Pool de risco : análise do impacto da resolução normativa nº 309/2012 em reajustes de operadoras de planos de saúde: um estudo de caso em um contrato

Abstract

This work deals with the adjustment of private health care plans of collective contracts with less than 30 beneficiaries. The purpose of this thesis was to analyze the implementation of Normative Resolution 309/12 in management adjustments of this type of contract. Based on current legislation, scenarios and methodologies of evaluation and adjustment calculation of a provider of health plan were presented. The tool used for the evaluation was the application of the theory of collective risk, which uses the concept of aggregate risk. It was found that the contract under 30 beneficiaries features a high risk to their own financial and actuarial balance. Two methodologies were proposed adjustment. A method of charging based on commercial prize and another based on pre-established goal of accidents. It was found that in both techniques the Risk Pool has lower rates of adjustment to the contract isolated and its dispersion is much smaller. We conclude that the Risk Pool contributes as a management tool, as well as inhibit the abusive application of adjustments, assists in retaining customers.