Sanctioned law obliging health plans to cover procedures outside the ANS list

President Jair Bolsonaro sanctioned, on Wednesday (21), the bill that puts an end to the limitation of the procedures covered by health plans, the so-called exhaustive list of the National Agency for Integrative Health (ANS). The sanction goes back to the example, covering all the indicated and necessary treatments regardless of whether they are listed.

However, according to the text, in order for the health plan to be obliged to cover a certain treatment, it must meet certain requirements. Are they:

The transition from the exemplary to the exhaustive list was carried out by the Superior Court of Justice (STJ) in June. The decision exempted health plans from paying for treatments, tests and drugs not provided for by the ANS, as well as depriving citizens of the possibility of going to court to obtain specific and unforeseen treatments.

The debate on the issue resulted in a discussion in the Chamber between senators, government representatives, ANS, health plans, doctors and patients’ families. The current text, which is back in full swing, arrived from the Chamber of Deputies and was unanimously approved by the federal Senate at the end of August.

security journalist (PL 2033/2022), Romário (PL-RJ) celebrated on social media.

According to the federal government, the sanction of the law, which now comes into effect, aims to prevent the interruption of medical care, especially for those suffering from rare diseases.

In a statement published to the press, the National Federation of Integrative Healthcare (FenaSaúde), which represents several groups of private health plans and insurance operators, regretted the decision and stated that the change places Brazil “Contrary to global best practices for evaluating drug incorporation and healthcare procedures, it makes it difficult to properly pricing plans and undermines the predictability of care costs, which can lead to high monthly fees and mass expulsions of care recipients supplementary health“.

The entity added that this measure could have a further impact on the financial situation of the sector. “For these factors, FenaSaúde is evaluating the possibility of turning to the judiciary, in defense of the approximately 50 million beneficiaries who today depend on the country’s health plans.”, Reported the federation.

* With information from Agência Brasil

The post-sanctioned law requiring health plans to cover procedures outside the ANS list first appeared on Olhar Digital.

Source: Olhar Digital