Health insurance, in its collective business modality, is indicated for any company, observing one question: to hire, normally, it is necessary to add a minimum total of three lives in group health insurance plan. The number of insured lives, composed of employees and their dependents, will also directly reflect on the value of the insurance and the way the insurer will assess the annual adjustment. Your hiring must be done by an insurance broker specialized in benefits and who will analyze the options available in the market, according to the needs of each client.
In the case of policy migrations, this guidance is also essential during the term of the policy for the evaluation of variables that determine the price and other vital issues such as the need for reimbursement, analysis of how many dismissed and retired people are in the plan’s extension, the existence of people in the enjoyment of the benefit in remission (dependents can remain with the benefit for a period without the need for payment), occurrences of treatments and hospitalizations,
Also, in the collective corporate modality, the readjustments in relation to the amount paid for the insurance are determined by the market, that is, it is established by the insurers or health operators themselves, according to the criteria established in the policy. The operator or insurance company must inform ANS about the adjustment applied in the policy.
One of the readjustments is calculated based on the index of variation of medical and hospital costs (VCMH), commonly known as financial readjustment. In addition to the VCMH, there is also a technical readjustment, which is determined based on the loss ratio of each contracting company, that is, based on the total cost of using employees and their dependents for the total amount of monthly fees paid during the same period. The greater the use, the higher the accident rate. Both readjustments, VCMH, and claims cannot be applied for less than 12 months. Some policies may even provide for the application of the adjustment due to a change in age groups, and in this case, the adjustment may occur in the month of the employee’s or his dependent’s birthday. In this sense, a specialized insurance broker can assist companies in preparing reports that point out the information needed for control measures. It can also contribute to the planning of health management actions such as lectures, mapping the health profile, preventive exams, such as bioimpedance, and, mainly, the implementation of a culture that encourages employees to use health insurance more in the context of prevention rather than for treatments or surgeries.