Health plan operators must follow new guidelines for relations with beneficiaries, according to Normative Resolution No. 623/2024 of the National Supplementary Health Agency (ANS), released this month. The changes represent an important advance in consumer protection by establishing clearer rules, defined deadlines, and accessible service channels.
Among the main points of the resolution are a series of obligations to make customer service more efficient and transparent. Operators are now responsible for handling requests that are not directly related to procedure coverage, allowing beneficiaries to track these requests online, and clearly disclosing all customer service and ombudsman channels on their websites.
Since July 1, 2025, operators have also been required to provide a protocol or registration number at the end of each service call, allowing beneficiaries to track the progress of their requests through the indicated channel.
In addition, they [the operators] must provide conclusive responses within the deadlines set by ANS and submit, in writing, the justification for any coverage denials, even if the consumer does not request this clarification. As a result, operators can no longer use generic terms such as “under review” or “in process,” which are so familiar to health plan beneficiaries, as they no longer meet the standards required by the regulations.
Benefit administrators are also subject to the new regulation and must comply with the relationship guidelines established by the agency, within the limits of their responsibilities to consumers.
Another important point is the mandatory provision of digital service channels, operating 24 hours a day, every day of the week, through platforms such as WhatsApp, websites, among others.
Finally, the resolution reinforces the role of the ombudsman within the operators. In addition to monitoring the resolution of customer service issues, the ombudsman must act to re-examine requests in cases of negative responses. Access to this channel must be facilitated, guaranteeing the beneficiary an effective review process.
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