ANS National Supplementary Health Agency. It is the regulatory agency linked to the Ministry of Health responsible for the health sector in Brazil.
Conselho Administrativo de Defesa Econômica, Brazil’s antitrust agency.
Cash Medical Accounts
Corresponds to medical care expenses adjusted by (i) the provision for reimbursement of SUS, (ii) IBNR, and (iii) depreciation and amortization.
Percentage paid for each medical service in addition to the monthly payment.
Refers to the nonpayment by health plans of amounts related to the services, medications, materials or fees charged by providers (hospitals, clinics, laboratories and others) and autonomous healthcare professionals.
Health Maintenance Organization, which offers employers or groups a solution for all the healthcare needs of their employees or members at lower costs negotiated with specific doctors, hospitals and clinics. These specific providers must be used by the employee at the lower rates to be offered to the health insurance plan.
General complaints index. Its purpose is to present a behavior thermometer of the sector’s operators in attending to the problems pointed out by the members. It includes the average number of complaints from members received in the previous three months and classified up to the data’s date of extraction. The index is based presented per 10,000 members.
Provision of events occurred but not reported. Provision for payment of events that have already occurred and were not informed to the company before the end of the period, which was constituted based on actuarial methodology.
Initial Public Offering.
Minimum adjusted equity. In order to operate in the healthcare market regulated by the ANS, the health plan operator must keep the adjusted shareholders' equity for economic purposes as established by the ANS. Minimum adjusted equity is calculated as equity less non-current intangible assets, tax credits arising from fiscal losses, deferred sales expenses and prepaid
Medical care ratio
Index that shows the relationship between healthcare expenses and total revenues from healthcare operations (effective payments).
National Accreditation Organization
It is a non-governmental and non-profit entity that certifies health services quality in Brazil, focusing on patient safety.
Outstanding claims reserve. Provision for the collateral of events that have already occurred, recorded in the accounts and not yet paid. The accounting record is made at the full amount informed by the supplier or member when the charge is presented to the entity, and is subsequently adjusted for glosses and discounts after company’s evaluation (medical auditors).
Provision for doubtful accounts – Provisions recorded as expenses even though they have yet to be incurred. A provision is accrued when a company creates a reserve representing the expected loss of an asset or an estimated expense.
Preferred Provider Organization, which offers lower costs to billed members in their health insurance plans. Similar to an HMO, except that employees or members may choose the physician of their preference instead of being limited to HMO providers. A member may choose between a member and a provider that is not a member.
Provision for SUS
Charges for the use of SUS by the members of the operator.
Refers to the Company’s cash balance held with the ANS to cover technical provisions.
The greater of (a) 20% of considerations in the last 12 months or (b) 33% of the annual average of events in the last 36 months, multiplied by the percentage of deferral, in accordance with the curve provided by the ANS.
Solvency margin. At a pre-established price, it corresponds to the adjusted shareholders' equity sufficiency to cover the greater of the following amounts: (i) 20% of the revenues from the gross payments or (ii) 33% of the last 36 months events annual average.
Sistema Único de Saúde, Brazil’s public healthcare system, which was inspired by the British National Health Service.
Unearned premiums reserve. It is characterized by the accounting record of the charged by the operators to hedge contractual risk proportional to the days not yet elapsed within the monthly coverage period, to be appropriated as revenue only in the subsequent period when the term is actually incurred.