So that we can scale the excerpt from 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 NR.
Before designing any development, we highlight in essence the second paragraph of Article 4: Chapter II (On the Governance of Operators)
Article 4 The governance practices and structures adopted by operators must consider the following principles:...
II — Equity: fair and isonomic treatment of all owners, operators' beneficiaries and other interested parties, taking into account their rights, duties, needs, interests and expectations.
One of the main risk factors they 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 assistance services to its beneficiaries, establish appropriate prices, and carry out actuarial and cost analysis in an appropriate manner.
The ANS established, through the RN 259/11 And from IN/DIPRO No. 48/15, the Service Guarantee Monitoring, in order to verify that the Beneficiaries are having access to the coverage contracted with the operators.
The verification is carried out every quarter by monitoring certain parameters, such as the frequency of complaints received by ANS referring to non-compliance with the maximum deadlines for consultations, exams and surgeries, or even denial of care coverage. Therefore, in the event of a possible non-compliance, there are sufficient regulations so that ANS determine the suspension of the sale of the Company's services, which may have an adverse impact on its operations.
In the face of possible risk exposures mentioned or not mentioned in this article, we stress the importance of increasingly integrating risk management and controls to the operational layers, as well as to adequately explore other information mechanisms, such as: reporting channels, customer service records (SAC), among other important sources for mitigation of corporate risks.
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