STJ: The Plan Cannot End the Case of a Seriously Ill Patient – 06/22/2022 – Daily Life

The second section of STJ (Supreme Court of Justice) It was decided Wednesday (22) that health plan operators who unilaterally terminate group contracts are obligated to maintain the bond of patients in hospital or patients undergoing treatment for critical illnesses.

The decision, which lower courts should follow in similar proceedings, says operators must ensure treatment continues until discharge from hospital.

We analyzed cases of a woman undergoing treatment breast cancer A minor with a chronic disease. Both went to court and were able to continue the coverage, but the operator appealed to Syrians for Truth and Justice, which has now consolidated understanding.

The Rapporteur of the case, Minister Luis Philippe Salomao, noted that the law already prohibits plan operators health Under no circumstances should individuals terminate the contract while the user is in the hospital, and state that the understanding should extend to group plans.

“Beneficiaries cannot be excluded when they are receiving treatment for a serious illness or undergoing medical treatment that threatens their livelihood,” he said.

The thesis defended by the rapporteur was that “the operator, even after the regular exercise of the right to unilateral termination of the collective plan, must ensure the continuity of the prescribed assistance care to the user in the hospital or in the full medical treatment which assures him of his survival or physical safety. until the actual demobilization, provided that the holder bears the full amount due.”

The other ministers unanimously followed the vote for the rapporteur.

For Attorney General Sander Gomez Pereira Jr., of the Federal Public Defense Office, breach of contract cannot put users’ lives at risk.

“It’s a contract that is cut abruptly, with obvious damage both to the health and sometimes to the life of the beneficiary,” he said before the ministers’ vote.