ANS publishes new rules for the constitution of Technical Provisions for Health Plan Operators

March 6th, 2023

On March 02, 2023, the National Supplementary Health Agency (“ANS”) published normative resolution No, 574/2023 (“NR No. 574/2023”), establishing new criteria for the incorporation of Technical Provisions to be followed by Private Health Care Plan Operators. Benefits administrators are not subject to this NR.

The Technical Provisions refer to amounts accounted for in the operator’s liabilities, which represent expected obligations resulting from the health plan operations. NR divides these provisions as follows:

Provisions for unreported events/losses (“PEONA”);
Provisions for unreported events/losses related to the Brazilian Unified Health System (“PEONA SUS”);
Provisions for events/losses to be settled (“PESL”);
Provisions for remission;
Provisions for unpaid premiums/compensation (“PPCNG”);
Provisions for insufficient premiums/compensation (“PIC”); and
Other necessary technical provisions for the maintenance of the economic-financial balance of the operators.

RN no. 574/2023 introduces specific requirements for each of the provisions mentioned above, by establishing how these requirements must be incorporated and calculated and pointing out the differences to be taken into consideration by large, medium, and small operators, as applicable.

Among the changes introduced by the new rule, the most important concern is the rules for calculating the Insufficiency Factor for Compensation/Premiums (“ICF”). From now on, the calculation will be based on the lowest amount obtained within 12 and/or 24 months of the operators’ activities, instead of being based solely on the last 12 months of the operators’ activities.

After RN No. 574/2023 is published, Normative Resolutions No. 393/2015, 442/2018 and 476/2021 are repealed.

NR No. 574/2023 will enter into force on April 03, 2023.

Demarest’s Life Sciences team is monitoring the updates in the industry and is available to provide any further clarifications that may be necessary.