Entendendo a sinistralidade do plano de saúde corporativo

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plano de saúde empresarial é um diferencial na hora de atrair talentos para uma posição dentro da sua organização. Também contribui para reter quem já faz parte da equipe. No entanto, precisamos entender um conceito que o envolve: a sinistralidade do plano de saúde.

Toda vez que o plano de saúde é acionado, isso se caracteriza como um sinistro. Sendo assim, a sinistralidade é equivalente à contabilização de ocorrências. É composta, portanto, pela relação entre custos e receitas da operadora.

Este artigo explica como funciona a sinistralidade no plano de saúde, conheça os principais fatores que a influenciam e quais são os programas de prevenção à saúde que ajudam no controle dessa contabilização de ocorrências. Acompanhe!

Por que controlar sinistralidade no plano de saúde?

Cada vez que o colaborador utiliza o seu plano de saúde para marcar ou executar qualquer procedimento — consultas, exames ou cirurgias — isso significa que houve um sinistro. O total de sinistralidades do plano de saúde é representado por um percentual. 

Quando há excessivas realizações, consequentemente ocorre um aumento nos custos da operadora. No entanto, esses custos são repassados para a organização por meio de reajustes anuais. Por esse motivo há a necessidade de controlar as sinistralidades.

Quais são os fatores que contribuem para as sinistralidades?

A utilização em excesso do plano de saúde é um dos fatores que contribuem para o aumento de sinistralidades. Por mais que ele pareça ser inesgotável, isso não é verdade.

Eventos de alto impacto, como as internações prolongadas em UTI, as complicações durante os partos e o surgimento de doenças agressivas também representam uma elevação nos custos da operadora do plano.

Por mais que as catástrofes não possam ser prevenidas ou evitadas, outras situações estão associadas ao estilo de vida e comportamento do colaborador.

Outro fator é a diminuição no quadro de funcionários — uma realidade vivida por muitas empresas atualmente por causa do novo coronavírus. Situações assim elevam a taxa de sinistralidade e, consequentemente, as despesas com o plano de saúde.

Quando há a redução no número de pessoas que estão no plano, diminui-se o prêmio pago. E se elas aumentam a utilização dos serviços, os gastos se tornam ainda maiores.

Como os programas de prevenção à saúde podem ajudar no controle da taxa de sinistralidade?

fotografia de profissionais realizando exames de prevenção de saúde para evitar o crescimento da sinistralidade do plano de saúdeCampanhas internas podem ser úteis para estimular o autocuidado dos colaboradores e evitar altos custos na sinistralidade do plano de saúde. 

Os programas de prevenção à saúde podem estimular os check-ups e exames preventivos, que verificam o bem estar do colaboradores e evitam a utilização do plano de saúde corporativo somente quando a situação já está grave.

Os cuidados com a saúde do trabalhador geram inúmeros benefícios para eles e para a empresa. Quando se investe no bem-estar do colaborador, a organização ganha um aumento tanto na produtividade do dia a dia quanto na qualidade de vida dele.

Esses programas também podem promover os benefícios das atividades físicas, que ajudam na melhora do condicionamento físico. Dentre as ações possíveis, destacamos as parcerias com as academias e a inclusão da ginástica laboral no ambiente de trabalho.

A alimentação saudável também deve ser promovida, pois ajuda a prevenir doenças como obesidade, diabetes e hipertensão. Palestras podem sanar dúvidas e orientar os colaboradores para uma rotina mais sadia.

De que maneira a tecnologia está presente nesses processos?

fotografia de profissionais analisando a sinistralidade do plano de saúdeCom o auxílio da tecnologia o controle e acompanhamento dos relatórios de sinistralidade do plano de saúde se tornaram mais simples e ágeis.

A gestão dos programas de saúde a favor do controle da taxa de sinistralidade necessita de ações automatizadas. Elas ajudam, por exemplo, na identificação de irregularidades nas cobranças.

Quando essas irregularidades são evitadas, a organização consegue impedir que certos reajustes sejam aplicados. Trata-se de um ganho imediato e muito importante. Além disso, torna os processos mais fluidos.

A tecnologia também facilita o manuseio dos dados armazenados, pois consegue coletar e analisar uma quantidade infinitamente superior em relação a capacidade de qualquer analista.

A equipe de Recursos Humanos passa a ter acesso às informações para consulta e gerenciamento, reforçando o controle da taxa de sinistralidade do plano de saúde corporativo.

Também é importante destacar que esses dados servem de apoio para as decisões dos gestores da companhia.

A tecnologia também pode auxiliar no controle e análise da sinistralidade por meio de uma eficiente consultoria e gestão de benefícios.

Sua empresa pode contratar com uma Gestão completa de Benefícios . Assim, tem à disposição uma equipe de profissionais técnicos e especializados que estão preparados para analisar e oferecer os melhores planos de saúde e benefícios corporativos.

Eles também contribuem para a gestão de seguro de vidaassistência odontológica, vale-transporte e cartões do Programa de Alimentação do Trabalhador (PAT), realizando a movimentação cadastral, os processos de reembolso, o controle e conferência de faturas e o acompanhamento da taxa de sinistralidade.

A 2easy possui uma equipe preparada para fazer a consultoria e gestão dos benefícios da sua empresa. Conte com o apoio dos nossos profissionais para atrair e reter talentos por meio das melhores decisões!

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