“The plans do not include medicines worth 10 million reais”

According to CEO Sami Foguel, the product focuses on small and medium-sized businesses (SMEs), with up to 99 employees.

Although they concentrate the majority of Brazilian formal jobs, these companies have historically struggled to offer this advantage to teams. Thus, the Lean coverage contract costs 45% less than traditional business plans, he calculates.

The accredited network includes hospitals such as Icaraí, Nossa Senhora do Carmo and Rede Casa, located in the neighborhoods of Bangu, Barra da Tijuca, Campo Grande, Centro, Humaitá, Ilha do Governador, Santa Cruz and Tijuca, in the capital of Rio de Janeiro, in addition to São Gonçalo, Niterói, Petrópolis and Teresópolis.

In an interview with GLOBO, the manager says he believes that the product can occupy the space left in the Rio de Janeiro market by Golden Cross, liquidated by the National Complementary Health Agency (ANS), and attract users who left Unimed-Ferj, in crisis. Foguel also rules out the possibility of Porto selling individual contracts “while the adjustments are regulated”.

How does the Porto Bairros line plan work?

The idea is a microregional plan, in which each holder, from a list of 12 districts, chooses four, and in each of them there is a hospital and laboratory approved to provide care. After all, how many hospitals do you use in your life? Typically, people have referral hospitals close to their home or work. That’s why we created this innovative product. It is about individual customization, where each employee, based on their needs and those of their dependents, chooses what suits them best.

This model may raise questions about access restrictions. What happens if the patient needs to undergo a test or procedure that is listed but not provided by the accredited hospital or laboratory?

In this case we have other associated hospitals. The plan obviously covers the whole list. But certain specialties are a little rarer, such as maternity, but we have support partners for these cases. The user simply needs to search for the operator through the app.

• More: Fleury expands its operations in an outsourcing model for small laboratories

And how do queries work?

Beneficiaries have access to the entire medical team from Porto to Rio. Today, we have our own doctors and also an accredited network.

SMEs have traditionally struggled to offer team benefits, particularly health benefits, due to their high cost. Is this a way to guarantee access to these companies?

Undoubtedly. If we think about our traditional packages, those in Porto Bairros are up to 40% more economical, and making them cheaper increases access. Unlike traditional products, in which a large part of the customers come from another operator, in Porto Bairros there is an aspect of insurance inclusion. About 45% of our corporate clients in São Paulo using this product did not have a plan before. There are restaurants, accounting offices, butchers, small shops.

Are there plans to replicate this model in other regions?

It depends on the region. São Paulo and Rio work well because they are large cities and have considerable geographic dispersion. Which does not mean that this concept of modularity cannot be applied elsewhere.

• In Sao Paulo: Rede D’Or Reaches Million Dollar Maternity Deal With Brazil’s Most Luxurious Room

Porto’s new plan adds to a movement of operators betting on smaller networks, exclusive agreements, combinations with digital services. Is there a reconfiguration of the sector?

Fully. In recent years we have seen SulAmérica, which was an independent operator, being sold to Rede D’Or; Allianz ceased operations in the country; Amil and Dasa created (in partnership) the Ímpar network; and Bradesco and Rede D’Or created Atlântica D’Or. There is a lot of consolidation and change. It’s a tough market.

He believes that this product can occupy the space left by Golden Cross in the Rio market and also attract landed users from Unimed-Ferj?

Undoubtedly. When we launch a product, we don’t have this competitive objective, but I think it will appeal to part of the population who were on these two operators. Not that they are alone, but I would be very happy to attract them, as well as entrepreneurs who do not grant this advantage to their employees.

• Unimed do Brasil takes over Unimed Ferj users: What changes in the service? How is the network accredited? Clear your doubts

Consumers, experts and the National Complementary Health Agency (ANS) defend the resumption, by operators, of the sale of individual packages. Is it on Porto’s radar?

As long as the adjustment is governed by the NSA, no question. In 2014, we had 51 million people with health insurance. There are now 53 million. The country has developed; subsequently, the penetration of complementary health care decreased. And these 53 million users, or 25% of the population, consume 65% of all health resources. I understand that there is a very elitist mentality when it comes to complementary health, which is to have this very broad plan, with an “intergalactic” list, where everything fits, and which is actually becoming more and more expensive and restrictive.

• “If the time comes to impose regulation on health plans, we will impose it,” said the president of the ANS

There should be space for dialogue. The paths taken over the past ten years have clearly not been successful. There would be intelligent ways to bring the individual back (on the market). For example: if there was an individual pool, as there is an SME pool, in which each operator would make an annual adjustment according to their pool. And what would be the amount of this adjustment? Everything that was needed. This could be an alternative; there may be others. But as long as there is government regulation, we will have no appetite for individuals.

What are Porto’s expectations in the face of the STF’s decision, which increased the rules for covering procedures outside the ANS list?

I think it brought a little more rationality to discussions about the role. This is a positive decision for the sector, because it provides criteria. There are interesting discussions on regulation, from the point of view of expensive drugs, for which the risk is not shared in the country (with the pharmaceutical industry). Obviously everyone wants to bring the best medicines, but most current health plans do not cover a 10 million reais medicine.

A few months ago, reports emerged that Porto was negotiating the entry of a minority partner in Porto Saúde. How did this happen?