False collective health plan is subject to ANS readjustment rates

bistsarker

Adjustments of dubious legality put the survival of the contract at risk, due to the excessive burdensomeness of premium payments to the insurer. With this understanding, the 1st Chamber of Private Law of the Court of Justice of São Paulo limited adjustments to a family's health plan to the ANS indexes. reproduction Reproduction “False collective” health plan is subject to ANS readjustment rates, says TJ-SP Despite being a business plan, which is not subject to ANS indices, the rapporteur, judge Francisco Loureiro, understood that the case is classified as a "false collective", to cover only a family nucleus of four people.

"This circumstance is decisive, because it requires Binance App Users Data the analysis of readjustments to the discipline applicable to individual and family plans, not collective ones", he stated. The rapporteur also said that, to define the legal regime, the activity and cause of the business entered into by the parties are taken into account, even if labeled differently. In the specific case, according to the judge, "it seems obvious that the common objective of both parties was the protection of a family group, which shifts the nature of the plan from business to family and places it under the protection of the Consumer Protection Code and Law 9,656/98".



According to Loureiro, contracting a clearly individual plan due to its scope and economic function as a collective plan has the purpose of "circumventing and escaping the control of cogent norms". "It is the escape from a protective legal regime to a common legal regime. This practice has already been recognized by the Superior Court of Justice, which extended the protective and cogent rules of individual and family health plans to 'false collective' plans", he said. Loureiro concluded that the allegation of abusive adjustments was credible: "It is possible to verify, moreover, a danger in the delay in the protection, as the excessive increase in monthly payments apparently resulting from the application of abusive indices — could lead to the aggravating party having to terminate the insurance plan contract. health, amid the notorious Covid-19 epidemic". The decision was unanimous.