{"id":6656,"date":"2023-08-17T10:33:30","date_gmt":"2023-08-17T13:33:30","guid":{"rendered":"https:\/\/acrisure.com.br\/insights\/?p=6656"},"modified":"2026-02-24T12:23:41","modified_gmt":"2026-02-24T15:23:41","slug":"ans-atualiza-regra-hospitais","status":"publish","type":"post","link":"https:\/\/acrisure.com.br\/insights\/ans-atualiza-regra-hospitais\/","title":{"rendered":"ANS atualiza regras para altera\u00e7\u00e3o de hospitais nos planos de sa\u00fade"},"content":{"rendered":"

[et_pb_section fb_built=”1″ admin_label=”Post” _builder_version=”4.20.0″ custom_padding=”0px||0px||false|false” global_colors_info=”{}”][et_pb_row admin_label=”Post” _builder_version=”4.21.0″ background_size=”initial” background_position=”top_left” background_repeat=”repeat” width=”100%” custom_padding=”0px||0px||false|false” global_colors_info=”{}”][et_pb_column type=”4_4″ _builder_version=”4.16″ custom_padding=”|||” global_colors_info=”{}” custom_padding__hover=”|||”][et_pb_text admin_label=”Conte\u00fado” _builder_version=”4.21.0″ _module_preset=”default” text_letter_spacing=”1px” custom_margin=”||||false|false” global_colors_info=”{}”]<\/p>\n

A <\/span>Ag\u00eancia Nacional de Sa\u00fade Suplementar (ANS)<\/span><\/a> aprovou a ado\u00e7\u00e3o de novas regras para a altera\u00e7\u00e3o de rede hospitalar das operadoras de planos de sa\u00fade. As mudan\u00e7as valem tanto para a retirada de um hospital da rede como para a troca de um hospital por outro.<\/span><\/p>\n

Entre as principais mudan\u00e7as est\u00e3o a amplia\u00e7\u00e3o das regras da portabilidade, <\/span>com a retirada de prazos de perman\u00eancia obrigat\u00f3ria <\/b>no plano, e a <\/span>exclus\u00e3o da exig\u00eancia de que o plano escolhido para a portabilidade seja na mesma faixa de pre\u00e7o.<\/b><\/p>\n

Outra conquista importante para os benefici\u00e1rios \u00e9 que as operadoras ser\u00e3o obrigadas a comunic\u00e1-los, individualmente, <\/span>sobre exclus\u00f5es ou mudan\u00e7as de hospitais e servi\u00e7os de urg\u00eancia e emerg\u00eancia na rede credenciada<\/b> no munic\u00edpio de resid\u00eancia do benefici\u00e1rio. A comunica\u00e7\u00e3o individualizada deve ser feita com 30 (trinta) dias de anteced\u00eancia, contados do t\u00e9rmino da presta\u00e7\u00e3o de servi\u00e7o.<\/span><\/p>\n

Al\u00e9m disso, segundo as novas regras, caso a unidade a ser exclu\u00edda seja respons\u00e1vel por at\u00e9 80% das interna\u00e7\u00f5es em sua regi\u00e3o de atendimento, a ANS entende que ela \u00e9 uma das mais utilizadas do plano e, assim, a operadora n\u00e3o poder\u00e1 apenas retirar o hospital da rede, <\/span>ela dever\u00e1 substitu\u00ed-lo por um novo.<\/b><\/p>\n

Entenda detalhadamente as altera\u00e7\u00f5es da ANS<\/b><\/h2>\n
Portabilidade<\/b><\/h5>\n

Nos casos em que os benefici\u00e1rios ficarem insatisfeitos com a exclus\u00e3o de um hospital ou do servi\u00e7o de urg\u00eancia e emerg\u00eancia do prestador hospitalar da rede de sua operadora, ocorrida no munic\u00edpio de resid\u00eancia ou no munic\u00edpio de contrata\u00e7\u00e3o do plano, <\/span>o benefici\u00e1rio poder\u00e1 fazer a portabilidade<\/b> sem precisar cumprir os prazos m\u00ednimos de perman\u00eancia no plano (um a dois anos).<\/span><\/p>\n

Tamb\u00e9m n\u00e3o ser\u00e1 exigido que o plano de escolhido ou de destino seja da mesma faixa de pre\u00e7o do plano de origem, como acontece atualmente nos outros casos de portabilidade de car\u00eancias.<\/span><\/p>\n

Comunica\u00e7\u00e3o<\/b><\/h5>\n

Como foi mencionado, a comunica\u00e7\u00e3o individualizada deve ser feita com 30 (trinta) dias de anteced\u00eancia, contados do t\u00e9rmino da presta\u00e7\u00e3o de servi\u00e7o.<\/span><\/p>\n

