The debate about health plans focused on appointments and exams gained strength with the proposal of the National Supplementary Health Agency (ANS) to test a product in an experimental regulatory environment (regulatory sandbox). The initiative was structured to receive contributions from society and to enable a model with coverage for strictly elective appointments and exams, with evaluation after the trial period.
In practice, this movement targets an audience that today alternates between YOUR, Popular clinics and discount cards, which do not follow the same level of regulation and oversight applied to plans supervised by ANS.
At the same time, the discussion brings up sensitive points for operators, providers, and consumers: coverage limits, Expectation of the beneficiary, contractual communication, Service capacity and compliance. In a more “lean” product, the operation and the relationship with the beneficiary cease to be a peripheral theme and become determinants for sustainability and reputation.
What are the consultation and exam plans in the ANS sandbox
The regulatory sandbox, in the context presented by the ANS, is a experimental environment to test a product with targeted coverage. The proposal cited by the Agency describes elective consultations in all specialties and Exams that are on the Rol, with mention of Absence of a quantity limit for those items within the proposed design.
The point that most impacts the consumer's purchase decision is the scope: it is a product designed for primary and secondary care, focusing on access to consultations and diagnosis, and not on hospitalizations and more complex events.
Why does the market call this model the “fourth way”
The term “fourth way” appears frequently in analyses of the sector to differentiate this type of product from the most common contracting modalities (individual/family and collective). Specialized portals and sector coverage started to use this nomenclature as a shortcut to explain a new product design aimed at appointments and exams.
For communication purposes, it is worth treating “fourth way” as market label, and not as a consolidated official category, because the design is under evaluation and depends on the sandbox regulatory cycle.
How the ANS regulatory sandbox works: rules, deadlines and product design
The ANS announced the opening of a public consultation to receive contributions on the sandbox proposal. The official content indicates the period of participation from 18/2 to 4/4, with a public hearing at 25/2, in addition to recording that the model was approved at a board meeting and that the trial period Expected is biennium, followed by evaluation for continuity or discontinuity.
There is also a relevant guideline for the commercial configuration: the proposal mentions that participating operators must register a new product In the format collective membership, following the guidelines of the experimental environment.
Coverage and Exclusions: Where Perceptual Risk Lives
In legal and sectorial reading, analyses summarize conditions and exclusions that usually accompany this type of product under discussion, including limitations on items such as therapies, urgency and emergency, and other coverage outside the scope of the sandbox.
The practical impact of this appears on two fronts:
- Selling and onboarding: the beneficiary needs to understand what the plan covers, what it doesn't, and how to use it.
- Service and complaints: most of the friction tends to arise from a divergence between expectation and contracted coverage.
Regulatory assessment and legality debates
In addition to the product design, there is public debate about the legal basis and regulatory limits for creating and testing this type of plan. Part of the legal sector published critiques with a view to complying with Law 9,656/1998 and the minimum coverage requirements.
This point matters for planning because it influences:
- risk of judicialization and rule changes along the way;
- The need for documentary governance and clear communication trails with the beneficiary;
- Reinforced attention to compliance, ombudsman and complaint handling.
Opportunities and challenges for operators and the health ecosystem
1) Market expansion focusing on access and diagnosis
The rationale behind the model is to expand access to regulated appointments and exams for those who are unable to afford more complete plans. The ANS itself cites the objective of expanding and simplifying access, increasing the diversity of products and the scope of supplementary health.
For operators, this may open up an avenue of acquisition, provided that the pricing considers:
- demand suppressed by inquiries;
- network and schedule capacity;
- operating service and support costs.
2) Demand management and “agenda bottleneck”
Plans focusing on appointments and exams tend to concentrate volume on a few flows: scheduling, rescheduling, exam preparation, results, and guidelines. If the network doesn't absorb the increased demand, the product loses perceived value quickly.
The metric that usually causes the problem first is operational: Time to be able to schedule and Abandonment rate on the channels.
3) Contractual communication as a retention pillar
In products with a narrower scope, communication is not just marketing. It becomes part of the accident control itself and the cost of service, because it reduces repeated contact, avoids undue refunds, and reduces complaints due to misaligned expectations.
