SEARCH GENERAL
DIRECTORY
Portability of Waiting Periods (RN 438)
1-Does the portability mobility standard apply to all types of plans?
Yes, portability of Waiting Periods is the beneficiary’s right to change from a private health care plan and will be able to do it for all types of Plans, whether for Individual Plans, Adhesive Collectives or Corporate Collectives, and provided that the destination is not in Active status with Suspended or Canceled Marketing with ANS. The original plan must have been contracted after January 1, 1999 or adapted to Law 9656/1998.
OMINT sells only Corporate Collective plans, so a new title / family can only enter this mode via portability. New dependents, spouse or child, will be able to enter via portability in the three modalities (Individual Plans, Collective by Adhesion or Corporate Collective) as long as they meet the other rules.
Beneficiaries will be accepted in plans with an Active status with Suspended Marketing in cases where an active contract already exists with the destination operator.
2 – How should the Portability Request be made?
The portability of waiting periods must be requested by the beneficiary directly at the destination plan operator or at the Benefits Administrator responsible for the destination plan.
Upon request, the beneficiary must present all documents proving compliance with the requirements for portability, and the Operator must provide a membership proposal containing the registration number of the selected product, for the beneficiary’s signature. It should be clarified that the beneficiary may request portability from both the Operator and the Benefits Administrator (if any), and it is not possible to restrict the exercise of portability to only one of them.
3 – What are the requirements to perform the Portability of Waiting Periods, under the terms of article 3 of RN 438/2018?
• The beneficiary must be linked to a health plan.
• The beneficiary must be up to date with the monthly payment with the operator of the plan of origin.
• The beneficiary must have met the term of stay, as appropriate:
(1) in the first portability, you must be at least 2 years in the operator of the origin plan or at least 3 years, if you have fulfilled temporary partial coverage (CPT) for pre-existing diseases and injuries;
(2) if the beneficiary joined the plan of origin exercising the Portability of Deficiencies, the minimum period of permanence required in the plan becomes 1 year, but if this portability was for a plan with coverage not provided for in the assistance segmentation of the plan of origin, the minimum term to be met will be 2 years.
• The plan of origin must be regulated, that is, it was contracted after January 1, 1999 or adapted to Law No. 9,656 / 98, except in the case of loss of bond.
• The price range of the destination plan must be equal to or less than that of the beneficiary’s home plan, considering the date of consultation with the portability of waiting period module of the ANS Health Plans Guide, unless the portability is a collective business plan to another collective business plan.
• If the destination plan is a collective contract, the beneficiary must be linked to the legal entity contracting the plan, or the beneficiary must be or have a bond with an individual entrepreneur.
• Present the compatibility report between the origin and destination plans or the compatibility consultation protocol number, both issued by the ANS Guide to Health Plans.
4 – What are the documents needed to perform the Portability of waiting periods?
In order to carry out portability of waiting periods, the beneficiary must present the following documents:
• Proof that you are up to date with the monthly payments, such as: proof of payment of the last 3 (three) monthly payments, or statement by the operator of the original plan or the contracting legal entity.
• Proof of length of stay, such as: signed adhesion proposal, or signed contract, or proof of payment of the required length of stay monthly fees, or statement from the originating plan operator or contracting legal entity.
• Compatibility report between the origin and destination plans or portability protocol number, both issued by the ANS Guide to Health Plans.
• If the destination plan is a collective contract, proof of link with the legal entity contracting the plan or proof referring to the individual entrepreneur.
• If the beneficiary is in compliance with CPT, he must present a copy of the Health Declaration completed in the plan of origin or of a document that attests that he was complying with CPT that specifies the pre-existing disease or injury declared.
5 – When is it possible to carry out the Portability?
The portability of waiting periods may be carried out at any time by the beneficiary, after having fulfilled the minimum term in the plan of origin. The operator will not be able to define a period for the realization of portability (window), if the beneficiary has already fulfilled the period of permanence in the plan.
