By Brazil Stock Guide – SulAmérica posted the highest medical-hospital complaint index among the major health plan operators analyzed by Brazil Stock Guide in the first quarter of 2026, according to data released by Brazil’s National Supplementary Health Agency, known as ANS. The operator recorded 5,824 medical-hospital NIPs, an average of 2.34 million beneficiaries and an MH IGR of 83.09, the highest reading in the selected group.
The figure does not simply measure the absolute volume of complaints. The medical-hospital IGR, or General Complaints Index, measures the incidence of NIP cases relative to the size of each operator’s beneficiary base. By that proportional metric, SulAmérica performed worse than peers such as Bradesco Saúde, Amil, Prevent Senior and the Hapvida/Notre Dame Intermédica group.
The snapshot matters because ANS released on Monday its first-quarter 2026 results through excellence lists, complaint-reduction lists and an interactive panel. The disclosure is part of Normative Resolution No. 623/2024, which created a quarterly assessment of how health plan operators handle their relationship with consumers.
A wide gap
Unimed Belo Horizonte had the lowest medical-hospital IGR among the major operators in the Brazil Stock Guide sample, at 41.83. It was followed by Unimed Seguros Saúde, at 52.08, and by the Hapvida/Notre Dame Intermédica group, with an estimated pro forma MH IGR of 52.14. SulAmérica, at the other end of the table, posted an index almost twice as high as the best performer in the sample.
The contrast with ANS’s own benchmark is even sharper. To qualify for the excellence list in the first quarter of 2026, medical-hospital operators needed an IGR of 2.4. That means even the best performer in the Brazil Stock Guide sample was more than 17 times above the excellence threshold. SulAmérica’s index was more than 34 times higher than the benchmark.
The consolidation of Hapvida and Notre Dame Intermédica changes the initial reading of the data. ANS organizes the figures by operator and registration number, not necessarily by economic group. On a standalone basis, Hapvida Assistência Médica S.A. had an MH IGR of 41.10, the lowest among the large operators analyzed individually.
For an economic and market-based reading, however, Notre Dame Intermédica should also be considered within the same group. Combining the two operators, the group had 11,986 medical-hospital NIPs, an average of 7.66 million beneficiaries and an estimated MH IGR of 52.14. That moves the group from an apparent standalone lead into a middle position, almost in line with Unimed Seguros.
The difference illustrates how the structure of ANS’s database can shape the perception of operating performance. For consumers, the contracted operator remains the most direct regulatory reference. For investors, the group-level view offers a clearer picture of consolidated operating quality.
The ANS benchmark
According to ANS, 235 medical-hospital operators qualified under the excellence criterion in the first quarter of 2026. In the exclusively dental segment, 211 operators qualified. Under the complaint-reduction criterion, 37 medical-hospital operators were classified, while only one exclusively dental operator met the requirements.
Bradesco Saúde is an important case in the large-operator sample. The company had an MH IGR of 62.02, still high compared with the excellence threshold, but it was included by ANS in the complaint-reduction list. That indicates sufficient improvement to qualify under that specific criterion, even though the operator remained far from the regulator’s excellence standard.
The quarterly assessment was created under RN No. 623/2024, which defines rules for how operators must respond when beneficiaries request covered or non-covered procedures and services. The rule also reinforces the requirement that consumers receive clear, adequate and precise information when they make such requests.
How the indicator works
A NIP, or Preliminary Intermediation Notice, is opened when a beneficiary contacts ANS to complain about a health plan issue. These cases may involve denial of coverage, delays in authorization, difficulty accessing care, reimbursement disputes or other assistance-related problems.
The IGR is calculated by dividing the average number of NIP cases in the period by the operator’s average number of beneficiaries, and then multiplying the result by 100,000. The indicator should therefore be read as a standardized complaint rate, not as a raw complaint count.
That methodology makes it possible to compare operators of different sizes. A company with millions of clients may have more complaints in absolute terms but a lower IGR than a smaller operator if complaints are proportionally less frequent relative to its beneficiary base.
There is also an important methodological caveat: in ANS data, a beneficiary means a link to a health plan, not necessarily a unique person. The same individual may have more than one active link. In addition, the data are frozen on a quarterly basis, meaning that later reclassifications of complaints do not alter the picture published for that specific period.
Regulatory pressure
In the agency’s statement, ANS president Wadih Damous said the periodic disclosure of results is intended to expand consumers’ access to information about operators’ performance. The regulatory logic is to use transparency, public comparison and quarterly monitoring as pressure tools for the industry.