Post by account_disabled on Jan 31, 2024 6:00:51 GMT -3
The health plan can establish which diseases are being covered, but not what type of treatment is achieved to cure them. Thus, the Superior Court of Justice forced a health plan to provide imported medicine for home treatment. reproduction Health plan can establish which diseases are being covered, but not what type of treatment is achieved for the respective cure, according to the STJ. The ministers of the 3rd Panel of the STJ explained that, although Law 9,656/98, which deals with private health care plans and insurance, allows the contractual exclusion of coverage for imported medicines and those used in home treatment, the clauses of the contract of the plan must be analyzed in accordance with the Consumer Protection Code.
Therefore, the panel understood that, if the Buy Phone Number List health insurance contract provides for coverage of the treatment of a certain disease, the contractual clauses that limit your right to the contracted treatment are abusive. The case involved a 61-year-old patient, suffering from chronic viral hepatitis C, whose health plan refused to cover or reimburse the amount spent on treatment using the drug Olysio Simeprevir 150mg, already registered by the National Health Surveillance Agency (Agência Nacional de Vigilância Sanitária (National Health Surveillance Agency) ( Anvisa).
The health plan operator claimed that article 10, caput , items V and VI, and article 12 of Law 9,656 allow it to exclude imported and non-nationalized medicines from coverage, in addition to those used in home treatment. According to the rapporteur of the appeal at the STJ, minister Nancy Andrighi, the operator's arguments are overcome because Anvisa has already registered the medication, and it is an abusive contractual clause that prevents the patient from receiving treatment “with the most modern method available in the moment in which the covered disease is established”.
Therefore, the panel understood that, if the Buy Phone Number List health insurance contract provides for coverage of the treatment of a certain disease, the contractual clauses that limit your right to the contracted treatment are abusive. The case involved a 61-year-old patient, suffering from chronic viral hepatitis C, whose health plan refused to cover or reimburse the amount spent on treatment using the drug Olysio Simeprevir 150mg, already registered by the National Health Surveillance Agency (Agência Nacional de Vigilância Sanitária (National Health Surveillance Agency) ( Anvisa).
The health plan operator claimed that article 10, caput , items V and VI, and article 12 of Law 9,656 allow it to exclude imported and non-nationalized medicines from coverage, in addition to those used in home treatment. According to the rapporteur of the appeal at the STJ, minister Nancy Andrighi, the operator's arguments are overcome because Anvisa has already registered the medication, and it is an abusive contractual clause that prevents the patient from receiving treatment “with the most modern method available in the moment in which the covered disease is established”.