Plano de saúde com coparticipação: afinal, como funciona?

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A saúde de alguém não tem preço, principalmente se ela representa sua marca. No entanto, as companhias vêm perdendo a capacidade de manter esse benefício e, erroneamente, deixam de oferecê-lo. Mas como solução, elas podem oferecer o plano de saúde com coparticipação.

Você sabia que, depois do salário, o plano de saúde é o benefício mais valorizado pelos colaboradores de uma empresa? Do ponto de vista estratégico, as empresas compartilham da mesma opinião — afinal, a manutenção da saúde dos funcionários oferece assiduidade, tranquilidade e produtividade para as organizações.

Continue a leitura e saiba como ele funciona.

O que é plano de saúde com coparticipação?

O plano de saúde com coparticipação é uma modalidade de pagamento diferente daquela tradicional, em que um valor fixo de mensalidade é pago por mês. Aqui, o colaborador paga, além da modalidade do plano, uma parte da despesa pelo atendimento prestado. Vamos detalhar!

A cobertura desse tipo de plano de saúde é a mesma de um tradicional, no entanto, ela se revela menos custosa para pessoas e empresas. Muitas companhias e colaboradores pagam mensalmente planos de saúde que são caríssimos e que raramente são usados.

Na coparticipação, o profissional paga uma taxa toda vez que realizar uma consulta ou exame. O custo muda de uma operadora para outra e pode ser cobrado tanto em valor fixo quanto percentual. A determinação parte do plano de saúde e deve ser contemplada em contrato.

No caso dos planos de saúde tradicionais, o colaborador consegue realizar todos os procedimentos previstos em contrato — sem que aconteçam cobranças extras. O fato é que esse tipo de plano se revela caro demais e, quando é assumido na totalidade pelo profissional, pode não caber no orçamento familiar.

Como funciona um plano de saúde com coparticipação?

plano de saúde com coparticipação

Podemos comparar o funcionamento de um plano de saúde com coparticipação com um seguro tradicional. Quando as mensalidades são pagas, o colaborador tem o direito ao atendimento médico em toda a rede credenciada prevista em contrato. Diante da necessidade de consultas e exames, uma parte do valor é pago por fora.

Essa é uma forma de reduzir os custos dos planos de saúde — tanto para empresas quanto colaboradores. Mas, antes é importante constatar se todas as necessidades dos colaboradores serão atendidas.

Essa diferença faz com que o plano de coparticipação seja mais barato do que o tradicional. Logo, quem não precisa ir ao médico frequentemente e também não faz tratamento contínuo para algum problema de saúde consegue gastar menos por meio da coparticipação.

Vale destacar que as cirurgias e internações não têm cobranças de valores a mais dos colaboradores que fazem parte do plano de saúde com coparticipação.

Quais são as vantagens do plano de saúde com coparticipação?

A principal vantagem desse plano é o seu custo mensal. Para aqueles que pouco usam e não precisam de muitas consultas e exames, o valor sai mais em conta. Outra vantagem é a possibilidade de dividir os gastos por um maior período de tempo.

Nos casos em que não há urgência, o beneficiário pode programar as consultas, exames e procedimentos ao longo de um bimestre ou semestre, por exemplo. Assim, ele paga menos taxas e consegue amortecer o impacto dos gastos no bolso, já que o pagamento acontece uma vez por mês.

Como existe um valor máximo de coparticipação para todos os procedimentos pagos, o beneficiário pode acompanhar o uso do plano por meio do canal de atendimento disponibilizado pela operadora. No fim de cada mês, o valor total do plano é gerado para o pagamento.

Todos os beneficiários do plano de saúde com coparticipação são informados sobre o valor máximo da cobrança — o que ajuda a manter o controle dos gastos e a fiscalização daquilo que foi estabelecido em contrato. Aliás, é muito importante ficar de olho nas cláusulas e detalhes apresentados nesse documento.

Por que é importante ficar atento ao contrato?

Quando a empresa opta pela contratação do plano de saúde com coparticipação, ela precisa ficar muito atenta ao que dispõe o contrato do serviço — inclusive com os valores e reajustes repassados para os beneficiários . Por isso, compare as opções disponíveis para ver a mais adequada à realidade da sua companhia.

Solicite à operadora do plano todas as informações necessárias, para que uma análise minuciosa seja feita. Peça a tabela utilizada como base para calcular os valores das consultas, exames e procedimentos com coparticipação. Verifique também a periodicidade das alterações.

Um canal também deve ser disponibilizado para o acompanhamento do uso do plano, tanto pelo colaborador quanto pela empresa — no caso de ser a responsável pelo pagamento da mensalidade. Um extrato deve mostrar as datas dos procedimentos, as respectivas descrições e os prestadores responsáveis.

O plano de saúde com coparticipação se revela um importante aliado na redução e controle de custos das empresas. Ele também pode ajudar a controlar o índice de sinistralidade nos planos de saúde. Por isso, deve ser uma opção considerada antes de reduzir o benefício ou cancelá-lo.

Deixe seu comentário a seguir contando como é o plano de saúde da sua empresa. Ele tem coparticipação ou segue o modelo tradicional? A 2easy conta com a melhor consultoria e gestão de saúde!

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