Find out what Hospital Equivalence is and how this legal theory has reduced the tax burden on medical companies by up to 70%.
CONCEPT OF HOSPITAL EQUIVALENCE.
It’s very likely that during the course of your activity you’ve already realized that the challenges that arise are much greater than those merely linked to the profession itself.
Owning a medical, dental or imaging clinic, or any other activity in the health sector, represents being in control of an economic activity company. And like any business, the challenges of dealing with the high taxes levied on your income have a direct impact on the future of your profession.
However, because you carry out an activity of extreme social need, the law grants you benefits aimed at boosting your growth through tax reductions, known as “fiscal incentives”.
And that’s where Hospital Equalization comes in.
A tax incentive that allows medical clinics to resemble/equivalence hospitals in tax collection, guaranteeing them a reduction in the IRPJ and CSLL tax burden of up to 70%.
This benefit has been responsible for the growth of more than 42% of the country’s clinics over the last decade, and it is still something of a novelty due to the lack of knowledge on the part of most doctors.
This is the method the state has adopted to boost society’s health. Granting an incentive to those who provide an essential service.
Well, to make it easier for you to understand how you too can take advantage of this benefit, we’ve put together an explanatory analysis, and at the end, we’ll show you how tax planning can analyze and adapt your clinic so that it can be included in the equivalence.
– Functioning and Impacts of the Economic Benefit;
– Introducing Hospital Equivalence in My Clinic;
– Medical Procedures Eligible for Hospital Equivalence;
– I’m a Simples Nacional member, how can I qualify for the benefit?
OPERATION AND THE IMPACTS OF THE ECONOMIC BENEFIT.
Hospital Equivalence is a tax thesis supported by Law No. 9,249/95, which applies to Corporate Income Tax (IRPJ) and Social Contribution on Net Profits (CSLL). These taxes will suffer a reduction in their calculation basis, with IRPJ going from 32% to 8%, and CSLL from 32% to 12%.
In order to simplify the technical legal specifications that are necessary for the application of the thesis, let’s look at a statement of the amounts paid by a clinic that didn’t carry out tax planning to comply with Hospital Equivalence, and one with the same results that has the benefit.
| Invoicing Month |
Taxes WITHOUT Equivalence – Month | Taxes WITH Equivalence – Month | Monthly savings | Annual savings |
| R$ 50.000,00 | R$9.665,00 | R$3.965,00 | R$5.700,00 | R$68.400,00 |
| R$100.000,00 | R$21.330,00 | R$7.930,00 | R$13.400,00 | R$160.800,00 |
| R$300.000,00 | R$67.990,00 | R$23.790,00 | R$44.200,00 | R$530.400,00 |
As shown above, a clinic that falls within the scope of Equiparação Hospitalar can save up to a thirteenth with just a single tax thesis tailored to its business.
INTRODUCING HOSPITAL EQUIVALENCE IN MY CLINIC.
The realization of this benefit in your clinic is directly linked to mandatory legal requirements listed by rules and regulations. The law that guides this thesis sets out the 3 fundamental requirements for achieving equivalence:
– Company classified as a Business Company;
– Company under the Presumed Profit Regime;
– Company that meets ANVISA standards;
– Activity eligible for equalization;
The law defines a “business company” as one that carries out its activity through a CNPJ. This means that self-employment or employment under the CLT are disqualified.
Therefore, the first step is to become a permanently registered company.
In the health sector, it is common to find professionals working in private hospitals or clinics as MEIs or even as self-employed individuals, who are not hired by the institution. In these cases, it is essential to be advised directly by a qualified tax lawyer, who can analyze the pros and cons of your specific case and make the necessary adjustments to your framework.
Well, if you are already registered as a company, but are not classified under the Presumed Profit Regime, we recommend that you take a look at our text on Tax Regimes because many entrepreneurs disregard the tax benefits linked to each tax regime in their professional activity, which may be causing you to leave various tax benefits on the table, limiting the growth of your company. What’s more:
When we talk about Simples Nacional Medical Clinics, at the end we mention a mechanism that demonstrates how you can apply for Hospital Equivalence.
