New law overturns taxing list for health insurance coverage

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Published law that overturns the taxing role for health plan coverage

With the publication of Law 14,454 in the Official Diary of the Union on Wednesday (21/9), the so-called “tax roll” for health plan coverage was overturned. Thus, health care operators may be required to provide coverage for tests or treatments that are not included in the list of procedures and events in supplementary health.

The rule comes from the Bill (PL) 2033/2022, approved at the end of August in the Senate. The text, which amended Law 9,656, of 1998, establishes that the List of Health Procedures and Events (Reps), updated by the National Supplementary Health Agency (ANS), will only serve as a basic reference for private health plans contracted to from January 1, 1999.

It will always be up to the ANS to edit a rule with the breadth of coverage in the scope of supplementary health, including transplants and highly complex procedures.

Treatments outside this list must be accepted, as long as they meet one of the conditions: being effective, in the light of health sciences, based on scientific evidence and a therapeutic plan; have recommendations from the National Commission for the Incorporation of Technologies in the Unified Health System (Conitec); or have a recommendation from at least one health technology assessment body that is internationally renowned.

The law was a response to the mobilization of associations of patients using health plans against a decision by the Superior Court of Justice that, in June this year, decided that the plans would only be obliged to finance treatments listed in Reps.

At the time, the 2nd Section recognized the list’s exhaustiveness, but understanding that it could be mitigated in exceptional cases; and also determined the technical criteria to be taken into account by the Judiciary in cases involving refusal of coverage by companies. With information from the Senate Agency.

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Magazine Legal AdviserSeptember 22, 2022, 12:37 pm

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