Análise dos aspectos atuariais das alterações no rol de procedimentos da Agência Nacional de Saúde Suplementar

Abstract

The supplementary health sector in Brazil is crucial for access to health services and is regulated by the National Supplementary Health Agency (ANS). Law 14.454, enacted on September 21, 2022, altered the ANS Procedures List, making it exemplary, which allows the inclusion of new exams and treatments not initially listed. This study aims to analyze the actuarial aspects of the changes in the ANS Procedures List before and after this law, focusing on the impact on risk management for health operators, particularly regarding revenues, expenses, premium adjustment calculations, and beneficiary behavior. Using both quantitative and qualitative actuarial methods, the analysis seeks to understand how the transition to an exemplary model affects cost predictability and the financial sustainability of health operators. The expected results should provide insights for more efficient and sustainable management, helping operators understand and evaluate the impact of regulatory changes, and promoting a better understanding of the specifics of supplementary health in society.