The portability must be requested by the beneficiary before joining the new plan. If the beneficiary adheres to a plan without using portability, if he identifies that he was entitled and requests the waiting period exemption later, the operator will not be obliged to exempt the waiting periods, even if the beneficiary demonstrates that he had this right before having adhered to the plan.
6 – What is the length of stay?
It is the uninterrupted period in which the beneficiary must remain linked to the plan / operator of origin to become able to exercise the portability of waiting periods. For the beneficiary to become eligible, he must remain in the plan of origin for a minimum period of 02 years, or for a period of 03 years, if he has fulfilled the period of partial partial coverage (CPT) for pre-existing diseases or injuries. For the beneficiary who is in the second portability, the term will be 01 year, regardless of compliance with CPT.
For purposes of counting the term of stay in cases where the beneficiary has made a plan change at the same operator, without interruption of time and between plans with identical assistance segmentation, the sum of the period during which the beneficiary remained linked to the operator of the plane of origin from the foreground.
7 – What is the deadline for effective portability at the destination operator?
The operator of the destination plan will have 10 (ten) days to analyze the request for portability of waiting periods, and supporting documents submitted by the beneficiary. The operator must send the conclusive answer, duly justified, stating whether the beneficiary meets the requirements to carry out the portability.
If the beneficiary does not meet any of the requirements to carry out portability, the portability request may be refused. Failure to send a response to the beneficiary within 10 (ten) days implies acceptance of the portability of the waiting periods.
For the Collective Business contract destination plan, the date of the effective date of the beneficiary’s bond in the destination plan must observe the cadastral change agreed in the contract between the contracting entity and the Operator.
8 – What are the Portability rules for Collective Business Plans?
Beneficiaries of corporate collective plans must observe all rules of the standard for exercising portability of waiting periods. The only exception is when the beneficiary who is linked to a collective business plan is exercising portability to another collective business plan. In this case, the price range compatibility requirement does not apply. In other words, the beneficiary of a collective business plan will be able to port it to another collective business plan regardless of its price.
Portability must respect the registration movement provided for in the relationship between the operator and the contracting legal entity, and, therefore, the effective date of the beneficiary’s bond in the collective corporate destination plan must observe the contractual registration movement.
9 – Can a hospitalized beneficiary exercise portability of waiting periods?
No, the hospitalized beneficiary cannot exercise portability and the hospitalized beneficiary cannot be terminated or excluded. If the beneficiary is hospitalized, the portability can only be required after discharge from hospital.
Except for this rule, the hypotheses in which the hospitalized beneficiary will perform portability due to the operator’s exit from the market, or due to the death of the contract holder, or due to loss of dependency condition, or due to dismissal, exoneration or retirement, or by termination of the collective agreement by the operator or contracting legal entity. That is, when the change of plan is not motivated by the beneficiary’s will (as provided for in articles 8, 12 and 13 of RN 438/18), even if he is hospitalized, the beneficiary will be able to exercise portability of waiting periods.
10 – Do I have to pay any Fees to qualify for Portability of Waiting Periods?
No. Any type of additional charge for carrying out portability is prohibited. In addition, the price of the plans cannot be differentiated for the beneficiary who is porting waiting periods in relation to the beneficiary who is contracting a plan without portability.
11 – How can the beneficiary prove that he / she is up to date with the Monthly Payment at the Operator of his / her Health Plan?
To prove the default, the beneficiary must present to the destination plan operator one of the following documents: proof of payment of the last 3 (three) monthly payments, or statement from the origin plan operator or contracting legal entity, or any other document able to prove the regularity of the monthly payment by the beneficiary.
12 – What are the Portability rules for Beneficiaries who had their Health Plan terminated?
There are different rules for cases in which the change in the health plan is motivated by the extinction of the beneficiary’s bond with his health plan, namely: by the death of the contract holder; loss of dependency; by resignation, dismissal or retirement, or termination of the right to maintain the plan pursuant to articles 30 and 31 of Law No. 9,656 / 98; or by termination of the collective agreement by the operator or contracting legal entity. For these cases, portability should be required within 60 days, starting from the loss of the bond.
