An explanation of how the grace period works in health plans, with tips to help when contracting or portability of medical insurance
Rio de Janeiro, RJ 11/1/2022 –
An explanation of how the grace period works in health plans, with tips to help when contracting or portability of medical insurance
When researching health plan options, the term “deficiency” causes constant skepticism in people, who often end up hiring a plan without analyzing the coverage offered.
The grace period is the time a customer needs to wait to start using their health plan benefits after employment. This is the legal guarantee that health insurance operators have in relation to their beneficiaries.
This information must be well defined in the plan contract and is part of each type of contract, although it works differently for each.
The ANS defines the following:
- a group health plan The grace period may be exempted in two cases: if the beneficiary enters into the anniversary of the contract or within 30 days after the conclusion of the contract.
- a Work Safety Plan There may be grace period compensation, as long as it is required, for plans with more than 30 beneficiaries.
- Individual or family health plan There is a grace period request
It is essential to pay attention to all of these details when hiring a health plan.
What are the main grace periods in the HMO?
According to the ANS, the maximum requirements for health plans are:
- Emergency and emergency: 24 hours;
- Simple consultations and exams: 30 days;
- Surgery and hospitalization: 180 days;
- Complex exams: 180 days;
- Delivery: 300 days
- Pre-existing diseases: 24 months.
How does deficiency work?
for emergencies – Since they are considered emergencies, the need to use the emergency room and other emergency services is 24 hours. That is, after the first 24 hours of contracting an IHC, you can use it for urgent and emergency situations.
However, for people who have a contract with an outpatient health plan only, emergency care, if hospitalized, extends only to the first 12 hours of care. After this period, the patient will bear the expenses. If the beneficiary has the hospital method, they are entitled to unlimited emergency and urgent care, although they may still be subject to a lack of surgeries and hospitalizations.
Birth – The maximum grace period stipulated by the ANS is 300 days. Therefore, it is important to plan well in this matter, especially when pregnancy is planned. In the case of premature birth, before it is planned, the delivery can be carried out through the HMO without additional charges, since it is carried out in the framework of urgent and emergency care.
Pre-existing illnesses or injuries – Pre-existing diseases can be described as comorbidities with which the beneficiary was already diagnosed prior to contracting the medical plan.
Some operators do not accept people with pre-existing conditions. But there is an option to include another type of pre-existing grace period, called Temporary Partial Coverage (CPT), which lasts for two years and is limited to procedures related to this disease.
deficiency reduction
So that the customer does not have to meet the new grace periods in the new plan, the customer can order deficiency reduction. However, there are some rules for using this feature.
For customers who have not previously contracted with a plan, some operators are offering to reduce the grace period. But it is important to note that companies are not obligated to offer this alternative. If a person intends to rent a plan, they can familiarize themselves with the promotional grace period.
If the beneficiary had a previous plan, there are some variants. The longer the stay, the greater the reduction in the next plan. For example, people who stayed for less than 3 months in the previous plan can usually choose the promotional grace period.
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