Health insurance card on a desk with medical bills

Health insurance card on a desk next to medical bills, a scene reflecting the financial challenges of Brazil's supplementary healthcare system.

About this subject

In Brazil, the supplementary healthcare system, regulated by the National Supplementary Health Agency (ANS), covers about 50 million beneficiaries, roughly 24% of the population. Health insurance operators offer different modalities, such as individual, family, and group plans, with costs varying according to age range, coverage, and region. Medical bills, like those shown in the image, represent expenses that may include consultations, exams, hospitalizations, and procedures, often not fully covered by plans, generating additional costs for users.

The rise in healthcare costs, driven by population aging and the incorporation of new technologies, has pressured operators to adjust monthly premiums annually. In 2023, the ANS authorized adjustments of up to 15.5% for individual plans, while group plans may have even larger increases, freely negotiated between companies and operators. This reality makes financial planning essential for beneficiaries, who must balance monthly payments with possible uncovered expenses.

The image also alludes to the bureaucracy of the supplementary healthcare system, where the beneficiary must present the insurance card to access services. Despite digitalization, many still carry the physical card, which contains data such as plan number, validity, and accredited network. The presence of medical bills on the table highlights the complexity of managing healthcare expenses, a relevant issue in a country where the SUS serves the majority of the population, but many turn to private plans seeking greater speed and comfort.

Frequently Asked Questions

What should I do if my health insurance does not cover a medical bill?

You can dispute the denial with the operator, request reimbursement if the service was provided out-of-network, or file a complaint with the ANS. In urgent cases, the judiciary can also be involved.

How are health insurance premium adjustments calculated?

For individual plans, the ANS sets a maximum annual index based on changes in healthcare costs. For group plans, adjustments are negotiated between the operator and the contracting company, with no predefined limit.

What is the difference between health insurance and health plan?

In Brazil, both are regulated by the ANS, but a health plan offers a network of accredited providers and predefined coverage, while health insurance typically reimburses expenses incurred at freely chosen services.