The Government established that patients with closed health plan options can request coverage, subsidies, or reimbursements for practices and medications by presenting prescriptions from doctors on the corresponding list. The measure was published in the Official Bulletin in Resolution 3934/24.
In the context of changes in the private health system, prepaid healthcare providers are allowed to limit coverage for members of closed medical plans. Beneficiaries can choose between coverage through providers on the list or external ones.
It is essential to ensure that practices and medications are prescribed exclusively by doctors included in the lists to avoid inconsistencies and financial risks. Resolution 3934/24 establishes that only professionals on the list are authorized to prescribe medications and treatments to request coverage.
The measure aims to ensure an efficient and equitable allocation of resources within the private health system. Beneficiaries of closed plans must consult with professionals from the list or switch to more expensive plans starting this Tuesday.
According to the Superintendence of Health, the measure seeks to reduce litigation and guarantee a balance within the health system. The new regulation also prevents the triangulation of funds between prepaid healthcare providers and social security institutions.
Prepaid healthcare providers must register in the Health Insurance Agents Registry to stop triangulating funds with social security institutions. Coverage in closed plans will depend on prescriptions from doctors on the corresponding Health Insurance Agent's list. This condition is mandatory for requesting coverage, subsidies, or reimbursements.
The measure aims to ensure the sustainability of the system and avoid deviations in the allocation of health resources. The Government believes that limiting coverage to list professionals will improve efficiency and equity in medical care for beneficiaries of closed plans.
