The National Supplementary Health Agency (ANS) has opened two public calls for subsidies to collect information on the following topics:

Both TPS 4 and TPS 5 are currently open for contributions until October 31st.

Any member of society can contribute, including citizens, health professionals, entrepreneurs, micro-entrepreneurs, start-ups, associations and entities representing the regulated sector, non-governmental organizations, public institutions, professional councils, educational and research institutions and other government bodies.

Below are the main aspects of each of the two TPS published by ANS.

TPS 4

With TPS 4, ANS seeks to receive proposals on the four topics that make up a project to reformulate the pricing and readjustment policy of health plans. These are:

  • readjustment of collective plans, focusing on the size of contract groupings and minimum guidelines for clauses readjustment;
  • financial moderating factor (for copayment and deductible plans), focusing on defining percentage limits and frequency of copayment and deductible, and defining non-eligible procedures;
  • mandatory or not, online sale of health plans and establishment of criteria for this;
  • technical review, focusing on defining criteria justifying the need for technical review of health plans and indicators or metrics that can be used to demonstrate that a health plan portfolio is in economic-financial imbalance.

The proposals will be organized and analyzed by ANS’ Product Standards and Qualification Board (Diretoria de Normas e Habilitação dos Produtos), which will then formulate the final contributions report, containing the technical analysis of the proposed alternatives for the topic. Subsequently, ANS will prepare a draft regulation, which will be submitted for public consultation - opening another opportunity for society to submit contributions.

TPS 5

TPS 5 objective is to collect proposals for new for new exclusively outpatient plan options containing:

  • scope of alternative exclusively outpatient plans;
  • mandatory coverages;
  • exclusions of coverages;
  • type of contracting;
  • coverage area; and
  • other contractual information relevant to the plans or alternatives proposed, such as the form of service, payment, entry, adjustments, duration and cancellation.

The theme of reformulating exclusively outpatient plans provided for in the ANS Regulatory Agenda for the triennium 2023-2025 in the section "Products Economic-financial evaluation".

The Superior Court of Justice (STJ) has already ruled on the need for ANS to regulate and oversee the topic in a recent lawsuit that discussed the Agency’s role in regulating discount health cards.

The Life Sciences & Health practice can provide more information on the topic.