LIMITES DE COPARTICIPAÇÃO NOS PLANOS DE SAÚDE

Summary

In this video, Roberta Dropa, a technical expert at Fratern Seguros, discusses health insurance plans with co-participation in Brazil. She clarifies how co-participation limits work, addressing common misconceptions about high costs. Roberta explains the two models: percentage-based and fixed table, emphasizing the importance of consulting an insurance broker for detailed plan understanding. She debunks myths about excessive co-payments, especially for hospitalizations, and assures viewers that co-participation plans can be more economical, with a focus on fixed table plans and their limits.

Takeaways

• 😀 Roberta Dropa, a technical expert at Fratern Seguros, discusses health insurance plans with co-participation in this video.
• 🔗 A previous video was mentioned for context, with a link provided in the description for viewers to watch before this one.
• 📈 In the last decade, there's been a near tripling of beneficiaries opting for health insurance plans with co-participation.
• 💡 Two models of co-participation are explained: percentage-based and fixed table-based.
• ⚖️ It's advised to consult with an insurance broker to understand the specifics of the plan being contracted.
• 🏥 Both basic plans with and without co-participation offer the same medical network, but co-participation plans are typically 20-30% cheaper.
• 💸 Common misconceptions about co-participation include fears of paying absurd amounts for services or exams.
• 💼 The average co-participation fee for elective consultations in fixed table plans ranges from 15 to 50 reais, depending on the plan category.
• 🚫 Co-participation fees are not accumulative in most health insurance plans with fixed tables, except for emergency care, simple exams, and simple therapies.
• 🏥 For hospitalization, co-participation is not charged per diem but as a fixed amount, which is symbolic compared to out-of-pocket costs.
• 🎥 Another video will be posted to explain health insurance plans with percentage-based co-participation.

Q & A

What is the main topic discussed in the video?

The main topic discussed in the video is how health insurance plans with co-participation work, including the limits of co-participation and how they are charged.

What are the two models of co-participation mentioned in the script?

The two models of co-participation mentioned are the model by percentage and the model with a fixed table.

Why have more people been migrating to health insurance plans with co-participation?

People have been migrating to health insurance plans with co-participation because they understand the mechanism of co-participation and the economy they have in the monthly premiums of health plans.

What is the difference between a health plan with co-participation and one without?

A health plan with co-participation can be 20 to 30% cheaper in monthly premiums compared to a plan without co-participation, but it requires the policyholder to pay a co-participation fee for each service used.

What is the average co-participation fee for elective consultations in health plans with a fixed table?

The average co-participation fee for elective consultations in health plans with a fixed table varies from 15 to 50 reais, depending on the category of the plan.

What is the purpose of a co-participation limit in a health plan?

The co-participation limit in a health plan ensures that once the policyholder reaches the limit, they will not be charged any additional co-participation fees for the rest of the month.

Do all health insurance plans with co-participation offer a participation limit?

Not all health insurance plans with co-participation offer a participation limit. It is a feature that varies among different plans and is typically valid for elective procedures, simple exams, and simple therapies.

How is co-participation for hospitalization handled in health plans with a fixed table?

In health plans with a fixed table, co-participation for hospitalization is usually a fixed amount that covers the entire stay, including surgeries and stays in intensive care units (ICUs), and is generally symbolic compared to what one would pay out-of-pocket.

Can the co-participation fees exceed the monthly limit in some health plans?

In most health plans with a fixed table, co-participation fees do not accumulate beyond the monthly limit. However, some plans may roll over the excess to the next month, but this is less common and typically found in older contracts.

What advice does the speaker give to those considering a health plan with co-participation?

The speaker advises those considering a health plan with co-participation to consult with their broker to understand the details of the plan they are contracting, including the type of co-participation and any limits that may apply.