Where technology decides the game: operation, relationship, and efficiency
The sandbox creates an environment with high regulatory visibility and reputational sensitivity. What tends to differentiate players is not just the product design, but the ability to deliver a consistent experience across three layers: dice, Attendance and communication.
It is at this point that solutions of CRM, automation, and omnichannel service make the product operable at scale.
How Plusoft solutions connect to the “fourth way” scenario
The proposal for a plan focused on consultations and exams requires an operation prepared for a high volume of interactions, clear contractual language, and standardized working hours. A relationship platform allows you to centralize history and reduce the cost per contact, especially when there are multiple active channels (WhatsApp, voice, e-mail, portal and app).
Below is a practical excerpt of applications aligned with the type of pain that this model usually generates.
CRM and a single view of the payee
To sustain service and retention, the operation needs:
- request history and protocols in one place;
- journey view (pre-order → onboarding → use → renewal);
- segmentation by usage profile (high scheduling volume; low utilization; recurrence of coverage questions).
This base enables actions such as guided onboarding, proactive alerts, and prioritization of deals.
Omnichannel service and chatbots for the largest demands
In consultation and exam plans, the main reasons for contact tend to be standardised:
- questions about coverage;
- how to make an appointment;
- exam preparation;
- scheduling status;
- network location.
Chatbots and self-service flows reduce queues, free up staff for exceptions, and increase availability 24/7, as long as content governance is aligned with the contract and product guidelines.
Marketing automation for education and correct use of the plan
The “invisible cost” of these products is often in miscommunication: the beneficiary misunderstands, opens repeated calls, and complains about something out of scope.
Automation solves with objective tracks:
- onboarding sequence with 3 to 5 short messages explaining coverage and use;
- appointment reminders and exam preparation;
- prevention campaigns and check-ups;
- transactional messages with compliance-reviewed language.
Satisfaction survey and reputational risk monitoring
The sandbox broadens the attention of the sector and the consumer. Automatic post-service and post-consultation searches help detect:
- schedule failure (insufficient network);
- coverage noise (inadequate communication);
- drop in quality in specific providers.
This allows correction before the topic becomes a recurring complaint on public channels.
Practical checklist for operating an appointment and exam plan with less friction
- Map the top 20 contact reasons and design resolution flows.
- Create an onboarding kit with contractual language translated to “everyday use”.
- Standardize the communication rule: confirmation, reminder, instruction, result, follow-up.
- Centralize data and protocols in the CRM to reduce rework and repeated contacts.
- Instrument operational metrics: response time per channel, resolved self-service rate, repeat call, NPS per stage.
- Compliance governance: review of scripts, messages, and bot flows based on the contract and product design.
How to prepare the operation for consultation and exam plans with CRM and automation
The ANS sandbox for plans focused on consultations and exams creates a market test with great potential for expanding access, with expanded attention to product design, network, and service governance. Execution depends on processes that sustain a high volume of interaction, with operationalizable contractual communication and traceability of requests.
If the objective is to launch or adapt an operation for this scenario, the safest path usually begins with centralizing the beneficiary's data, omnichannel service with automation, and communication journeys that reduce coverage doubts.
Do you want to evaluate how to structure this operation with CRM, automation, and integrated service? Talk to a Plusoft expert now.
Frequently Asked Questions (FAQ)
Do these plans cover any inquiries?
The proposal released by the ANS describes coverage for strictly elective consultations and indicates inquiries in all specialties within the presented drawing.
Are the exams unlimited?
In the institutional text, the ANS mentions its intention to guarantee coverage for Rol exams “with no quantity limit” within the proposal submitted for the sandbox. The final rule depends on the outcome of the regulatory process and the parameters of the registered product.
How long does the sandbox test last?
The ANS describes the trial period of biennium, followed by evaluation to decide whether to continue or discontinue the model.
Why does the service operation weigh more heavily on this type of plan?
Because the usage focuses on schedule and coverage questions. This increases contact volume and exposes communication failures quickly, raising operational costs and reputational risk.
