Understand how co-participation works!

Co- participation during a health plan occurs when the user pays for a few medical expenses - additionally to the monthly fee already imposed. Therefore, all services and procedures performed will have a particular amount to be paid. 

It may appear to be an option that may not worthwhile, but that's where you create a mistake! The monthly fee for this sort of plan can vary greatly counting on the health care provider, but the amounts are usually much lower. Another important factor: co-participation are often a hard and fast amount or a percentage of the amount!

 

How it works?

In co-participation , there's a fee charged for the service used - often, this cost can vary between a hard and fast or percentage amount, already stipulated within the contract. 

Often, a hard and fast amount of R $ 40 or 20% are often charged - for a consultation, for instance - of the quantity indicated within the plan table.

However, there are exceptions to co-participation , like hospitalizations - that only fixed charges are allowed, and percentage charging is prohibited. 

 

Advantages of this modality

If you're thinking of hiring this sort of health plan, it's important to understand what the benefits for you!

Generally, co-participation is right for those that don't have chronic diseases - but still want to be safe when it involves health. additionally, the monthly fee is far cheaper and coverage remains an equivalent as for a standard plan. 

 

How is that the charge made during a plan with co-participation?

Generally, the way you're charged depends tons on the sort of plan you would like to rent. See more below:

Business

Yes, co-participation also can be seen in corporate health plans! Where the charge is formed directly on the user's payroll. 

Many companies usually choose this modality when the readjustment remains under negotiation, to scale back the company's ratio as a results of co-participation . 

Individual and collective membership

The charge during this sort of plan is formed within the monthly bill of the health plan. However, it's possible that certain delays may occur between the time the service is employed and therefore the billing. 

 

ANS rules and changes

Even with some measures revoked and changes that would not be completed, there's no limit to the share to be charged to the user - however, ANS suggests that it's up to 30% of the worth of the procedure actually paid by the health operator. 

Another important factor: the user can't be charged for the entire cost of the service used. Hospitalizations must have a singular value that has all procedures and services.

ANS has also reformulated the exemption rules, placing quite 250 procedures that ought to be exempted in terms of the referred modality. 

In addition to the services available, information on the date of contract, start of coverage, shortages et al., must be made available within the contract. The user also can see the sort of accommodation contracted, care data, topographic point and ANS contact details on the web site provided by the health operator !

 

Check which procedures are freed from charge!

Chronic treatments

There is no limit to radiotherapy, hemodialysis and oral and intravenous chemotherapy. This also applies to chronic hemotherapy and immunobiologicals for diseases defined within the DUTs - Usage Guidelines. 

Preventive exams

Among them, we highlight mammography, which may be done every two years for ladies between 40 and 69 years aged. Fecal occult blood tests are often performed one a year for adults 50 to 75 years aged. 

Fasting blood sugar is tested annually for patients over 50 years aged; lipidogram is additionally done annually for men over 35 and ladies over 45 years of age. 

HIV and syphilis tests are often done once a year, while glycated hemoglobin are often performed up to 2 times a year in diabetic patients. One exam which will be performed as repeatedly as necessary is colonoscopy in adults between 50 and 75 years old. 

Queries

The user is entitled to an exemption from collection in up to 4 consultations per annum - provided it's performed with GPs. they're the pediatrician, general practitioner, geriatrician and gynecologist. 

Prenatal exams

Fasting blood glucose;

Urine culture;

Serum iron; 

Direct COOMBS test;

Toxplasmosis;

AND THE;

Hepatitis, HIV and syphilis;

Blood typing;

Cervico-uterine cytology.

In addition, you're exempt from up to three ultrasound exams and 10 consultations with an obstetrician. 

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