This guide explains how corporate health insurance works in Brazil , its basic concepts, enrollment rules, costs, legal obligations, and best practices for HR.
Ideal for companies that are starting its operations in Brazil, want to understand concepts related to choosing a health plan, such as reducing costs, increasing employee satisfaction, and considerations when contracting or renewing benefits.
Key topics: types of health plans, coverage, waiting periods, scope, eligibility, adjustments, costs, providers, co-payment, legislation in Brazil.
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What is a corporate health plan?
A corporate health plan is a group benefit contracted by the company to offer medical assistance to its employees (and, in some cases, their dependents). It usually offers better cost-benefit than individual plans and allows for customization of coverage, networks, and financial conditions.
Why do companies offer health insurance? (and why do employees value it so much?)
In Brazil, health insurance is consistently cited as the most desired benefit by employees .
A survey by CNN Brazil showed that “health insurance was identified as the most desired benefit by workers, followed by food vouchers . “
Robert Half ‘s 2024 Benefits survey , which identifies health insurance as one of the most valued benefits by qualified professionals in the country.
Given this, companies that offer health insurance plans gain clear advantages in:
- Attracting and retaining talented people
- Reducing absenteeism
- Greater satisfaction and engagement
- Market competitiveness
- Financial organization (in models with tax incentives)
For sectors such as technology, consulting, engineering, logistics, and professional services, company health insurance has become virtually mandatory to compete for the best hires.
Is health insurance mandatory in Brazil? What does Brazilian law say?
In Brazil, labor laws do not require companies to offer health insurance to their employees, except in specific situations, such as:
1 – Collective Bargaining Agreements or Unions Agreements: Some unions may establish the provision of health insurance as a mandatory benefit.
2 – Employment contract : If the benefit has been previously agreed upon and is included in the contract, it becomes an employee’s right.
Apart from these cases, the company is free to decide whether or not to offer the benefit.
For the hiring process to be efficient — both financially and operationally — it’s necessary to understand the selection criteria so that the health plan is suitable for the needs of the company and its employees.
Types of corporate health plans and their impact on price adjustments
Health plan for Micro and Small Enterprises - 2 to 30 employees
In this type of plan, the annual adjustment is based on the operator’s pool, that is, an average that includes medical inflation and the average plan usage of all the health operator’s clients with up to 30 lives. In addition, there are usually waiting periods for new beneficiaries. However, if a letter of continued coverage from a previous plan with a similar company is presented, this waiting period may be waived. This type of plan also applies to MEI (Individual Microentrepreneur) health plans .
Health plan for Small and Medium Enterprises - 30 to 99 employees
For companies of this size, the main benefit is the complete waiver of waiting periods, including for the elderly and pregnant women, provided they are included in the plan within the legal timeframe. Some providers often offer differentiated prices for companies of this size. This discount percentage per person is usually between 5% and 15%, depending on the provider.
Corporate health plan for more than 99 lives
In this type of plan, the vast majority of operators and insurers offer differentiated prices for companies of this size through negotiation. Regarding the annual adjustment, operators consider the company’s claims ratio in the readjustment. Therefore, it is essential that Human Resources (HR) is aware of the importance of using the health plan properly to avoid a very high annual readjustment.
Coverage options for a corporate health plan
Outpatient
This type of coverage includes services performed only in doctor’s offices and clinics, such as medical consultations, diagnostic tests, therapies, and minor procedures. It is ideal for those who do not need frequent hospitalizations but want regular medical follow-up.
Inpatient
Hospital coverage guarantees care in a hospital setting, including hospitalizations, surgeries, ICU, and other procedures requiring hospitalization. When combined with obstetrics, it also covers prenatal care, childbirth, and follow-up care for the newborn in the first days of life.
Types of inclusion in a corporate health plan
Compulsory Inclusion
This is a type of corporate health plan where the entire eligible group (partners, administrators, employees, or dependents) must enroll in the plan. The mandatory option is usually 10 to 20% cheaper than the optional one.
Optional
It allows greater flexibility in choosing health plan beneficiaries. In this type of plan, there is no obligation to include the entire eligible group linked to the contracting company. Because of this flexibility, it has slightly higher rates than the mandatory option.
Accommodation standards of a corporate health plan
Shared Room Plan
Here, the patient shares a room with others, generally with less privacy and more restrictions on visits, resulting in a lower cost for the plan.
Private Room Plan
This accommodation option is for individuals, offering greater privacy, comfort, and flexible visiting hours, but comes with a higher monthly fee.