The third requirement is essential in the physical structure of the company, its infrastructure and adequate sanitary control.
Among the requirements mentioned above, there are various rules, judgments and jurisprudential understandings that complement the numerous possibilities for this thesis, so that being accompanied during the implementation of this thesis is what guarantees the effectiveness of the request.
If you have any doubts about whether your clinic meets all the necessary requirements, our team (whats link) can help you comply safely and efficiently.
MEDICAL PROCEDURES ELIGIBLE FOR HOSPITAL EQUALIZATION
Among the mandatory requirements that the clinic must have, the normative text of Law No. 9,249/95 itself brings some activities eligible for the benefit, such as:
– Diagnostic and therapeutic assistance;
– Clinical Pathology;
– Imageonology (labor, graphic and image exams);
– Pathological and Cytopathological Anatomy;
– Nuclear Medicine;
However, it is worth noting that complementary rules and case law have increased the legislative understanding of eligible activities, including numerous other activities:
– Surgeries (in general);
– Orthopedics;
– Otorhinolaryngology;
– Outpatient procedures;
– Oncology treatment services;
– Dermatological procedures (hair implants, facial harmonization, etc);
– Dentistry;
– Other.
The Superior Court of Justice (STJ) has ruled in Theme 217 that the interpretation of the article of law on “hospital services” must be made objectively, i.e. from the perspective of the taxpayer’s activity.
In general, the STJ takes the view that the Hospital Equivalence is only applicable to “simple medical consultations”.
This understanding has opened the way for various medical activities to take advantage of this tax benefit in recent years. For this reason, carefully analyzing the activities provided in your clinic is essential to lead you to the benefit.
Well, if you fit the mandatory requirements that the law imposes for the request, we at Vieira Advogados Associados follow as a primary precept a tax consultation that demonstrates the effectiveness that this and other tax theses can positively impact on your cash, thus elaborating a specific and complete tax planning for your clinic.
I’M A MEMBER OF SIMPLES NACIONAL, HOW CAN I QUALIFY FOR THE BENEFIT?
If your clinic falls under the Simples Nacional tax regime, as a rule, the equalization argument is not applicable. However, as mentioned above, each tax regime has its own peculiarities and theses that can reduce your tax burden.
Doctors in the Simples Nacional tax system are open to numerous tax structuring possibilities, such as the so-called R FACTOR. We therefore advise you to read our website or contact one of our professionals directly to specifically analyze the opportunities you may be taking advantage of.
However, in order to focus specifically on the thesis discussed here, I must inform you that if your clinic is in Simples Nacional, it is quite possible that Hospital Equivalence will be your turning point.
In a country where 99% of companies currently belong to Simples Nacional because they believe they pay less tax under this regime or neglect to follow up their legal affairs, when we look at the health sector, a tax analysis often shows that it is much more advantageous for some clinics to switch from Simples Nacional to Lucro Presumido. However, this analysis is decisive when looking at the entire reality of the company, such as its cash flow, employees, partners and the activity carried out, since there are a number of other tax benefits available in the health sector, which can result in much greater savings than just Hospital Equivalence.
With regard to Hospital Matching, we at Vieira Advogados Associados have identified that around 84% of the clinics we serve that are currently covered by Simples Nacional benefit significantly from migrating to the Presumed Profit system by granting them Hospital Equivalence.
This is because, as with other types of business, the doctor also fails to check the existence of appropriate tax rules for his activity, believing that the Simples Nacional regime is the only or most viable way to set up his clinic. In most cases, this is not true.
That’s why, even if you have a clinic under the Simples Nacional regime or if it doesn’t meet any other requirements, we advise you to undergo a tax analysis with a professional who will be able to identify your case and the savings theses it has.
