Tips On How To Choose The Health Plan Carrier For Your Company

There are so many options on the market that it becomes a tough decision for the company. Know that before signing the contract, it is essential that the entrepreneur is aware of the various criteria that can not be restricted to the monthly fees charged.

We’ve prepared this post to help you select the most appropriate plan for your employees. Keep reading and stay on top of 5 tips on how to choose the best carrier to suit your business!

1. Check the registration of the operator in ANS

The National Supplementary Health Agency (ANS) regulates health plans in Brazil. In this way, the first tip when choosing the carrier is to know if the institution has a current registration in that organ.

To make this check, go to the ANS website and check the status of the carrier using the company’s registration number. Through this channel, you can also research consumer complaints.

Speaking of complaints, the businessman can complete his research by checking on Procon or sites such as the Complaint Here if there are complaints from the company that offers the medical covenant. Knowing the experience of other users will prevent you from hiring a health plan operator with a bad reputation, as well as future problems with the contractor.

2. Refer to the plan coverage

After consulting if there are no problems with the registry of the health plan operator, it is time to check the coverage of the agreement. What type of assistance do you want to offer your employees? For this decision you should consider the age of the users, the number of children and dependents, etc.

Know that the ANS determines the list of what should be covered in the Role of Procedures and Events in Health – a document published every two years. It defines a minimum coverage role that companies must follow, according to the segmentation of the plan, which can be:

  • . Outpatient;
  • . Hospital with or without obstetrics;
  • . Dental; among others.

It is necessary for the entrepreneur to select one of the segments and see if the coverage is according to what he wants to offer the employees.

In the outpatient segment, for example, ANS determines that the operator covers medical consultations in clinics or clinics, exams, treatments, and other outpatient procedures. The hospital without obstetrics should include hospital admission (except childbirth care ), with no time limit.

The rules determined by ANS, on the minimum coverage, are directed to all contracts entered into after January 1, 1999, or adapted to Law 9656/98, in the case of new plans.

3. Research the scope

In addition to an understanding of the coverage that the health plan operator offers, it is also necessary to pay attention to the regions covered by the agreement. There are plans with a national scope, while others focus on regional care.

If your company, for example, has employees who continuously travel or have affiliates in other locations, it may be interesting to think about a broader scope.

4. Consult the accredited network

Another point to be analyzed is the service of the certified system. Where are the hospitals, emergency services networks, and clinics that are part of the plan located?

Make sure it addresses the interests of your employees, for example:

Are located in regions close to the home or the workplace?

Will the employee lose hours of travel to get through the medical appointment?

There are agreements in which the employee or dependent can consult with a doctor of their confidence even if he does not state as accredited. It is a situation that works through a policy of right to reimbursement if the value is lower than those determined in the contract.

In addition to the accredited network, check if the operator has a service network with different channels of customer service, such as telephone, e-mail, chats, etc. In this way, you can get any questions regarding coverage and procedures quickly.

5. Be aware of the needs

Finally, an essential aspect that the businessman must check before signing the contract with the health plan operator is related to the shortcomings. This is the time to wait for consultations, surgeries, exams, and other procedures.

The shortage changes according to each coverage and segmentation of the medical insurance; in this sense, the ANS determines the maximum waiting period that the operator or insurer may require for each situation.

When the business plan has 30 participants or more, it is exempt from meeting the grace periods. However, the rule applies only to the employee who agrees within 30 days of signing the contract.

In this way, new employees must count 30 days of being linked to the company to be entitled to join the plan. However, when the program has fewer than 30 participants, the health plan operator may require the maximum grace periods determined by the ANS.

Now that you already know what factors to consider when hiring a health plan operator for your employees, our tip is for you to be well acquainted with the profile and needs of your staff before choosing the agreement that will offer the best coverage and comprehensiveness.

Want more information about the business health plan? Please contact us and get all your questions!