Healthcare Coverage - Minimum Mandatory Coverage List

This is a minimum list of some 5,000 procedures that must be covered by new private healthcare insurance plans, meaning those whose beneficiaries signed up after the promulgation of Law Nº 9,656.

Pre-existing Condition

Condition that must be declared by the beneficiary when signing the agreement with the plan. In this case, there is a waiting period of two years.

Cash bond requirement

Private health insurers can´t demand cash bond checks in collateral as a pre-condition for services.

Guaranteed Access to Healthcare (Periods and Network)

The ANS established periods of 7 to 21 days for health insurance and plans to make appointments. The private health insurer is bound to offer a professional in the specialty desired by the beneficiary, even if not the practitioner of preference.

Urgency and Emergency

These are procedures that imply immediate risks to life or irreparable injuries to patients, including those resulting from personal accidents or complications during pregnancy. Outpatient plans must ensure urgent and emergency coverage, limited to the first 12 (twelve) hours of healthcare services.

Program for Health Promotion and Risk and Disease Prevention

ANS estimulates insurers to promote a change in the healthcare system model, upgrading the quality of life of healthcare plan beneficiaries.

Supervisory intervention for healthcare issues

When the private health insurer presents serious administrative abnormalities that endanger the continuity or quality of the healthcare, ANS can establish a direct intervention for 365 days at most to solve these problems.



ANS - Agência Nacional de Saúde Suplementar - Av. Augusto Severo, 84 - Glória Rio de Janeiro/RJ - Brasil - CEP: 20021-040