Proposal received criticism for excluding urgencies and hospitalizations; Agency evaluates contributions sent at the public consultation closed in April
ANS (National Agency for Supplementary Health) proposed the creation of a new type of health insurance with limited coverage and reduced cost. Focused mainly on individuals, the model can be tested for 2 years through a sandbox Regulatory – Controlled Experimentation Environment.
The proposal establishes coverage for elective consultations only (previously scheduled) with exams listed on the ANS list. Emergency care, hospitalizations and therapies would not be included. According to the agency, the intention is to expand access to basic care through the supplementary sector and, at the same time, relieve the demand for simple care in the SUS (Unified Health System). Read the plan (PDF – 3 MB).
The product will be offered in the collective modality by adhesion and with 30% co -participation. A bonus system is also planned for beneficiaries who join care programs and remain linked to the plan.
According to ANS, the new model is directed to a portion of the population that is in the so -called “3rd via” Health: Citizens who do not want to use SUS, do not have traditional health insurance, but can afford punctual private services. The agency argues that the plan can contribute to the reduction of queues in SUS by absorbing part of this repressed demand.
“The proposal is aimed at an audience that has no traditional health insurance, who uses services such as popular clinics, discount cards and prepaid cards and that takes on financial risk when they use these services. The citizen who uses these services knows that what they are hiring has a limit linked to the amount they can pay. It is estimated that there are at least 50 million people in this situation.”the agency reported in a statement to power360.
The ANS highlights, however, that the new product does not fit as a conventional health plan. “They are not health plans, but access to health. Nothing changes to those who already have plan. This new product does not allow the exercise of needs to another type of plan.”it says.
That is, those who join the new plan, restricted to elective consultations and exams, will not be able to migrate to existing products. Similarly, beneficiaries of traditional plans will not be able to change to this new model within Sandbox Regulatory
The proposal was submitted to Public Consultation No. 151which was open between February 18 and April 4, 2025. A public hearing was also held on February 25. The agency now continues with the analysis of the contributions. “The decision making of the Board of Directors will consider all manifestations received”it says.
According to ANS, it is not yet possible to estimate the values of the new product, as the studies are in the early stages. As a reference, the agency uses exclusively outpatient plans – considered the lowest cost in the sector – that cost, on average, R $ 360 in the 1st semester of 2024.
Criticism
The proposal received criticism. In a statement sent to the presidency of ANS, the MPF (Federal Public Prosecution Service) the absence of an AIR (Regulatory Impact Analysis), a tool that previously evaluates the effects of regulatory measures on consumer, companies and SUS itself. According to the MPF, the lack of the instrument compromises the transparency and risk assessment of the initiative.
In response, ANS stated that it has prepared a technical note based on previous studies of the sector and that, according to current legislation, AIR can be dismissed.
“Air is one way to support decision making, but not the only one”declared the agency.
The main concerns include restricted coverage, the risk of replacing traditional plans with simplified models and the possible increase in demand for more complex care in the public system.
The Sanitarist and Professor at UFRJ (Federal University of Rio de Janeiro) Ligia Bahia evaluates that the proposal does not respond to the main problems of the supplementary health sector.
“It is a cool proposal of what is being debated today. Judicialization, abusive adjustments, denial of coverage and the list of procedures are the central themes. This proposal ignores all this.”he said.
Ligia also disputes the argument that the new product would relieve SUS: “In the 1990s and 2000s, there was an increase in the number of plans beneficiaries, and SUS was never relieved. On the contrary, as the proposed plan already provides that much of the care will be made by SUS, the public system tends to be even more overwhelmed.”.
The expert also criticizes the way the product has been presented to the public. “This proposal can cause serious damage to health. Creates the illusion of wide access for a low value, but leaves out essential areas such as oncology, psychiatry, care for people with disabilities, surgery, hospitalizations and medicines. It is not an illusion – it is an illusion.”it says.
