Misinterpretation of ANS RN 433/18 reaches the Supreme Court

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You don't need to be an expert in the sector to know: the biggest controversy of the year involving supplementary healthcare in the country is, certainly, the debate over healthcare plans with deductibles and co-participation. As we pointed out here , the controversy over the topic gained great repercussion in the first half of the year due to the measure previously being analyzed by the National Supplementary Health Agency (ANS) and, in recent weeks, after the publication of Normative Resolution 433, which updates the rules for these types of supplementary health care in Brazil, have been the target of attacks from different sectors.


But, after all, is the contention justified? First of all, it is important to present some aspects to better understand the issue. Presumed since Law 9,656 (Health Plans Law) in 1998, the two modalities B2B Lead still lacked more specific rules for their greater dissemination and knowledge throughout society, which was timidly accomplished by Consu Resolution 8/98, well before the creation of the ANS. The standard published by ANS on June 28th, after extensive public consultation, therefore sought to fill the existing gaps in the legislation to ensure greater legal certainty and predictability for both the consumer and the different agents in the sector.

In this way, RN 433/18 determined the monthly and annual limits that the consumer will be able to pay for the various procedures and also defined a list of more than 250 items exempt from charges, such as treatments for chronic diseases and cancer, preventive exams, among others. Through this device, the standard adds layers of consumer protection to existing modalities, but, until now, little regulated by the ANS. One example is the definition of a maximum percentage (quite modest compared to that used in other countries) of the value of the procedure for products with co-participation, ensuring greater predictability and reducing waste.



Also according to RN 433/18, the maximum amount that the beneficiary can pay for co-participation must not exceed the amount corresponding to the consideration (monthly fee) and/or 12 monthly payments per year (annual limit). This means that, if the monthly fee is R$500, for example, the limit for extra expenses with deductible and co-participation, diluted over the months, will be R$6,000 (R$500 x 12 months of the year).