prepared by ANS, the list aims to check the quality of health plans offered to the population taking into account four important factors:

  • compliance with technical specifications;
  • guaranteed access to a provider network that meets the demands of contractors;
  • the quality of care;
  • and the financial health of the institution.

To find out how is the evaluation of the health plan that you want to hire, simply consult the ANS site , where you can also make a comparison between two or more options.

Make sure that the services meet your needs

Once you are sure of the reliability of the chosen operator, it is important to check carefully what is being offered and some services that are especially important for the elderly in question are established in the contract.

Check, for example, if the health plan have preventive medicine program, it covers nursing homes and caregivers and if there is the possibility of including an adult as a reference, so that it can make difficult medical decisions (authorization for surgery when the elderly is unconscious, for example).

If you are hiring the plan for an old man who takes the 3rd age to travel or who constantly travels to visit friends and relatives, be sure also that the contract has national coverage.

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