Operation on the Supplementary Healthcare Market
The applicant company may start selling its products only after the pre-license for private health insurer operation has been granted.
Operator Contracts with a Network of Healthcare Providers
In 2003 and 2004, the National Regulatory Agency for Private Health Insurance and Plans established the contracting rules for the operators with healthcare service providers. These rules require that the legal instruments must clearly and accurately establish the conditions for their execution specifically in clauses that define the rights, obligations and responsibilities of the Parties.
Designation of Professional Staff
The ANS registers professionals to perform the functions of Intervenor for Financial and Economic Issues or Liquidator in various parts of Brazil. In order to be included in this listing, a professional must present a signed resumé describing his/her technical capabilities and professional experience, while also meeting the requirements defined in advance by the ANS.
Circumstantial Evidence of the Crimes of Money Laundering or Concealment of Rights and Values
Promulgated in 2005, Normative Resolution Nº 117 establishes steps intended to prevent and combat crimes of money laundering or concealment of assets, rights and values that must be complied with by private health insurers. These operators are bound to keep the registration information on their beneficiaries updated, including dependants, representatives, service providers, whether belonging or not to an accredited or referenced network, brokers, partners, shareholders, administrators and other customers, in addition to copies of documents supporting such information, without adversely affecting other requirements addressing specific regulations.
Types of Operation on the Supplementary Healthcare Market
Operators that are segmented in compliance with the provisions set forth in Articles 3 to 9 of this Resolution must be classified under the following types:
- benefits management organization;
- health maintenance organization (HMO);
- private health insurer;
- dental group;
- self health insured;
- medical cooperative;
- dental cooperative;
- nonprofit health insurer.
It is also worthwhile recalling that health insurance companies are also regulated by the ANS.
Supervisory interventions for financial and economic issues or for healthcare issues
The supervisory interventions for financial and economic issues or for healthcare issues can be decreed, depending on the severity of the case, when the ANS detects insufficient guarantees underpinning an even financial balance and severe administrative or economic financial anomalies, or severe administrative irregularities in a private health insurer, jeopardizing the continuity and quality of the services rendered to its beneficiaries.
Transfer of Corporate Control
Any corporate modification is considered as an alteration or transfer in corporate control that assigns to an individual person or corporate entity, or a group of persons or entities linked through a voting agreement or under common control, the status of controller, either directly or through other subsidiary companies, in a manner that ensures its permanent preponderance in corporate decisions and the power to elect the majority of the administrators, as set forth in brazilian law. Mergers, acquisitions and corporate splits or spin-offs of medical or dental self insured systems are subject to the provisions set forth in the specific standard on this topic.