In such cases, in order to carry out the portability, the active bond, length of stay, and compatibility by price range requirements do not apply. In other words, this beneficiary will be able to portability even if he is no longer linked to his plan, he will not be required to have a minimum time in the plan, and he will be able to choose a plan regardless of its price. In addition, portability may be exercised by beneficiaries of unregulated plans, contracted before January 1, 1999 and not adapted to Law No. 9,656, of 1998.
13 – Can portability of waiting periods be exercised by legal entities?
The portability of waiting periods cannot be exercised by legal entities, there is no normative provision for the portability of contracts. The portability is an individual right granted to health plan beneficiaries, regardless of the type of contract, from a source plan to a destination plan.
When the destination plan is a collective contract, the contract must be in force for the portability to be exercised, and the beneficiary must prove eligibility to enter the contract. This rule does not apply to the collective business contract signed by an individual entrepreneur, since he is an individual and not a legal entity.
14 – How can the request for Cancellation of the Plan of Origin be verified after the Portability of Waiting Periods has been carried out?
After exercising the portability, the beneficiary must request the cancellation of his link with the plan of origin within 5 (five) days from the date of the beginning of the term of his link with the plan of destination. There is no deadline for assessing the request to cancel the original plan. The verification of the request for cancellation of the origin plan must be carried out by the operator of the destination plan in the manner it deems most operationally viable, directly with the beneficiary.
Expired the period of 5 (five) days, if the beneficiary does not prove the request to cancel the link to the origin plan, when requested by the operator of the destination plan, this may invalidate the portability and demand compliance with the waiting periods applicable to the beneficiary, and may charge the costs resulting from assistance coverage that may already be used in the plan, provided that the consumer is previously notified of the loss of the right to portability for failure to comply with the cancellation requirement of the original plan, and informed about the grace periods to be fulfilled in the plan.
15 – What is Special Portability of Waiting Periods?
Special Portability is the beneficiary’s right to change his health plan without the need to comply with waiting periods or temporary partial coverage, in the event of being linked to an operator health plan that is leaving the market, or that is in the process of extrajudicial liquidation or cancellation of registration. The Special Portability of waiting periods is published by ANS, which opens a period of up to 60 (sixty) days, which can be extended, so that the operator’s beneficiaries leaving the market exercise portability.
In Special Portability, the requirements for length of stay and compatibility by price range do not apply. In other words, the beneficiary will be able to port it without having to comply with the minimum time spent on the plan and will be able to choose a plan regardless of its price.
16 – What is the Protocol Consultation of the ANS Guide to Health Plans?
The Portability of waiting periods module of the ANS Guide is a tool that helps the beneficiary to change health plans without fulfilling new waiting periods or Temporary Partial Coverage (CPT). The Portability module allows the beneficiary to know and compare compatible health plans before changing plans. The ANS Guide Protocol Consultation is the space where the consumer will be able to check the information of the consultation previously carried out and about the plan selected in the Plan Guide for adhesion / contracting or for portability of waiting periods. To access the protocol number, the consumer will be able to make the consultation based on his CPF and date of birth.
17 – What is the Compatibility Report issued by the ANS Health Plans Guide?
The compatibility report issued by the ANS Guide is the document that shows that the beneficiary’s plan (origin plan) is compatible with the selected plan (destination plan) for the purposes of portability of waiting periods, on the date of consultation. For the plans to be compatible, the beneficiary’s home plan must fall within a price range equal to or higher than the price range of the destination plan. The compatibility report is issued by the ANS Plan Guide together with a protocol number, and is valid for 5 (five) days from its issue.
18 – Is it possible to exercise Portability for a plan that has Assistance Coverages not foreseen in the Origin Plan?
Yes, the destination plan may have coverage not provided for in the assistance segmentation of the origin plan, in which case, the waiting period operator may be required to comply with waiting periods for the new assistance coverage.
