SUS, the public base

Brazil’s Sistema Único de Saúde (SUS) promises universal, comprehensive and free access to health services across the country, from prevention through high-complexity care and transplants. It is run jointly by the federal government, the states and the municipalities, and the Ministry of Health states that SUS is open to everyone in Brazil, whatever their immigration status, at no charge.

Nobody joins SUS through a job. A person registers as a SUS user and receives a Cartão Nacional de Saúde (CNS). In 2025 the Ministry of Health made the CPF taxpayer number the main identifier, while foreigners without a CPF are still identified by their CNS. Health records and appointments are available through the Meu SUS Digital app.

What a Brazilian employer owes

Brazilian legal commentary notes that no law requires an employer to provide a private health plan; offering one is the employer’s decision. What a CLT employer does owe are payroll items: social security contributions to INSS, deposits to the FGTS severance fund, and reporting through eSocial. Employer guides describe these as funding pensions and benefits rather than a separate health premium, since SUS is funded through taxes.

That turns the plan into a recruiting and retention decision rather than a statutory gap to fill. A private plan is the benefit that opens access to private hospitals, labs and specialists alongside SUS.

Planos de saúde and the ANS rulebook

Private health plans, planos de saúde, are regulated by the Agência Nacional de Saúde Suplementar (ANS) under Law 9,656/1998. A plan an employer sponsors for its staff is a plano coletivo empresarial.

ANS caps the waiting periods (carências) a plan can set: 24 hours for urgent and emergency care, 300 days for full-term childbirth and 180 days for other care. Plans can set shorter periods, never longer ones. In employer plans with 30 or more members, no waiting period applies when the employee asks to join within 30 days of the plan starting or of joining the company. A team of one or two will not reach that size, so ask how waiting periods apply to a plan that small.

For pre-existing conditions the employee declares, a plan can apply partial temporary cover (cobertura parcial temporária) for up to two years. During that time it can exclude high-complexity procedures, ICU beds and surgery related to the condition. When someone leaves an employer plan, operator guides that follow ANS rules say they can move to an individual or family plan from the same operator without new waiting periods, as long as that operator sells individual plans; self-managed (autogestão) plans are the exception.

How the plan is treated in pay

According to Brazilian legal commentary on CLT article 458, paragraph 2, item IV, added in 2001, medical, hospital and dental care an employer provides, directly or through health insurance, does not count as salary. Tax commentary adds that the value stays outside the social security contribution base when the cover reaches all employees and directors, and that plans which differ by job level have been challenged by the tax authorities.

If the employee pays part of the cost, the employer can deduct that share from pay only with the employee’s prior written authorisation, under the labour court’s Súmula 342. Because these points touch payroll and tax at once, check the plan design with a local adviser or tax professional in Brazil.

International policies sit in a grey area

Companies that want to operate in Brazil’s private health market need an operating authorisation from ANS, which registers the operator and each product. That is the regulated route for cover sold inside Brazil.

Foreign international policies are less settled. In a 2021 ruling (REsp 1,850,781/SP), the Superior Court of Justice treated an international health policy from an English insurer as an international contract rather than a regulated Brazilian plan, so ANS’s annual price-adjustment rules did not apply. Health-sector press reports that prosecutors and the industry have raised the status of these policies with ANS. Neither point settles the question for a particular employee.

Either way, SUS stays in place as the public base. An international plan sits on top of it, and a locally registered ANS plan is the regulated alternative. Our overview of international health insurance for remote employees shows how the same choice plays out in other countries.

Entity, EOR or PJ contractor

To employ someone under the CLT, a foreign company needs a Brazilian entity with a CNPJ registration and eSocial enrolment, or an employer of record that acts as the legal CLT employer and runs INSS, FGTS and eSocial on its behalf.

Engaging the person through their own company, the arrangement known as PJ, moves health cover onto the contractor, who arranges their own plan. EOR guides warn that PJ setups carry a high risk of reclassification as CLT employment, with back FGTS and INSS due. Our page on health coverage for EOR employees and contractors abroad compares the three routes.

Requesting an introduction

Use the form on this page to tell us the Brazilian state and city where your employee lives, how many people are on your team there, whether dependants should be included, and whether you employ through an entity or an EOR. Mithril1 passes those details to a benefits partner that arranges health cover for remote and cross-border staff. Plans, pricing and who is eligible are then decided by the partner and the insurer. Our guide to employee benefits for small businesses has the rest of the section.

A few useful answers

Common questions

Does a remote employee in Brazil already have public health care?

Yes. SUS is open to everyone in Brazil, whatever their immigration status, at no charge, and a person registers as a SUS user rather than joining through a job.

Does a Brazilian employer have to provide a health plan?

Brazilian legal commentary notes that no law requires it, so offering a private plan is the employer’s choice. A CLT employer does owe INSS contributions, FGTS deposits and eSocial reporting.

How do international health policies fit Brazil's rules?

Plans sold in Brazil’s private market need ANS authorisation for the operator and each product. A Superior Court of Justice ruling in 2021 treated one international policy as an international contract, and prosecutors and the industry have since raised the question with ANS, so the status of these policies is still debated.

Are there waiting periods on Brazilian employer plans?

ANS caps them at 24 hours for urgent and emergency care, 300 days for full-term childbirth and 180 days for other care. Employer plans with 30 or more members cannot impose one when the employee joins within 30 days.

Does an employer-paid plan count as salary in Brazil?

CLT article 458 says medical, hospital and dental care the employer provides is not salary. For social security, tax commentary says the value stays outside the contribution base when the plan reaches all employees and directors.

International Health Insurance for Remote Employees in Brazil