Health plan cancellation for nonpayment

Brazil’s National Supplementary Health Agency (ANS) has set new rules for the unilateral cancellation of contracts for nonpayment to be valid. Normative Resolution (RN) 593/23, which came into force on February 1, 2025, defines the criteria for canceling plans in which the plan member is responsible for payment. The RN covers:

• individual or family plans;

• collective employer plans contracted by sole proprietors;

• collective plans for former employees (dismissed and retired), public servants, members of self-managed health plans and those who pay a benefits administrator directly.

Main rules for cancellation

For the health plan to cancel the plan or remove a member for nonpayment, the following is required:

• there must be at least two overdue monthly payments, consecutive or not, within the last 12 months of the contract;

• the member must be notified of the nonpayment by the 50th day after the first missed payment, as a requirement for removal or termination of the contract.

Key points about payments

• Days overdue on monthly payments that have already been paid do not count as a period of nonpayment.

• If the health plan fails to collect the monthly payment through its own error (such as not issuing the payment slip or failing to process the payroll deduction or direct debit), the period of nonpayment will not be considered for cancellation.

• If the notice of nonpayment is received after the 50th day overdue, the member must have another 10 days to settle the debt.

How must the notice be given?

The health plan must prove that it notified the member of the nonpayment, recording the date and form of communication; otherwise, the termination or removal will be invalid. In addition, the health plan must state in the notice the deadline for paying the debt, which must be at least 10 days after the notice is received.

The accepted channels are:

Letter with proof of delivery (AR):no recipient signature required.
Personal delivery: with a receipt signed by the member.
Recorded phone call:including calls via IVR (interactive voice response), with data confirmation.
Email: with a digital certificate or read receipt.
Text message (SMS or WhatsApp):valid only if the member replies confirming receipt.

Fines and interest on debts

In case of late payment, health plans may charge:

• a fine of up to 2% on the amount owed;

• late-payment interest of up to 1% per month (0.033% per day), plus inflation adjustment, if provided for in the contract.

Special cases

1. Removal under collective contracts:in employer-sponsored or affinity-group collective plans, removal for nonpayment can only occur if provided for in the contract and with the knowledge of the contracting company.

2. Hospital stay: if the member is hospitalized under a plan with hospital coverage, the contract cannot be suspended or canceled for nonpayment until they are discharged. The cancellation notice can only be sent after discharge.

What to do if the charge is disputed?

If the member disagrees with the amount charged, they must question the health plan within the deadline for settling the debt. The health plan must respond to the dispute and grant a new 10-day deadline for payment if the charge is upheld.