Plano antigo pode ser atualizado
- 6 de julho de 2011 |
- 23h03 |
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Categoria: Planos de saúde, Serviços
GISELE TAMAMAR
A partir do dia 4 de agosto, os clientes de planos de saúde antigos – contratados antes de 1999 – poderão adaptar seu contrato ou migrar de plano dentro da mesma operadora para garantir uma lista mais ampla de procedimentos médicos sem precisar cumprir o período de carência.
Além disso, o contrato do usuário que optar pela alteração terá limite de reajuste anual regulado pela Agência Nacional de Saúde Suplementar (ANS). Só no Estado de São Paulo existem 670.697 usuários de planos individuais antigos e mais 1,3 milhão de beneficiários de planos coletivos.
De acordo com o Instituto Brasileiro de Defesa do Consumidor (Idec), com a adaptação ou migração, os contratos passam a ser regidos pela Lei de Planos de Saúde. Sem isso, os convênios anteriores a 1999 são regulados apenas pelo Código de Defesa do Consumidor (CDC), o que implica na necessidade de recorrer à Justiça contra eventuais cláusulas abusivas, como as que limitam coberturas de cirurgias, exames ou não cobrem determinados tipos de doenças.
A advogada do Idec Juliana Ferreira lembra que o consumidor não é obrigado a fazer a mudança de plano. Antes da decisão, é preciso avaliar se a modificação vale a pena. “Não existe resposta pronta. Cada consumidor precisa sentar, analisar seu contrato atual e, só então, decidir se compensa ou não migrar ou adaptar seu plano de saúde”, diz a especialista.
Custo
Na avaliação da coordenadora institucional da Associação Brasileira de Defesa do Consumidor (Proteste), Maria Inês Dolci, é importante destacar o custo da alteração.
No caso da adaptação, a operadora deve apresentar uma proposta após o pedido do usuário em até cinco dias úteis e o ajuste do valor com a ampliação da cobertura não deve ultrapassar 20,59%. Já no caso da migração, o beneficiário pode escolher a melhor opção entre os planos oferecidos pela operadora e o preço será aquele já praticado no mercado. A vantagem é que ele não precisará cumprir o período de carência.
“O consumidor precisa analisar suas necessidades, quais as vantagens e os planos oferecidos, e se o valor cobrado está de acordo com o orçamento da família”, explica a coordenadora da Proteste.
A leitura do contrato exige atenção. A norma da ANS prevê que a proposta deve ser redigida de forma clara e precisa, em linguagem de fácil compreensão, sendo obrigatório dar destaque às cláusulas restritivas de direitos dos beneficiários, as de reajuste anual e por faixa etária, por exemplo.
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abusivas, adaptação, Agência Nacional de Saúde Suplementar, ajuste, ampliação, ANS, antigos, Associação Brasileira de Defesa do Consumidor, beneficiários, carência, CDC, cirurgias, cláusulas, coberturas, Código de Defesa do Consumidor, contrato, convênios, doenças, exames, Gisele Tamamar, Idec, Instituto Brasileiro de Defesa do Consumidor, Juliana Ferreira, Justiça, Lei de Planos de Saúde, limite, lista, Maria Inês Dolci, médicos, mercado, migração, mudança, necessidades, operadora, orçamento, plano, planos coletivos, Planos de saúde, planos individuais, procedimentos, proposta, Proteste, reajuste, usuário, vantagens
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