See in 5 answers how to activate life insurance and health insurance during the dengue crisis

The second quarter of 2024 began with an increase in dengue cases: there are now more than 2.5 million probable cases and 923 confirmed deaths, according to data from the Ministry of Health released on April 1st. The folder also informs that 454 municipalities in 11 states have already declared a state of emergency because of the disease.

Officials from PAHO (Pan American Health Organization) have already described the beginning of 2024 as probably the worst season so far observed in the Americas for the mosquito-borne disease. Aedes Aegypti.

Given the growing concern about health protection and financial security, the InfoMoney listed 5 main doubts that may arise for users of insurance and health plans. Next, experts answer how to use the benefits in cases of diagnosis and treatment of dengue.

1 – What insurance covers dengue fever and what coverage is offered?

Some insurance policies offer specific coverage for dengue fever, such as life insurance. Coverage may vary depending on the insurer, but generally includes compensation in case of death, income or daily hospital stay for hospitalizations (the compensation for which corresponds to a certain number of days in the hospital), daily incapacity for temporary incapacity (which provides an amount to the insured corresponding to to the income it generates for a certain number of days) and specific coverage for tropical diseases, which compensates the user who is diagnosed not only with dengue, but also with other diseases such as zika, chikungunya and yellow fever, explains Dennys Rosini, product director at insurance company Prudential.

2 – What is the user’s right to diagnose and treat dengue through the health plan?

Health plans must cover costs related to the diagnosis and treatment of dengue, including exams, consultations and medications. It is important to check the plan’s coverage and use the services available in the accredited network to ensure access to the necessary care. It is essential to be aware of the accredited networks and coverage offered by the plan to guarantee access to the necessary services, explains Nycolle Soares, a lawyer specializing in Health Law.

3 – What differentiates insurance and health plan coverage?

Insurance generates cash compensation to the insured according to the coverage contracted in the case of specific risks. For example: a dentist (self-employed professional) was diagnosed with dengue and had to stay away from work, unable to see clients, for 14 days. If he has contracted daily temporary disability coverage for 15 days, he is covered and will receive compensation in the contracted amount – in this case, corresponding to 14 days of work, explains Bernardo Ribeiro, co-founder of insurtech Azos.

The health plan covers consultations, exams, procedures (which may include hospitalizations) carried out in the diagnosis and treatment of the disease, either through reimbursement to the user or by paying directly to hospitals, clinics, healthcare professionals, etc. Furthermore, insurance and health plans can be purchased as a complement to each other, but they are regulated by different bodies. While the ANS (National Supplementary Health Agency) supervises health plan operators, Susep (Private Insurance Superintendency) supervises insurance companies. Therefore, complaints about each product must be forwarded to the respective authority.

4 – What changes, in practice, if the public authorities declare a dengue epidemic?

When public authorities declare a state of emergency, this means that the situation requires a quick and efficient response to deal with a specific crisis, such as an epidemic. The epidemic decree indicates that the situation has reached a higher level of dissemination, requiring more comprehensive and intense prevention and control actions. These declarations allow the government to take more agile and targeted measures to combat the spread of the disease, both in the area of ​​health and social assistance. Furthermore, decrees may impact contracts established between individuals, such as insurance, allowing adjustments or partial suspensions due to unforeseen and exceptional circumstances, informs the lawyer.

5 – How careful should I be when taking out insurance so as not to ‘be left in the lurch’ if I have dengue fever?

For experts, when considering taking out insurance to guarantee coverage in cases of dengue fever, it is essential to pay attention to the contractual details, especially the applicable deductibles and how they are treated in relation to the period of absence. It is important to understand whether the insurance contracted has a retroactive deductible or not, as it can significantly impact the amount to be received during the period of temporary incapacity, warns Ribeiro.

Furthermore, it is important to assess whether the coverage specifically includes dengue and whether there are specific deficiencies for this disease, highlights Rosini.