By Brazil Stock Guide — Brazil’s private healthcare regulator, ANS, is keeping alive a proposal that could allow extraordinary premium increases for individual health plans that have become financially unbalanced.
Known in Brazil as a “technical review,” the mechanism would apply to individual and family plans purchased directly by consumers rather than provided through an employer. It could allow health plan operators — companies that sell and manage private health plans — to raise premiums above the ordinary annual adjustment set by the regulator in order to restore the financial balance of specific portfolios.
The issue regained attention following the release of ANS’s 2026–2028 Regulatory Agenda and reports that it could return to the agency’s board for discussion. The prospect has attracted investor interest because it could ease the burden of legacy portfolios that have been closed to new customers for years and are operating with high medical-loss ratios.
No change, however, has been approved. ANS has not denied that the technical review remains under discussion. What the agency has denied is that it has already decided to create a new rate increase, which in some cases could take the total annual adjustment to as much as 20%.
The distinction matters. The inclusion of the subject in the regulatory agenda means that it will continue to be studied. It does not mean that a rule has been approved, that the 20% ceiling will be adopted or that health plan operators are already entitled to impose extraordinary increases.
ANS’s response suggests that the proposal remains alive at the technical level but continues to face political, legal and possibly internal resistance, particularly in an election year. The existence of studies and draft regulations shows that the mechanism is being examined. The regulator’s public denial, however, reduces expectations that approval is imminent.
A technical review would allow ANS to authorize increases on top of the ordinary annual adjustment to restore the financial balance of specific individual-plan portfolios. Earlier drafts provided that the total adjustment, including the regular annual increase, could be capped at 20% a year and phased in over a period of three to five years.
It would therefore not amount to an automatic 20% increase for every member. Any adjustment would depend on the financial condition of each portfolio, approval from ANS and the eligibility criteria ultimately established by the regulation.
Brazil had approximately 8.45 million members enrolled in individual or family health plans as of March 2026. Of that total, around 7.70 million were covered by contracts signed from 1999 onward, after Brazil’s private health plans law took effect, while approximately 751,000 remained in contracts signed before the legislation.
An eventual technical review would not automatically apply to all of them.
The portfolios attracting the most attention from operators are not necessarily limited to contracts signed before 1999. They mainly consist of individual plans that stopped being sold many years ago and have remained closed to new customers.
As members in those portfolios age, and without younger customers entering the pool, some portfolios have reached a point at which medical claims and healthcare costs exceed the premium revenue collected from members.
Operators are therefore particularly focused on these closed legacy portfolios. Because individual contracts are subject to an annual rate cap set by ANS, some companies have struggled to fully pass through rising medical costs, especially in ageing portfolios that are no longer open to new customers.
BTG Pactual said in a research note that Amil could be the largest relative beneficiary of an eventual technical review. Around 14% of the company’s membership base is concentrated in individual plans, and parts of that portfolio have previously recorded medical-loss ratios above 100%.
Hapvida could also benefit, as approximately 18% of its healthcare membership is enrolled in individual plans. BTG, however, said Hapvida’s portfolio is generally newer and appears to have healthier financial indicators, suggesting a smaller relative benefit than at Amil.
XP Investimentos also views the discussion as potentially positive for the industry, particularly for health plan operators with significant exposure to older individual contracts. The bank identified Amil and Unimed cooperatives among the main potential beneficiaries.
The proposal nevertheless faces significant obstacles. An earlier public consultation was suspended by the courts, which required more extensive studies, greater transparency and broader public participation before any regulatory change could proceed.
There are also questions over whether ANS has the legal authority to create, through its own regulation, a third form of price adjustment in addition to the annual increase and age-related adjustments already permitted.
Consumer groups argue that the mechanism could effectively transfer the business risk of health plan operators to members.
ANS could also impose conditions on operators seeking a technical review, including requiring them to resume sales of individual plans. That would reduce part of the potential benefit, as companies would once again have to offer products subject to tight regulatory control and limited pricing flexibility.
For the market, the technical review represents a possible future route to improving the profitability of loss-making individual-plan portfolios. For consumers, it could be perceived as a third rate increase, on top of the annual adjustment and age-band increases.
That political sensitivity helps explain why ANS has sought to draw a clear distinction between a technical discussion and a decision that has already been made.
The technical review therefore remains alive but is still at a preliminary stage. No rule has been approved, no timetable has been established and there is no guarantee that the mechanism will ultimately be adopted. For now, it represents a regulatory option for health plan operators rather than a concrete change to Brazil’s health plan pricing rules.
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