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STJ decides that operators cannot cancel collective health plans during treatment of serious diseases

Thais Fonseca

Entertainment

Decision was made after judgment of appeals against decisions that benefited users

Decision was made after judgment of appeals against decisions that benefited users.  Photo: Pixabay.
Decision was made after judgment of appeals against decisions that benefited users. Photo: Pixabay.

The Superior Court of Justice (STJ) decided, this Wednesday (22), that operators of collective health plans cannot disconnect a person during treatment of serious illness. The decision is of the Second Section and must be followed by the courts and judges throughout Brazil. According to the legislation, termination of the contract is prohibited in the case of individual and family plans, but collective plans are not mentioned.

This gap in the legislation represented a nuisance for people who were users of plans and with serious illnesses, and they had to go to court to ensure that the treatment was carried out. In the decision, rapporteur Minister Luis Felipe Salomão proposed a thesis that was unanimously approved by colleagues.

“The operator, even after the regular exercise of the right to unilateral termination of the collective plan, must ensure the continuity of the assistance care prescribed to the hospitalized user or in full medical treatment, guaranteeing his survival or his physical safety until the effective discharge, provided that the holder fully bears the due consideration”, he wrote in the decision.

The decision came after the judgment of two appeals presented by an operator against decisions that benefited two users. From them, the STJ became the thesis that should be applied throughout the country. In the actions, the company said that there was no illegality in the cancellation of collective insurance, claiming that each case involving the topic has its peculiarities, which prevent giving a uniform treatment to the issue.

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