It started to take effect this Thursday, 1st, 69 new mandatory coverages in the list of procedures for health insurance, according to Normative Resolution No. 465/2021. RN also updates the list of consultations, exams and treatments that health plans are obliged to offer, according to assistance segmentation – outpatient, hospital with or without obstetrics, reference or dental.
The list includes 19 oral medications covering 28 indications for the treatment of various types of cancer; 17 immunobiologicals with 21 indications for the treatment of inflammatory, chronic and autoimmune diseases, such as psoriasis, asthma and multiple sclerosis; 1 medicine to treat a disease that leads to bone deformities; and 19 procedures between exams, therapies and surgeries for diagnosis and treatment of diseases of the heart, intestine, spine, lung, breast, among others.
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There are also other updates to improve the wording and consolidate rules foreseen in understandings already disclosed. These are changes in the Usage Guidelines (DUTs) and the improvement of descriptive terms for procedures already listed in the list.
The coverages are valid for beneficiaries of health plans contracted from January 2, 1999, the so-called new plans, and for users before that date, but which have been adapted to the Law of health plans.
To define the new procedures that become part of the coverage list, the National Health Surveillance Agency (ANS) evaluated a set of criteria, such as proven clinical benefits, alignment with national health policies and the relationship between the cost and effectiveness of technologies.
According to the ANS, the incorporated procedures are those in which the collective gains and clinical results are the most relevant for all patients.
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