Areas of coverage of a corporate health plan
Regional
It generally has a more restricted network of providers and tends to have a lower cost compared to plans with broader coverage. It is ideal for companies whose employees live and work in a specific location and do not need coverage in other areas.
National
It offers access to a wide network of accredited providers in different states and regions. It is suitable for companies with branches in multiple locations, employees who travel frequently for work, or those who want the flexibility to use the services anywhere in Brazil. The cost is higher than the regional plan.
International
International health insurance typically includes coverage for urgent and emergency care abroad or the possibility of reimbursement for treatments outside of Brazil. It is essential for companies with operations or expatriate employees in other countries, who frequently travel abroad for business, or who desire a level of protection that includes international medical assistance. It has the highest cost due to the breadth of coverage.
Costing models for a corporate health plan
The cost of a corporate health plan refers to who pays the monthly fee for the benefit. The three main modalities determine the division of costs between the contracting company and the employee:
Contributory
In this model, employees pay part or all of the cost of the health plan through payroll deduction .
Non-contributory (Employer-sponsored health plan)
In this model, the company sponsors the full cost of the health plan, and the employee does not have any deductions from their salary for this purpose.
There may or may not be co-payments for procedures (consultations, exams, etc.). In this case, co-payments serve only as a mechanism for financial regulation and awareness of plan usage.
Hybrid
This refers to a model that blends different cost-sharing methods for different beneficiary groups. It can be a plan where the company pays fully for employees (non-contributory), but dependents can be included on a contributory basis (with the total or partial cost borne by the employee).
The choice of cost-sharing model directly impacts the monthly amount to be paid by the company and employees, as well as the perception of the benefit and, in some cases, the right to maintain the plan in situations such as dismissal without just cause.
Co-participation
Co-participation is a type of health insurance plan contract where, in addition to the monthly fee, the client pays a percentage of each medical consultation, exam, and procedure. This percentage varies, and the most common range is 10% to 30% of each procedure. The advantage is that, in this modality, the user has more affordable monthly payments.
Many companies question whether co-payment is worthwhile. Generally, it really is, provided it is well-calibrated. The main advantages are a reduction in monthly fees and an incentive for the responsible use of the plan. However, it offers less cost predictability, since the level of utilization will directly impact copayment.
How much does a corporate health plan cost in 2025?
The cost depends on several factors, as discussed. It depends on the age of the team, region, operator, type of accommodation, coverage area, and usage history (claims rate). For reference, here are some updated values:
Health plan pricing tables
Quick checklist for choosing the ideal plan
- How many employees do I have, by age group?
- Is my team younger or more senior?
- What is the essential hospital network?
- What is the maximum budget per person?
- Do I want to sponsor the health plan?
- How will the costs be covered?
- Do employees have dependents?
- Is it possible to include aggregates?
- Does the company want national coverage?
- Is there a risk of contract termination?
- What is the company’s claims rate?
- Are there any patients hospitalized, on leave, or receiving benefits undergoing complex medical treatments?
The importance of choosing a specialized insurance broker.
Before thinking about the health insurance provider, the hospital network, the type of accommodation, or the costs, the most important thing is to find the right broker.
The brokerage firm will be your strategic partner, responsible for conducting the entire process with security, transparency, and technical expertise. They will analyze the company’s profile (“pool of eligible candidates”). This includes:
- Age range of employees
- Presence of dependents or other family members
- Geographic distribution of the team
- Presence of expatriates
- Usage history (if any)
- Company growth projection
This analysis is crucial because each company has different costs, needs, and risks. Therefore, there is no universally considered “best health plan.” What exists is the best plan for your company at that particular moment, considering:
- the necessary hospital network,
- the type of coverage expected,
- the eligibility policy,
- the available budget,
- the method of costing
- the level of use by employees,
- and the Brazilian regulatory framework.
Without a technical analysis of the data, the company risks contracting an inadequate, undersized, overly expensive plan, or one with insufficient network coverage, potentially leading to employee frustration and unnecessary business costs.
How Garantia Corretora helps your company
With expertise in technology companies, consulting firms, engineering firms, logistics companies, and multinational corporations, Garantia Corretora offers:
- Comparative analysis between operators
- Team usage diagnosis
- Cost reduction strategy
- Ongoing support to HR
- Health Business Intelligence (for companies with more than 100 employees)
- Expertise in expat plans
- Consultative and independent service
To receive more details on pricing, we recommend filling out the form below. Contact us so we can assess the option best suited to your company’s profile. English, Spanish and Portuguese are spoken.
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