{"id":5941,"date":"2016-11-28T19:15:51","date_gmt":"2016-11-28T21:15:51","guid":{"rendered":"https:\/\/acrisure.com.br\/insights\/?p=5941"},"modified":"2026-01-06T10:53:11","modified_gmt":"2026-01-06T13:53:11","slug":"o-que-meu-plano-de-saude-cobre","status":"publish","type":"post","link":"https:\/\/acrisure.com.br\/insights\/o-que-meu-plano-de-saude-cobre\/","title":{"rendered":"O que meu plano de sa\u00fade cobre?"},"content":{"rendered":"<p>[et_pb_section fb_built=&#8221;1&#8243; admin_label=&#8221;Post&#8221; _builder_version=&#8221;4.19.4&#8243; custom_padding=&#8221;0px||0px||false|false&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_row admin_label=&#8221;Post&#8221; _builder_version=&#8221;4.19.4&#8243; background_size=&#8221;initial&#8221; background_position=&#8221;top_left&#8221; background_repeat=&#8221;repeat&#8221; width=&#8221;100%&#8221; custom_padding=&#8221;0px||0px||false|false&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_column type=&#8221;4_4&#8243; _builder_version=&#8221;4.16&#8243; custom_padding=&#8221;|||&#8221; global_colors_info=&#8221;{}&#8221; custom_padding__hover=&#8221;|||&#8221;][et_pb_text admin_label=&#8221;Conte\u00fado&#8221; _builder_version=&#8221;4.21.0&#8243; _module_preset=&#8221;default&#8221; text_letter_spacing=&#8221;1px&#8221; custom_margin=&#8221;||||false|false&#8221; global_colors_info=&#8221;{}&#8221;]<\/p>\n<p>Essa \u00e9 uma d\u00favida que muitos benefici\u00e1rios t\u00eam em rela\u00e7\u00e3o ao servi\u00e7o de sa\u00fade. Seja sobre consultas com especialistas, tratamentos ou procedimentos cir\u00fargicos, como saber o que est\u00e1 inclu\u00eddo no seu plano de sa\u00fade? A Ag\u00eancia Nacional de Sa\u00fade Suplementar (ANS) elabora o <a href=\"https:\/\/www.ans.gov.br\/images\/stories\/Materiais_para_pesquisa\/Materiais_por_assunto\/Rol_de_Procedimentos_2016_total.pdf\" target=\"_blank\" rel=\"noopener\">Rol de Procedimentos em Sa\u00fade<\/a>, v\u00e1lido para os planos contratados a partir de 02 de janeiro de 1999 e para os planos anteriores \u00e0 data, mas que foram adaptados. Trata-se de uma lista, atualizada a cada dois anos, que define as consultas, exames, procedimentos e tratamentos que s\u00e3o obrigat\u00f3rios de acordo com o tipo contrato, que pode ser ambulatorial, hospitalar com ou sem obstetr\u00edcia, de refer\u00eancia ou odontol\u00f3gico.<\/p>\n<p style=\"color: #495358; font-size: 22px; font-weight: bold;\">Rede Credenciada<\/p>\n<p>Para saber quais atendimentos voc\u00ea tem direito, \u00e9 preciso conhecer o tipo do seu plano. Interna\u00e7\u00f5es, por exemplo, n\u00e3o s\u00e3o cobertas em planos ambulatoriais, apenas nos hospitalares com ou sem obstetr\u00edcia, ou de refer\u00eancia. O mesmo ocorre com a rede credenciada e tratamentos. Confira quais hospitais, laborat\u00f3rios e cl\u00ednicas prestam atendimento pelo seu plano e fique atento a poss\u00edveis altera\u00e7\u00f5es. As operadoras podem substituir ou descredenciar prestadores a qualquer momento. Essas altera\u00e7\u00f5es devem ser autorizadas pela ANS e comunicadas aos benefici\u00e1rios com 30 dias de anteced\u00eancia, com exce\u00e7\u00e3o dos casos de fraude ou infra\u00e7\u00e3o por parte do prestador.<\/p>\n<p style=\"color: #495358; font-size: 22px; font-weight: bold;\">Cobertura Geogr\u00e1fica<\/p>\n<p>Pode ser nacional, estadual, grupo de estados, munic\u00edpios e grupo de munic\u00edpios. \u00c9 obrigat\u00f3ria a cobertura na regi\u00e3o de resid\u00eancia do benefici\u00e1rio para atendimentos eletivos, de emerg\u00eancia e urg\u00eancia. Quando a <a href=\"https:\/\/segurosinteligentes.com.br\/oldrh\/_old\/o-que-fazer-quando-nao-ha-medico-disponivel-na-minha-cidade\/\" target=\"_blank\" rel=\"noopener\">abrang\u00eancia geogr\u00e1fica<\/a> contratada n\u00e3o \u00e9 cumprida, o consumidor pode exigir o atendimento em outro prestador, o reembolso do valor do servi\u00e7o ou informar o problema \u00e0 ANS.<\/p>\n<p style=\"color: #495358; font-size: 22px; font-weight: bold;\">\u00d3rteses e pr\u00f3teses<\/p>\n<p>Planos regulamentados pela Lei n\u00ba 9.656, de 1998 cobrem de forma obrigat\u00f3ria pr\u00f3teses, \u00f3rteses e seus acess\u00f3rios que necessitam de cirurgia para serem colocados ou retirados. Planos n\u00e3o regulamentados por essa Lei podem excluir a cobertura a \u00f3rteses e pr\u00f3teses. Por\u00e9m, \u00e9 preciso ressaltar que no Artigo 10 dessa mesma Lei h\u00e1 a exclus\u00e3o da cobertura de \u00f3rteses e pr\u00f3teses n\u00e3o ligadas ao ato cir\u00fargico, ou seja, n\u00e3o implant\u00e1veis, como: \u00f3culos, coletes ortop\u00e9dicos e pr\u00f3teses de substitui\u00e7\u00e3o de membros.<\/p>\n<p>[\/et_pb_text][\/et_pb_column][\/et_pb_row][\/et_pb_section]<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Saiba aquilo a que tem direito de acordo com seu tipo de plano e contrato.<\/p>\n","protected":false},"author":1,"featured_media":5943,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_et_pb_use_builder":"on","_et_pb_old_content":"","_et_gb_content_width":"","footnotes":"","_links_to":"","_links_to_target":""},"categories":[22],"tags":[9],"class_list":["post-5941","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-legislacao","tag-rh"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.4 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>O que meu plano de sa\u00fade cobre? 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