change in rules for communicating contract termination by operators has a new date

The National Supplementary Health Agency (ANS) announced a new date for the entry into force of Normative Resolution (RN) No. 593, of 2023, which deals with the new rules for communicating to beneficiaries about the possibility of termination or exclusion from the health insurance contract. health plan due to lack of payment. The standard, which will also allow new forms of notification to consumers, will come into force on September 1, 2024.

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The extension of the date was decided by ANS in order to allow “better adaptation of operators to the new rules” and so that the agency can prepare materials that help clarify doubts that may arise in light of the changes brought about by the standard.

RN 593/2023 will now regulate the notification of the beneficiary due to default, whether the beneficiary is contracting an individual or family plan, an individual entrepreneur contracting a collective business plan, or someone who pays the monthly fee for a collective plan directly to the operator. Furthermore, the standard provides for the use of electronic means to communicate with the consumer, in addition to the already established forms.

According to the new RN, the operator must provide notification of default by the fiftieth (50th) day of non-payment as a prerequisite for the exclusion of the beneficiary, suspension or unilateral termination of the contract on the operator’s initiative due to default.

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The notification will be considered valid after the fiftieth day of default if the operator guarantees a period of 10 days, counting from the notification, for payment of the debt to be made. However, days of delay in paying monthly fees already paid will not be counted as a period of default for the purposes of termination, contractual suspension or exclusion from the contract.

In order for the beneficiary to be excluded or the contract to be suspended or unilaterally terminated due to default, the rule establishes that there must be at least two unpaid monthly payments, consecutive or not, within a period of 12 months. It will be up to the operator to clearly prove the notification of the default situation, demonstrating the date of notification to the consumer.

When it comes into force, RN 593 will allow new forms of notification to beneficiaries. Electronic means, such as e-mail with digital certificate and reading confirmation, text message to cell phones, message in mobile device applications and recorded telephone call with data confirmation, will be authorized.

However, notification made via SMS or mobile device application will only be valid if the recipient responds confirming its acknowledgment. Communications by letter or through the operator’s representative, with signed proof of receipt, will continue to be permitted.

The RN defines that the notification must include the period of delay with an indication of the outstanding competencies and the number of days of default, in addition to the form and deadline for paying the debt and regularizing the contract, as well as the operator’s means of contact to clarification of doubts.

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In cases where the operator is unable to notify the consumer about default, the rule defines that cancellation can only occur 10 days after the last attempt to contact the beneficiary, as long as there is proof by the operator of the attempted notification by all means. described in the resolution.

RN 593 will apply to contracts concluded after January 1, 1999 and to those that were adapted to Law No. 9,656, of 1998, allowing contracts prior to the beginning of their validity to be amended to provide for all means of notification established in new regulation.