2 agreements pass machete with stampede

2 health plans with a health giant name faced adverse situations and are terrorized in the midst of a critical scenario

And the financial crisis caused by the Covid-19 pandemic still has its consequences in some sectors. In fact, incredible as it may seem, even some health plans were affected.

This situation ended up harming even big names like Unimed.

First of all, it is worth highlighting that there are strong rumors throughout the country about the possibility that some Unimed plans are falling apart.

In fact, two shocking situations involving the giant generated even more concerns and that is what we will talk about now…

The case of Unimed Cáceres

In November 2023, as explained by the ANSthe plan of Unimed Caceres faced serious inconsistencies in its capital.

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This crisis was highlighted by the insufficiency of guaranteed assets, negative net working capital and the non-recognition of a balance representing technical provision.

In response to these adversities, Unimed Cáceres and ANS established a Term of Assumption of Economic-Financial Obligations-TAOEFwhich started on April 1, 2019.

Through it, one of the alternatives was a capital contribution from R$7,950,000.00with each member responsible for a deposit of R$150,000.00.

However, at the end of the agreement in March 31, 2022the irregularities persisted without solution.

In view of this, ANS applied planned measures, culminating in Resolution 2,851/2023, which forced Unimed to pass the machete and sell its portfolio of beneficiaries within 30 days.

In addition to suffering from the suspension/ban on sales of the cooperative’s plans or products.

The measure adopted by ANS, however, raised concerns about the significant impacts that would occur in the city of Cáceres and the region, directly affecting the municipality’s health services.

In response to the ANS resolution, the Federal Judge of the 1st Court of Cáceres, Francisco Antonio de Moura Júniorexpressed his concern and also highlighted that the delay in judging the case is not justified given the urgency imposed by the situation.

In response, he appointed a conciliation hearing for December 18, 2023, on the premises of the Judicial Subsection of Cáceres-MT.

It is worth mentioning that the progress of this battle for the survival of Unimed Cáceres remained uncertain, while the courts seek alternatives that can reconcile the financial health of the cooperative and the continuity of service to the local population.

The conciliation hearing scheduled for December promised to be a crucial moment in resolving this crisis.

In January 2024, the board of SISMA/MT confirmed the communication received from Corretora Globoregarding the situation of Unimed Cáceres members who opted for plan migration.

Which ended up generating, in a way, a stampede of customers.

According to him, they had until January 12th to complete the plan portability and, since before the official notification, the board sought to resolve the issue in several meetings.

Following legal action, which is still under analysis by the Judiciary, according to process no. 1049580-70.2023.8.11.0041, which was filed with the 8th Civil Court of Cuiabáon December 29, 2023.

Employees who felt harmed could file individual actions by contacting SISMA to schedule a meeting with legal counsel.

According to findings from the Focus TVthe process remains open in 2024.

See the full statement left by Unimed Cáceres from June 2023 below:

“Dear Unimed Customers, Members, Providers and Individuals.

We inform that Unimed Federation of the State of Mato Grosso, as representative of its individual affiliates before the State Clearing Chamber, informed Unimed Cuiabá about the default of Unimed Cáceres with the State Clearing Chamber, referring to the month of May/2023 , leaving Unimed in non-compliance with the National Exchange Manual.

In this sense, Unimed Cuiabá hereby announces that it will comply with the National Exchange Manual, suspending service to Unimed Cáceres beneficiaries in the exchange system, from this date onwards, except for urgent/emergency care and patients already hospitalized patients who will be maintained.

UNIMED CUIABA BOARD OF DIRECTORS Cuiabá, June 28, 2023“

Another stampede

Now in 2024, another Unimed unit that experienced problems was Unimed-Rio.

This is because, in March 2024, it informed that it would start transfer all its beneficiaries to Unimed Ferj (Unimed of the State of Rio de Janeiro) in April.

According to ANSthe aforementioned operator has 452,598 beneficiaries in medical assistance plans and 33,150 beneficiaries in exclusively dental plans.

It is worth highlighting that, as determined by law, there will be no changes to prices, products, network or shortfalls with the transfer of customers.

Doctors (there are around 4 thousand members) will also continue with the same current conditions as the operator.

Still, as explained by Globethis decision to transfer customers was made this past Tuesday morning (05) in a meeting led by the collegiate board with:

• Federal Public Ministry
• State Public Ministry
• Public Defender’s Office of the State of Rio de Janeiro
• Unimed do Brasil
• Unimed National Central
• Unimed-Rio
• Unimed Ferj.

What was the outcome of Unimed-Rio?

Another health plan from the giant that ended up suffering a stampede was Unimed-Riowhich was under the fiscal and technical direction of ANS since the year 2015.

According to ANS, the Unimed-Rio will continue its activities as provider of health services, ceasing to act as a health plan operator.

At the meeting, it was agreed that the Ferj unit will maintain the operator’s network, with the contraction of all operational services to support the portfolio transfer transition phase throughout 2024.

It is worth remembering that in September 2023, ANS had already authorized the transfer of 73 thousand contracts from Unimed-Rio to Unimed Ferj.

When searching for statements from Unimed-Rio, no notes were found on the subject, but the space remains open so that it can present its version of the facts.

In the first half of that same year, the accumulated loss was R$840 million.

According to industry sources, last year’s migration was considered a kind of test for the announced transfer March 5, 2024.

Unimed Ferj, as operator, counts today with 80 thousand customers. Furthermore, the Unimed system in the State of Rio, with 18 municipal operations, has around 1.2 million customers.

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