We also emphasize that, in any situation in which the portability of waiting periods occurs, the beneficiary may choose a plan with coverage not provided for in the segmentation of the plan of origin, and in that case, it may always be required to comply with waiting periods for new assistance coverage.
19 – How is the Price Compatibility of Exclusively Dental Plans for Portability?
For exclusively dental plans, the destination plan whose monthly payment is less than or equal to the monthly payment of the original plan plus 30% (thirty percent) is considered in the same price range. That is, the beneficiary can port to any exclusively dental plan that is up to 30% more expensive than his current plan.
20 – Can the Beneficiary exercise Portability within the same Operator?
When the beneficiary changes his health plan at the same operator, without using the portability rule, the plan that the beneficiary joined is called a successor plan.
For purposes of counting the permanence period for portability, in cases where there has been a change of plan in the same operator, without interruption of time and between plans with identical assistance coverage (same assistance segmentation), the entire period in which the beneficiary remained linked to the operator of the original plan since the first plan.
In this case, the imposition of new waiting periods will only be applicable when, in the new plan, access to health care professionals, entities or services not included in the previous plan is guaranteed, including a better standard of accommodation in hospitalizations, but only in relation to these increased health care professionals, entities or services, or only in relation to this better standard of accommodation.
21 – What are the Portability rules for the Beneficiary in Remission?
The portability of waiting periods may be exercised by beneficiaries who are in the benefit of the remission period, which may be required after the end of the remission or during the remission, which will be terminated from the beginning of the term of their link with the destination plan. Beneficiaries who are in remission will observe all the rules of the standard for the realization of portability of waiting periods. In relation to compatibility by price range, the beneficiary must inform the amount of the monthly fee he would be paying, that is, the amount he paid before entering into a remission updated for the adjustments suffered in the contract (this information must be included in the Plan Operator’s Declaration. of Origin for Portability purposes).
At the end of the referral, if there is a contractual provision for the exclusion of the beneficiary, the portability rules must be applied to the beneficiary who has been excluded from his health plan, in which the active bond term requirements do not apply to permanence, and compatibility by price range. This beneficiary who was excluded at the end of the remission must request portability within 60 (sixty) days from his effective exclusion from the plan or the date on which he becomes aware of his exclusion.
22 – What are the Portability Requirements for Newborns and Adopted Children under 12?
The newborn, natural or adopted child, who has been enrolled in the parent’s / guardian’s plan as a dependent within a maximum period of 30 (thirty) days from birth or adoption, may not be required to remain in the plan of origin for the exercise of portability of waiting periods, provided that the parent / guardian’s plan includes obstetric coverage.
The adopted child under 12 years of age which has been enrolled in the plan as a dependent within 30 (thirty) days of adoption, cannot be required to remain in the original plan for the exercise of portability of waiting periods.
It is important to note that, with the exception of the length of stay, all other rules of the portability rule are applicable to the newborn or adopted child, such as, for example, the waiting periods requirement for coverage not provided for in the care segmentation of the patient’s plan of origin.
23 – In Family Contracts, can any member of the contract exercise Individual Portability of Waiting Periods?
Yes. The portability of waiting periods is an individual’s right. In the case of family contracts, only the beneficiaries who exercise portability are terminated, maintaining the contract for the other beneficiaries.
Contact OMINT: – Any clarification that may be necessary, regarding Portability of Waiting Periods, may be requested by email portabilidade@omint.com.br
For Beneficiaries interested in joining OMINT via portability, it is necessary to correctly fill in one of the following forms:
Standard Portability – Annex I
Portability due to loss of link – Annex II
Further information and / or clarifications can be found in the ANS FAQ – National Supplementary Health Agency or in the Guidance Booklet, on the ANS portal:
FAQ – Questions and Answers
http://www.ans.gov.br/images/stories/Particitacao_da_sociedade/2017_comite_ estrutura_produtos/oficinas-ggrep-ciclo3-faq.pdf
ANS Guidance Booklet
http://www.ans.gov.br/images/stories/noticias/pdf/Cartilha_Final.pdf