health

The increase causes an impasse between retirees and the health plan

Pensioners who use the Fênix Medical health plan in Votorantim concern a greater than 40% increase in month-to-month charges that might happen in the coming months. The Association of Pensioners and Pensioners of Votorantim (Apevo) considers the realignment an abuse and contradicts the selections of the National Supplementary Health Agency (ANS), which is liable for regulating the sector.

About 750 associates from the KZP membership class ought to obtain the increase in month-to-month charges. According to Apevo’s president, Jose Carlos Ferreira, expectations have been for a correction of at most 15.5%. “However, Fênix is ​​adamant about altering the worth and insists on a charge of 43%, claiming the increase in the claims ratio of the teams coated by the settlement,” he mentioned.

In a memo, Apevo mentioned that as early as January it’ll ship members a readjustment of month-to-month health plan charges inside the most restrict set by the ANS, which is 15.5%, and will strive by all attainable means and authorized means, obtain settlement with Fenix ​​​​​​​​Medical in order that the readjustment is maintained inside these parameters. “We will spare no effort to make sure that changes are utilized inside the authorized limits set by the Regulatory Agency, safeguarding the pursuits of our associates, together with taking authorized motion as essential to assessment the adjustment charges,” the memo concluded .

In flip, Fênix Medical reported that Apevo was passing on distorted data to its members. This is as a result of, in line with the firm, the adjustment clauses of the collective membership plans are offered by free negotiation between Apevo and the operator, and the data that the regulatory company units a most adjustment of 15.5% in the modality isn’t actual.

The healthcare operator additionally mentioned it has at all times acted inside the legislation, following the course of set out in the contract in addition to the ANS guidelines for implementing the correction. “Regardless of this complete scenario, Fênix assesses the profit to the beneficiary and is on the market, if crucial, to supply different options to beneficiaries/members who should not happy with the accepted charges, inside the framework of the present resolutions,” the observe concluded.

Users really feel

In the center of this impasse are customers – retirees – who must do every thing they will to make the cost and take care of the adjustment annually. This is the case of Maria Ide Amaral, 78 years previous, and her husband Jaime Mesias, 83 years previous. They have been Fênix prospects for over 10 years and say that is the first time the correction has been this excessive. According to the pensioner, the huge downside is that the wage doesn’t develop at the identical charge as different issues. “About 12% will do, 15% will likely be tougher, however 40%? It is unimaginable to pay,” he mentioned.

Apevo instructs members to make the cost with a 15% adjustment that will likely be included in that month’s invoice and await additional steerage on the February installment.

Fênix, on the different hand, makes itself out there to make clear the whole calculation memorial and the methodology used, making the course of as clear as attainable. (Thais Marcolino)

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