So that we can scale the section of the Normative Resolution 443 of 2019 (RN 443/19), related to equity in serving the interest group of a Health Plan Operator, we highlight some of the risk factors associated with this RN.
Before designing any development, we highlight the essence of the second paragraph of Art. 4: Chapter II (Governance of Operators)
Art. 4th The governance practices and structures adopted by operators must consider the following principles: ...
II – Equity: fair and isonomic treatment of all owners, beneficiaries of operators and other interested parties, taking into account their rights, duties, needs, interests and expectations.
One of the main risk factors are potential failures in the functioning of the Company's information technology systems, which may compromise its operations and adversely affect it. The Company's business depends on information systems to provide services to its beneficiaries, establish adequate prices and perform actuarial and cost analysis properly.
The ANS instituted, through the RN 259/11 and gives IN/DIPRO No. 48/15, Monitoring the Service Guarantee, in order to verify whether the Beneficiaries are having access to the coverage contracted with the operators.
Verification is carried out every quarter by monitoring certain parameters, such as the frequency of complaints received by the ANS regarding non-compliance with the maximum deadlines for consultations, exams and surgeries, or even denial of assistance coverage. Therefore, in an eventual non-compliance, there are sufficient regulations for the ANS determine the suspension of the commercialization of the Company's services, which could have an adverse impact on its operations.
In the face of possible risk exposures
cited or not in this article, we reinforce the importance of increasingly integrating the risk management and controls to the operational layers, as well as properly exploring other information mechanisms such as: complaints channel, customer service records (SAC), among other important sources for the corporate risk mitigation.
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