\n

\u201cAl\u00e9m de ser informado oficialmente sobre qualquer mudan\u00e7a na rede hospitalar da sua operadora, o consumidor ter\u00e1 maior mobilidade, pois ficar\u00e1 mais f\u00e1cil fazer a portabilidade de car\u00eancias caso o hospital de sua prefer\u00eancia saia da rede de sua operadora\u201d, ressalta o diretor-presidente da ANS, Paulo Rebello.<\/span><\/p>\n<\/blockquote>\n

Redu\u00e7\u00e3o da rede hospitalar<\/b><\/h5>\n

Em rela\u00e7\u00e3o \u00e0 redu\u00e7\u00e3o de rede hospitalar, uma das principais mudan\u00e7as est\u00e1 relacionada \u00e0 an\u00e1lise do impacto sobre os consumidores atendidos pela operadora. De acordo com a regra atual, \u00e9 observada a quantidade de interna\u00e7\u00f5es realizadas no intervalo de 12 meses. Ou seja, se o hospital em quest\u00e3o n\u00e3o registrar interna\u00e7\u00f5es de benefici\u00e1rios no per\u00edodo de 12 meses, o estabelecimento pode ser exclu\u00eddo pela operadora.<\/span><\/p>\n

Com a nova norma, <\/span>a ANS passa a avaliar o impacto da retirada do hospital junto aos benefici\u00e1rios do plano.<\/b> Desta forma, caso a unidade a ser exclu\u00edda seja respons\u00e1vel por at\u00e9 80% das interna\u00e7\u00f5es em sua regi\u00e3o de atendimento, a ANS entende que ela \u00e9 uma das mais utilizadas do plano. Portanto, a operadora n\u00e3o poder\u00e1 apenas retirar o hospital da rede, mas dever\u00e1 substitu\u00ed-lo por um novo.<\/span><\/p>\n

Substitui\u00e7\u00e3o de hospitais<\/b><\/h5>\n

A avalia\u00e7\u00e3o de equival\u00eancia de hospitais para substitui\u00e7\u00e3o tamb\u00e9m ter\u00e1 regras pr\u00f3prias. Agora, ela dever\u00e1 ser realizada a partir do uso de servi\u00e7os hospitalares e do atendimento de urg\u00eancia e emerg\u00eancia, nos \u00faltimos 12 meses. Assim, se no per\u00edodo analisado os servi\u00e7os tiverem sido utilizados no prestador exclu\u00eddo, <\/span>eles precisar\u00e3o ser oferecidos no prestador substituto.<\/b><\/p>\n

Ainda neste caso, a regra do impacto sobre os benefici\u00e1rios tamb\u00e9m ser\u00e1 considerada. Se o hospital a ser retirado pertencer ao grupo de hospitais que concentram at\u00e9 80% das interna\u00e7\u00f5es do plano, n\u00e3o ser\u00e1 permitida a exclus\u00e3o parcial de servi\u00e7os hospitalares.<\/span><\/p>\n

Al\u00e9m das mudan\u00e7as, a norma aprovada mant\u00e9m um crit\u00e9rio importante para o consumidor: <\/span>a obrigatoriedade do hospital substituto estar localizado no mesmo munic\u00edpio do exclu\u00eddo, exceto quando n\u00e3o houver prestador dispon\u00edvel.<\/b> Neste caso, poder\u00e1 ser indicado hospital em outro munic\u00edpio pr\u00f3ximo.<\/span><\/p>\n

\n

\u201cO foco da ANS com os novos crit\u00e9rios est\u00e1 na seguran\u00e7a do consumidor com o seu plano de sa\u00fade. A proposta \u00e9 que o benefici\u00e1rio seja menos afetado em raz\u00e3o da rela\u00e7\u00e3o desfeita entre a operadora e o prestador. Esta proposta de normativo \u00e9 fruto de um cuidadoso trabalho de elabora\u00e7\u00e3o, que contou com intensa participa\u00e7\u00e3o social e amplo debate\u201d, afirma o diretor de Normas e Opera\u00e7\u00f5es de Produtos da ANS, Alexandre Fioranelli.<\/span><\/p>\n<\/blockquote>\n

> Confira o comunicado da ANS na \u00edntegra<\/a><\/p>\n

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A decis\u00e3o amplia a portabilidade de car\u00eancias e obriga a comunica\u00e7\u00e3o individualizada nos casos de mudan\u00e7as na rede hospitalar.<\/p>\n","protected":false},"author":1,"featured_media":6663,"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":[78],"tags":[95],"class_list":["post-6656","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-ans","tag-legislacao"],"yoast_head":"\nANS atualiza regras para altera\u00e7\u00e3o de hospitais nos planos de sa\u00fade<\/title>\n<meta name=\"description\" content=\"A nova regra da ANS amplia a portabilidade de car\u00eancias e obriga a comunica\u00e7\u00e3o individualizada nos casos de mudan\u00e7as na rede hospitalar.\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, 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