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HEALTH INSURANCE FOR PEOPLE WITH DIABETES: HOW DOES IT WORK AND WHAT ARE THE ADVANTAGES?

    People with diabetes need constant health care for guidance, consultation, treatment or even interventions if necessary. Thus, the demand for health insurance for those with diabetes is universal, as there are millions of people with this condition.

    For the purposes of inclusion in a health plan, diabetes is classified together with injuries or pre-existing diseases, according to the rules applicable in Brazil. The beneficiary, therefore, must declare his/her condition as a person with diabetes at the time of hiring.

    Read on and find out how the health plan works for those with diabetes!

    How important is health insurance for people with diabetes?

    Syringe and medical drugs for diabetes, metabolic disease treatment

    According to the Atlas IDF-2017 , of the International Diabetes Federation (IDF – International Diabetes Federation ), Brazil is the fourth country with the most cases of diabetes. Furthermore, an estimated 40% of the entire patient population in Latin America is unaware that they have the condition.

    People with diabetes need medical follow-up or examinations more frequently. Although the condition can be under control, one must be aware and be able to act whenever necessary.

    In most cases, food control with good nutritional guidance and healthy habits such as physical activity are enough to have quality of life. However, a health plan is indispensable and needs to be accessible for when there is any need.

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    Thus, common exams and more complex exams may be necessary and a health plan covers these demands. In turn, the guidance of a Nutrition professional is essential to lead a normal life, taking care of diabetes .

    In more complex situations, surgical interventions may be necessary, as well as medication for advanced treatments. For all these reasons, the person with diabetes should not do without a health plan. The person must always seek good guidance .

    How does it work and what are the rights of the person with diabetes in the health plan?

    From Law No. 9,656/1998 and its numerous amendments over the years, access to health plans for people with injuries or pre-existing diseases started to be regulated. To this end, in 2007, the National Supplementary Health Agency (NSA) published the normative resolution RN No 162/2007 .

    Thus, the NSA began to regulate the form of access to the health plan for people with diabetes or other pre-existing conditions. In order to have this right for everyone, however, it is necessary to declare the real condition at the time of contracting the plan, by completing the Health Declaration.

    In turn, the person interested in the health plan must choose between two forms of contracting: temporary partial coverage and contract grievance. See the features of each.

    Temporary partial coverage

    Young diabetic woman having breakfast at home.

    Temporary partial coverage is a form of restriction applicable to hiring a health plan in cases of injury or pre-existing illness. This limitation can be maintain for a period of up to 24 months. This is from the subscription or contractual adhesion to the plan.

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    Therefore, it is an authorized grace period for conditions declared to exist before contracting. However, the restriction can only be applied in 3 situations:

    • surgeries;
    • high-tech beds;
    • highly complex procedures (defined by the ANS).

    In these cases, it is essential to clarify that, in all situations that arise, access can only be restricted when directly related to the declared condition. At the same time, after the grace period, access will be free and without the need for any additional charge.

    Coverage with grievance of contract

    Coverage with injury consists of an increase in the monthly fee of the health plan. The objective is that the contracting party, even if in a declared pre-existing condition (such as diabetes), can have full coverage of the contracted plan.

    This is the customer’s option, being freely negotiated between the operator and the beneficiary. This model must be govern by a specific contractual amendment. It must define the percentage or value, as well as the period of validity of the grievance.

    What are the benefits of a health plan for people with diabetes?

    Before considering the advantages that a health plan can provide, it is important to highlight the needs. People with diabetes may have specific demands resulting from the condition and development of diabetes.

    As we have seen, for these beneficiaries, being able to have routine or specialized medical consultations already characterizes the importance of a health plan. However, there are several advantages that may be available when hiring, such as:

    • availability of routine or emergency medical consultation;
    • availability of medical consultation in several specialties;
    • nutritionist guidance and follow-up;
    • counseling and follow-up by a psychologist;
    • access to laboratory tests;
    • right to certain essential surgical procedures.
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    It is important to emphasize that, although it is not yet on the ANS list, the supply of the insulin pump and the respective supplies is an obligation of the health plan. This situation is consolidated in numerous court decisions across the country.

    How to choose the best health plan for people with diabetes?

    Hiring a health plan requires some care so that expectations can be meet to the extent of each person’s possibilities. In the case of people with diabetes, other details must be consider when choosing.

    Thus, even if the person’s current situation is in control with healthy habits and adequate food, consider the future possibility of needing hospitalization. Thus, it is necessary to take this type of coverage into account when choosing a health plan.

    Another aspect to consider is the requirement for temporary partial coverage. In this case, the operator may not require the grace period or reduce the period to less than 24 months.

    Of all the precautions that a person with diabetes must take when hiring a health plan, the main thing is to have good advice. With this, it is possible to evaluate the most adequate plans to the individual condition and within the person’s reality.

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