Health plans will include new procedures from 2018
The National Agency of Supplementary Health (ANS) on Tuesday (07) that in January 2018 will enter into force the new mandatory minimum coverage of health insurance. The Normative Resolution with the update of the Role of Procedures and Events in Health, which is the minimum list of procedures that health plans are required to offer to beneficiaries, will be published on Wednesday (8/11) in the Official Gazette of the Union
In this process, the inclusion of 18 new procedures, such as exams, therapies and surgeries that serve different specialties, will be included, the expansion of coverage for seven other procedures, including oral cancer drugs. According to the agency, for the first time a drug for the treatment of multiple sclerosis will be incorporated into the Rol.
On January 2, 2018, the new list of coverage begins, serving the 42.5 million beneficiaries who have plans and 22.6 million with dental plans. The roll is mandatory for all health plans contracted as of the entry into force of Law 9,656 / 98, the so-called new plans, or those that have been adapted to the law.
The list of procedures covered by health insurance plans is updated every two years to ensure access to the diagnosis, treatment and follow-up of diseases through techniques that enable the best health outcome. However, companies need to meet proven scientific criteria for safety, efficiency and effectiveness. If these rules are not met, the operators must pay a fine of 80 thousand reais for a violation.
The decision also aims to prevent the prevalence of chronic diseases. "In Brazil, chronic non-communicable diseases have a high burden and have a significant impact on health problems due to mortality, morbidity and costs. The adoption of the burden of disease as one of the elements considered in the review, therefore, brings important subsidies for the taking "The Normative Resolution is part of a continuous process of ANS, and is discussed within the scope of the Standing Committee on Health Care Regulation (ANS). Cosaúde), composed of representatives of the government, the supplementary health sector and consumer protection bodies.
The scheme then goes through public consultation for the manifestation of the whole society. This year the public consultation was available between June and July and received 5,259 contributions online, with 53% of consumers, 26% of contributors who identified themselves as "other", 13% of service providers, 4% of servers 3% of health plan operators and 1% of managers.
Of the suggestions made in this process, three new procedures were included in the list. In addition, two other methods were already present on the roster, so their guidelines have been updated so more patients are benefited.
Procedures - 8 Oral Medications for Cancer, Lung, Melanoma , prostate, neuroendocrine tumors, myelofibrosis and leukemia (afatinib, crizotinib, dabrafenib, enzalutamide, everolimo, ruxolitinib, ibrutinib and tramatinib) - Positron Emission Computed Tomography (PET-CT) for diagnosis of neuroendocrine tumors.
- Immunobiological (natalizumab) medication.
- Antiangiogenic chemotherapy and optical coherence tomography for treatment of secondary macular edema, diabetic retinopathy, central retinal vein occlusion and central vein branch occlusion retina; -Radiation for treatment of keratoconus.
- Laparoscopic laparoscopic surgery to treat ovarian cancer (debulking) - Laparoscopic surgery to restore pelvic support (vaginal vault prolapse) - Laparoscopic surgery to clear uterine tubes - Laparoscopic surgery to restore tubal permeability uterine; - Amniotic fluid screening by PCR: laboratory examination for the diagnosis of gestational toxoplasmosis.
- Endoscopy for treatment of vesicoureteral reflux, urinary tract infection disease - Immunoprophylactic therapy against respiratory syncytial virus (palivizumab) .
The consumer should contact the ANS and make the complaint. The service channels are:
Dial ANS: 0800 701 9656 - Free telephone service, available Monday through Friday, from 8 am to 8 pm (except public holidays)
ANS Portal: Consumer Service Center, available 24 hours a day
ANS centers: Attendance from Monday to Friday, from 8:30 a.m. to 4:30 p.m. (except public holidays), in 12 cities located in the five regions of Brazil
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