Why is the company getting rid of individual plans

At the end of 2021, a project worker started Transforming your individual and family health plansOnly groups remain. Why does this happen? Experts say individual plans are less profitable for businesses because monthly fee adjustments are regulated, while group plans can be increased at will. Emile has been contacted, but she has not commented on her business strategy.

A worker made a triangulation to sell individual plans. First, the operator handed over the wallet with 337 thousand customers to APS, which belongs to the same Amil group. APS is now seeking to turn these clients into a consortium of three health and investment partners: Fiord Capital, Director of Investments, Seferin & Coelho, for Private Health Investments, and CEO, Henning Von Koss.

Amil and APS are controlled by the UHG (United Health Group). APS, UHG’s small operator, ditched the group plans and kept only the individual plans. That is, it was exclusively with the least profitable part, according to experts.

The National Agency for Complementary Health (ANS) is responsible for analyzing the negotiations between all parties. The agency agreed to hand over from a worker to APS in December, but suspended in february Attempt to transfer APS to the association made up of the three companies mentioned.

Movement is allowed

This triangulation led by Amil is permitted by the ANS. The The law that established the regulatory body in 2000 He says the Autonomous System has the power to authorize the registration and operation of health operators, as well as emanations, mergers, incorporation, change or transfer of control of the company.

However, the regulatory agency evaluates a number of requirements in negotiation. For example, if the interested parties have the financial strength to take over the portfolio. It was this interrogation that temporarily prevented the change in leadership of the APS. Operations are confidential.

Faster to work

Lawyer Rafael Ropa, of Vilhena Silva’s office, believes the involvement of three firms draws attention. Direct selling from one company to another is allowed without including a third party. Golden Cross converted its single card to Unimed; Porto Seguro did the same with Emile, for example. When contacted, Emile did not explain why she was doing this triangulation.

The health plan law, which was enacted in 1998, prohibits cancellation of health plans by operators. The suspension or termination of the contract can only occur in cases of fraud or default of more than 60 days.

according to ANSThe operator must have an agency-approved registration to work in the health insurance sector. This authorization is the first step in the approval process for a corporation with the municipality.

For Riba, Amyl’s triangulation can be explained by one reason: to speed up negotiations. APS is a registered operator with the ANS, while the consortium will have to wait for this authorization. “It will be a step forward [para esses sócios]’, she says.

interrogated by UOLUHG said it does not comment on “market speculation”.

Individual plans ‘a problem with the boot’

Idec (Brazilian Institute for Consumer Protection) health program coordinator Ana Carolina Navarrete says companies are offering fewer and fewer individual and family plans because of the ANS’ strict oversight of monthly fee adjustments.

The agency announces annual adjustments to this method, which makes companies obligated to follow this decision. The last correction was -8.19% meaning that the beneficiaries received a discount on the monthly fee valid until April of this year.

In the case of group plans, annual adjustments are made by free negotiation – they are not regulated by the ANS.

According to her, individual plans have a strong commitment among the elderly and people undergoing treatment for chronic diseases, that is, those who use the service frequently. “The increment control established by the US Air Service is attractive, for example, to seniors who are not employed or have no employment relationship,” Navarrete says.

According to agency data, the number of individual and family plan users in Brazil reached 8.91 million in January 2022. This figure represents 18.2% of the total 48.9 million beneficiaries of private health plans in the country.

Idec advocates that group contract modifications are made in the same way as individual contracts. “If the agency doesn’t do that analogy, the market trend is for individual plans to lose more space.”

Primary health care history

Headquartered in Jundiaí (SP), APS was established in 1999 and its current partners are Amil and Santa Helena Saúde, which is also part of the United Health Group. The operator has not sold individual plans for at least two years.

After the acquisition of Amil’s portfolio, APS transferred 7000 collective plans to operator Sobam, part of UHG, after approval by ANS. The municipality says that both parties abide by the rules established by the regulations and that it does not see any connection with the transfer of a worker to APS.

“Nothing changes for the beneficiaries, who are still receiving the service from the same authorized network, backed by the same terms of contracted services and under the same regulatory agency rules,” APS stated at the time.

In September 2018, APS was bought by the group that controls Amil – Jundiaí’s operator was part of the Sobam Group, and was also sold with the Sobam Health Plan, Pitangueiras Hospital and eight medical centers. The purchase price was not disclosed.

Positive results

In 2019, the first year under the supervision of the Public Health Group, APS profits amounted to R$3.757 million, an increase of 87.1% over 2018. The company highlighted only one operational reform at the medical center, which, according to the document, brought more Flexibility. At the service and convenience of the beneficiaries.

In 2020, APS reported a profit of R$6,466 million – a 72.1% jump over the previous year – according to the company’s latest financial report. The document shows that the operator cut costs in the first year of the pandemic, and only highlights the renegotiation of property rents.

Regarding investments, he referred to the implementation of telemedicine for private network beneficiaries. It also made available a nursing specialist in the call center service to answer users’ questions about COVID-19.

In the first semester, APS observed a “sudden and appropriate drop” in medical care in the accredited network, motivated by social isolation and restrictions on activities. This, according to the worker, brought “positive results”.

Already with the resumption of consultations, exams and surgeries from July, the company increased its expenditures and “reduced in results,” summarizes the financial report.

“Despite the challenges in the face of the pandemic and its consequences, the operator ended fiscal year 2020 with a satisfactory net result, with adequate collateral assets and a good solvency margin,” says an extract from the report.