Health Plans: Congress Introduces 12 Coverage Projects | Economy

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Parliamentarians present plans to expand coverage of health plans

Following the decision of the Second Section of the High Court of Justice (STJ) that health plans are not necessary to cover medical treatments and services that are not on the mandatory list of the National Supplementary Agency for Health (ANS), several parliamentarians introduced bills. With the aim of expanding the procedures offered by the Congress of Law. So far there have been three projects in the Senate and nine in the House.

They are added to others that were already in place, but which are not yet voted on and therefore not yet in law.

At trial, some exceptions were allowed, but the STJ imposed restrictions that the Brazilian judiciary would not normally consider. In practice, the decision taken on Wednesday (8) means that it will be much more difficult for users of health plans to obtain coverage in court for proceedings not listed by the regulatory agency.

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Until now, the majority of the Judiciary understood that the role of the ANS was exemplary, that it was possible to cover procedures that were not listed when recommended by a doctor.

In their projects, parliamentarians try to turn this previously understood understanding into law. The three senators who presented the projects were Fabiano Contarato (PT-ES), Mecias de Jesus (Republicans-RR) and Rogério Carvalho (PT-SE).

In the Chamber, there are the projects of deputies Luis Miranda (Republicans-DF), Eduardo da Fonte (PP-PE), Guiga Peixoto (PSC-SP), Alencar Santana (PT-SP), Fábio Trad (PSD-MS). Miguel Lombardi (PL-SP), PCdoB chairman, and another between deputies Ney Leprevost (União-PR) and Felipe Francischini (União-PR).

In addition, MP Natália Bonavides (PT-RN) presented a petition with the aim of including her own previous project on the agenda of the plenary session.

In a statement, Deputy Luis Miranda said he was “into the fight”. He also stated that on Tuesday (7), before the decision of the STJ, he met with the fathers and mothers of the patients who were against the measure and with the Speaker of the Chamber Arthur Lira (PP-AL). Miranda said she wants to create a working group to work on the issue, including the participation of the ANS president.

“The change puts the whole system in a state of insecurity. Families with legal aid will be denied different treatments and the problems will also affect the public health system with more burdens,” Miranda said in a statement to his adviser.

Senator Fabiano Contarato’s project also tries to make it clear that the list is not exhaustive. In his view, the ANS’s list of procedures is merely “a minimum basic reference for covering health care plans.”

“We cannot accept that the benefit of the health plan will harm the population. health plans, but a qualified medical team, ”Contarato said in a statement issued by his press office.

STJn verdict

At trial, Minister Villas Bôas Cueva, who was the first to look into the matter on Wednesday, voted in favor of having an accurate list, which he said would lead to predictability in the elaboration of the costs of the plans. But he also proposed some exceptions, and they were included in the vote of Minister Luis Felipe Salomão, who had already voted in a previous session, with the same understanding that prevailed in the trial.

The first condition for accepting the exemption is that the procedure, although not provided for in the list, has been expressly rejected by the ANS for inclusion in the list. The second point is that the effectiveness of the treatment must be demonstrated “in the light of evidence-based medicine.”

It will also require the recommendations of the nation’s leading technical bodies, such as the National Commission for the Integration of Technologies into the Common Health System (Conitec), and foreign ones. Finally, it will be necessary, where possible, to call for an “institutional dialogue” between magistrates and specialists in the field.

In his vote, Minister Villas Bôas Cueva also said that the user could seek his own plan to negotiate an extended correction or coverage contract so that he has access to procedures that are not on the ANS list.

“It is unknown at this time what he will do after leaving the post. to choose a more comfortable procedure for restoring health, restoring reciprocity and maintaining the economic-financial balance of the agreement, ”the minister said at trial.

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