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Factors that influence the cost and readjustments of health plans

The cost of health plans is determined by a series of factors involving the personal characteristics of the beneficiaries, specific characteristics of the plan, as well as economic and regulatory aspects. This cost is readjusted periodically, which is essential to maintain the sustainability of the services provided.

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Below, we detail the types of readjustments applied to health plans.

Health plan readjustments

The National Supplementary Health Agency (ANS) determines specific criteria for the readjustment of health plans, which can occur in two main ways:

Annual readjustment

This adjustment takes place on the anniversary of the contract and is based on the Variation in Medical and Hospital Costs (VCMH). When costs in the health sector increase, this has a direct impact on the cost of procedures, necessitating an adjustment in the monthly fee to ensure the viability of the services provided.

Adjustments by age group

As the beneficiary gets older, the monthly fee changes. The older the age group, the higher the cost of the plan tends to be. The ANS sets a maximum limit for this readjustment in order to protect consumers from excessive increases.

What factors influence the amount of the readjustment?

New procedures on the ANS list

Updates to the ANS list of procedures require operators to adapt by investing in technology and expanding coverage, which increases costs and impacts monthly fees.

Age of beneficiaries

The age of the beneficiary is one of the main factors influencing the cost of health plans. Older people generally face higher premiums due to the greater risk of illness and the need for frequent medical care.

Claims rate

The claims rate, which is the ratio between the total costs of the services used (claims) and the amount of monthly fees paid, influences adjustments, especially regarding business insurance. A high claims rate can lead to higher adjustments, which is why it is important to use your health insurance plan conscientiously.


The rules imposed by regulatory agencies, such as the ANS in Brazil, influence costs. This includes mandatory coverage for certain treatments and procedures.

In short, the cost and adjustments of health plans are influenced by a combination of factors. Knowing this helps beneficiaries to choose plans that best meet their needs and to prepare for possible price adjustments over time.

Here at Pryor Global, we work together with the best insurers and operators in the country to offer our clients a complete portfolio, with options that meet their needs and specificities. Talk to our team and see how we can help you choose the best benefits for your employees.

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