STJ authorizes readjustment in collective health plans by age group

The STJ (Supreme Court of Justice) authorized the readjustment of collective collective health plans by age group. However, the change must follow three basic rules: there must be a contractual provision, it must follow rules from government regulatory bodies and it must not be done with random calculations or unreasonable percentages, that is, unfair.

The decision was unanimously taken by the Second Panel of the STJ. The change should mainly affect seniors who are about to turn 60. According to the National Supplementary Health Agency (ANS), there are, on average, 7.4 million beneficiaries aged 59 or over.

This adjustment is discussed in the Judiciary as the ANS only imposes value ceilings for individual and family plans. Thus, according to consumer protection entities, operators impose abusive increases, which ends up making it difficult for the elderly to use them.

The Second Panel of the STJ also determined that, when they observe abusive prices in the readjustments, the judges must determine who will produce the evidence, that is, the operators or the users of the plans.

The issue of health plans is already being discussed, in Brazil, in other developments, such as the limits of the list of treatments that must be paid for by the plans. In February, the trial to discuss the matter was postponed. On the occasion, mothers chained themselves to the STJ in an act of protest for treatment for their children with disabilities.

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