Out of contract
It is irregular for a health plan operator to break a unilateral contract without justifications that are explicit in the contract.
Conditions for canceling a health plan contract must be made explicit
Based on Normative Resolution 195/2009, judge Carlos Eduardo Batista dos Santos, of the 2nd Civil Court of Brasília, determined that an operator maintains the author as a beneficiary of an individual health plan and pays her compensation for moral damages.
An 81-year-old woman had her health plan canceled by her health insurance provider unexpectedly, without prior notification and without offering alternatives. The elderly woman had been a beneficiary of the plan since December 2013, when she joined the services collectively.
According to the decision, the patient has been undergoing medical treatment for breast cancer since 2009. After the announcement about the termination, she sought the feasibility of maintaining her quality on an individual basis with the operator, without success.
The company’s defense argued that the contract termination was carried out in accordance with the terms of agreement and the legislation applicable to the matter. Furthermore, the company claimed that the health plan was valid from November 1, 2010 until October 31, 2023 and that it opted to terminate the contract at the end of the pre-established period of validity.
The decision points out that Resolution 195/2009 establishes that the conditions for canceling a contract or suspending coverage in private collective health care plans through collective or corporate membership must be expressly included in the contract signed between the parties.
The judge upheld the woman’s request, confirming the effects of the emergency relief previously granted, in order to condemn the health operator to maintain the status of beneficiary in individual plans, with the same amount of the monthly fee they have already been paying and subsequent adjustments. by the criteria defined annually by the National Supplementary Health Agency (ANS).
The judge also considered that the revocation of the plan generates moral damages and ordered the company to pay compensation for moral damages, in the amount of R$ 10 thousand.
Click here to read the decision
Process 0744743-79.2023.8.07.0001
