collective plans must maintain treatment even with cancellation

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The Superior Court of Justice (STJ) ruled today (22) that operators of collective health plans must guarantee the continuity of medical treatments in the event of unilateral termination of the service provision contract.

These types of plans are offered as assistance benefits to groups of company workers. In the case of individual plans, operators were already prohibited from canceling the plan during treatment.

The processes that led to the trial involve a woman who had breast cancer and appealed to the courts after her plan was canceled by the operator and a teenager with a serious illness.

By the decision of the Second Section of the court, the operators have the contractual right to cancel the contract, but they must maintain the treatment indicated to the patients until the medical discharge. On the other hand, the patient must maintain the monthly payment of the plan, with the original contractual conditions.

The collegiate unanimously defined a thesis that should guide the processes that deal with the same issue.

“The operator, even after the regular exercise of the right to unilateral termination of the collective plan, must ensure the continuity of the assistance care prescribed to the hospitalized user or in full medical treatment, guaranteeing their survival or their physical safety until the effective discharge, provided that the holder fully bears the due consideration.”

The case judged by the collegiate establishes the understanding on the matter in the STJ and can be applied to similar cases that are being processed in the Judiciary throughout the country. Operators can appeal the decision.

SOURCE: Agência Brasil

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