Experts debate predictability in health plan contracts

The list of procedures of the National Health Agency (ANS) needs to be exhaustive, not exemplary, to maintain the economic-financial balance of health plan contracts. This is the understanding of the experts who participated this Tuesday (31/8) in a virtual seminar of the series “Legal Journey of Supplementary Health” on predictability in health plan contracts.

Playback/YouTubeExperts debate predictability in health plan contracts

The minister of the Superior Court of Justice Luís Felipe Salomão he spoke of the concern with the excessive judicialization of health issues and defended legal certainty and the binding precedents of the higher courts. “We have to maintain a stable and predictable jurisprudence,” stated the minister.

He cited a decision of his rapporteurship, accompanied by the other members of the 4th Panel of the STJ, which concluded that the ANS list, both of medicines and treatments, should be exhaustive. However, Salomão recalled that there is disagreement between the collegiate bodies of the court, as the 3rd Panel understands that the role of the ANS is exemplary. The controversy will be settled by the 2nd Section of the STJ (EREsp 1.886.929).

The divergence between the Classes was also addressed by the former Minister of Finance Mailson da Nóbrega: “This creates uncertainty, since the ANS role is the basis for calculating the insurance monthly fee. Making it an example, a blank page, creates difficulties to operationalize the insurance. Unpredictability generates consequences and plans start to become unfeasible”.

ANS Attorney, Daniel Tostes he also highlighted the importance of considering the exhaustive list, since all other rules are based on this structuring measure of the supplementary system. According to him, the agency has increasingly approached the Judiciary to exchange information and even to point out the impacts of excessive judicialization of health in Brazil. “ANS has also been improving its list of procedures,” he said.

For José Cechin, executive superintendent of the Institute for Supplementary Health Studies (IESS), the excess of court decisions related to health plan coverage causes insecurity and unbalances contracts: “It’s a signal to people that they don’t need to worry about coverage when contracting the plan, because it is possible to call the Judiciary to expand this coverage”.

Mediated by the judge of the Court of Justice of Tocantins and president of Copedem (Permanent College of Directors of State Schools of Magistracy), Marco Villas Boas, the event was promoted by IESS, by Copedem and by Conjure.