The National Supplementary Health Care Federation FenaSaĂşde is the association of 20 leading health insurers, HMOs and group dental plans, and is one of the federations that constitute the National Confederation of General Insurance, Private Pension and Life, Supplementary Health and Capitalization bond Companies (CNseg).
17
Large groups represented
20
Member companies
7
Health insurers
9
HMO
4
Dental plans
24.6 Million members
1
Insurance Market Premiuns by segments - 2017 17% 5%
42% 36%
General Insurance
Capitalization bond
Insurance Market
2 1
“Health & Dental Plans has a 42% share of the Insurance Market’s overall premium.” Sources: DIOPS - ANS/Susep/FenaSaúde
Life & Pensions
Health & Dental Plans
Annual Premium Income (R$ billion)
General Insurance
70.8
Capitalization bond
20.8
Life & Pensions
155.6
Health & Dental Plans
183.4
Total
427.0
FenaSaúde Members At December 2017
39.1 %
Share in premiums
39.8 %
Share in claims
49.4 % 18.2 %
share of total members
membership growth of health plans in last five years
dec17/dec12
30.6 %
membership growth of dental plans in last five years
dec17/dec12
71.7
billion reais in premium income in 2017 (12.4% growth over 2016)
71.9
billion reais in total expenditures (Claims + SG&A) in 2017 (10,4% growth over 2016)
60.0
billion reais claims in 2017 (11.4% growth over 2016) 3 1
Regulatory framework The Health & Dental plans market in Brazil is regulated by the Health Plans Law - Law 9.656/98, which established the industry’s main requirements. The regulatory framework required strict practices and rules for the Health & Dental Plans operators. Among such rules, the following are worth of notice:
Rate Increase caps | individual plans
10 Standard age bands and rules regarding age band rate increases
No unilateral termination of contracts by Health & Dental Plan operator | individual plans
No age band rate increases for individuals older than 60
Rules & Limits for grace periods Standard product (health & Dental) segmentation
4
No risk selection by age and health condition Rules for retirees and dismissed workers regarding continuation of coverage under employer’s plan.
The role of the National Supplementary Health Agency | ANS The National Supplementary Health Agency (ANS) is the regulatory agency responsible for the sector. It is linked to the Ministry of Health with autonomy pursuant to the legislation that created lit - Law 9.961/2000. Its function is to promote public interest advocacy in Supplementary health care, regulating and overseeing health & dental plan operators, health insurers and benefits administrators, including their relationships with service providers and consumers.
5
dental plans market of Brazil’s 2017 GDP
209 billion in total gross premium income
70 million
Brazilians with guaranteed access to medical and dental services
199 billion total expenditures (claims and SG&A)
184 billion
in net premium income
151 billion
The Health & Dental Plans Market in Brazil The Brazilian Supplementary health market is among the largest private systems in the world. 6
in health care expenses
83.6% loss ratio
in the health plan business
54 %
of health spending in Brazil is private
Source of the data: ANS and FenaSaĂşde / Last 12 months ending in 4Q17
2 .8 % is the share of the health &
Active Operators with benefits according to T ype Type
Operators with members
Self-insured
160
Medical Cooperatives
295
Not for profit Organizations
45
HMO
255
Heath Insurers
9
Dental Cooperatives
105
Dental Plans
186
TOTAL
1,055 Source: TABNET - ANS – extracted in August/18
69.8 million members | 80.9% group plans and 18.8% individual plans
47.2
million
members with health coverage
22.6
million
members with dental coverage 7
Share of Beneficiaries by Contract T ype
Medical Coverage
Source: TABNET - ANS – extracted in August/18.
Dental Coverage 17.4%
19.5%
8.3% 13.6%
Group
8
66.6%
74.2%
Affinity
Individual & Family
What’s returned to society: the performance of Supplementary Health Care Health & Dental plan operators are responsible for organizing the mutual system upon which the functioning of Supplementary Health Care is based. It is this solidarity system that allows members access to treatments and therapies that few could afford to pay directly, which gives it great social significance. Supplementary Health & Dental Care helps improve quality of life and contributes to raising the population’s life expectancy. Furthermore, it also stimulates the creation of new markets and jobs.
9
DATA FROM 2017
23.4% 1.5
of the elderly in Brazil have private health care plans
billion
medical and dental procedures per year
270
million
physician appointments per year
521
thousand
births per year
817
million
exams per year
8.0
million
in-patient events per year
33
million
radiological exams per year
3.4 8.0%
million
jobs
of Brazil’s workforce Source: IESS - Dec/2017
78.4% or
311
thousand
physicians work in the private sector
data from Demografia MĂŠdica [Medical Demographics) in Brazil 2015
138
thousand
134
thousand
outpatient clinics
hospital beds
Source: CNES/MS/December/2017
Source: CNES/MS/December/2017
11
Mission Our mission is to contribute to the consolidation of the private health care market through exchanges of experiences and evaluations of topics of common interest, the development of proposals for the growth and improvement of the market and our strengthening as an institutional representative of the private Supplementary health care providers.
12
FenaSaúde The Federation is chaired by Solange Beatriz Palheiro Mendes. The current Supervisory Board, elected in February 2016 for a three-year term, is composed of 14 representatives of FenaSaúde’s membership. fenasaúde’s board
VOCÊ SEMPRE B E M.
www.fenasaude.org.br
version: October 2018
Learn about FenaSaúde’s activities at